Appliances

47


Appliances




Study Points



image What appliances do pharmacists dispense?


image What makes an ideal wound dressing?


image What can be supplied for dressing a wound?


image What appliances are available for urinary incontinence?


image The appliances available for a patient with a stoma


image How to supply graduated compression hosiery


image How to supply a truss



Introduction


In addition to dispensing medicines, pharmacists have traditionally had a role in dispensing and supplying appliances. Appliances are sometimes termed as medical devices. In the European Union, there is a requirement that all appliances have a CE marking on them. This indicates that the product conforms to the relevant medical device directives laid down by the EU. There are some medical devices, which are exempt from the CE marking requirement an example of which would be made to measure hosiery.


In the UK, only the appliances which are listed in the Drug Tariff can be supplied on an NHS prescription.


The main types of appliance which pharmacists supply are wound dressings, incontinence and stoma products. Pharmacists are also required to supply and to measure and fit hosiery and trusses. Other appliances which pharmacists can supply include needles and syringes, bandages, ear syringes and peak flow meters.



Wound dressings


When the skin becomes damaged, it will undergo a process of wound healing. The speed and mechanism of the healing of the wound will depend on the degree of tissue loss and the depth and site of the wound. One major concern is that the wound may become infected.


The wound healing process consists of four overlapping phases:



1. Haemostasis. This is not always considered a phase in all publications. Bleeding is stopped by a combination of vasoconstriction and coagulation. It happens immediately the wound has occurred and can last from a few seconds to a few days, depending on the wound.


2. Inflammation. This is cleansing and removal of debris. This phase starts a few hours after haemostasis and can last a few days. The inflammatory response leads to redness, heat and swelling. Macrophages and polymorphs in the blood begin to clean the wound of debris, damaged tissues and bacteria. This leads to the production of exudate and the wound can become macerated.


3. Proliferation. This is characterized by granulation and vascularization. This starts after a few days and continues for a few weeks. It is the stage when the wound is rebuilt.


4. Maturation or epithelialization. At this final stage of wound healing, the collagen is remodelled.


From the phases required for healing, it can be seen that for effective wound healing the wound needs an adequate blood supply and nutrients, particularly vitamin C. Therefore some conditions which affect the flow of blood to the wound might affect the speed of the healing process, such as diabetes or vascular disease. Certain drugs can also affect the wound healing process, such as cytotoxics.


In the past, wound dressings were used mainly to protect the wound and keep the area clean and warm. A greater understanding of the wound healing process has led to more advanced dressings. Understanding the different types of dressings and the wounds which they treat requires a degree of specialism.


An ideal wound dressing should:



Wound dressings can be categorized in the following ways.




Advanced wound dressings




image Hydrogel dressings: these are used to give the wound moisture as they are a polymer matrix which contains 96% water


image Vapour permeable film and membrane: these are impermeable to fluids and bacteria but permeable to air and water vapour. They are available with or without an absorbent pad


image Soft polymer dressings: these are available with or without an absorbent pad or biocellulose


image Hydrocolloid dressings. A number of hydrocolloids are available, e.g. pectin and gelatin. These form a gel when exposed to the exudate and promote moist wound healing. These dressings are combined with a semi-permeable film and come with or without adhesive


image Foam dressings: these contain polyurethane foam which absorbs the exudate. They can be adhesive or non-adhesive and can come with or without a plastic film backing. They are categorized further in the BNF into those for lightly, lightly to moderate and moderate to heavy exudating wounds


image Alginate dressings: these are made from the alginic acid derived from brown seaweed. These dressings are highly absorbent which makes them useful in exuding wounds. They are available as dressings or sheets and can be adhesive or non-adhesive


image Capillary action dressing. Hydrophilic fibres in the dressing draw up the exudate. Low adhesive wound contact layers on either side of the fibres prevent any the fibres contaminating the wound


image Odour absorbent dressings: these dressings contain activated charcoal to reduce the odour coming from the wound


image Antimicrobial dressings: these dressings contain honey, silver, iodine or other antimicrobials to lower the number of bacteria in an infected wound.

< div class='tao-gold-member'>

Related posts:

  1. Oral unit dosage forms
  2. Solutions
  3. Drug evaluation and pharmacoeconomics
  4. Emulsions

Stay updated, free articles. Join our Telegram channel
Tags:
Jun 24, 2016 | Posted by in PHARMACY | Comments Off on Appliances

Full access? Get Clinical Tree
Get Clinical Tree app for offline access