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Mefix dressings for superficial partial thickness burns
Mefix Dressings for Superficial Partial Thickness Burns
W
Isabel Harvey Clinical Nurse Consultant Department of Emergency Medicme The Canberra Hospital, Fax: 02 6244 3310
INTRODUCTION
DISCUSSION
This paper discusses the use of retention dressings, namely Mefix (Molnlycke), in the management of erythema and superficial partial thickness burns in the Emergency Department of The Canberra Hospital. There are various brands of retention dressings on the market. Mefix happened to be readily avadable at The Canberra Hospital so became the dressing of choice.
The Emergency Department sees approximately 240 bums patients per year. One third of these are children under 13 years of age. The majority of the bums are superficial pamal thickness burns which, with the exception of facial burns, are treated with Mefix The infection rate is negligible and appears to relate solely to poor patient compliance with discharge instructions.
BACKGROUND A Burns Special Interest Group was estabhshed at The Canberra Hospital in December 1994. It consisted of Clinical Nurse Consultants from the Plastics Ward, Paediatric Surgical Ward and myself from the Emergency Department, 2 paediatric surgeons and a plastic surgeon. The management of burns at The Canberra Hospital needed to be rationalised so a commonly agreed protocol was formulated for superficial partial, deep partial and full thickness bums. This article will only address the management of superficial partial thickness burns. Following on from work done in the Burns Unit of the Royal Perth Hospital in Western Australia and the Adelaide Children's Hospital in South Australia it was agreed that we would trial a retention dressing on superficial partial thickness burns. As the majority of burns patients were managed in the Emergency Department the trial was conducted in the Emergency Department. The trial of Mefix dressings was conducted over 4 months in early 1995.32 patients including chddren were treated with Mefix. 71% had good results and were satisfied with the use and care of the Mefix dressing. In one patient, the dressing fell off after one day so the patient was unimpressed. This patient had had a grease impregnated dressing applied at the referring hospital prior to transfer to The Canberra Hospital. The grease on the skin probably prevented the Mefix from sticking. 25% of patients failed to present for follow up and were uncontactable. Based on these results we felt confident enough to incorporate Mefix into our burns protocol bearing in mind we would continue to assess the results.
30
AENJ VOLUME 1 N O . 4 MAY 1 9 9 8
In 1996, 135 patients were treated with Mefix dressings. 40 patients (30%) did not have follow up. Reasons for this are varied. Some patients' burns were assessed as being of such a minor nature that follow up was not required and patients were instructed on self removal of the dressing. Some patients were travelling through Canberra and were advised to seek review back in their home state. Some patients were inadvertently referred back to their local doctors for review. A small proportion of patients failed to present for follow up as requested. Mefix use in burns is a relatively new concept in Canberra. Though we have had education sessions with some general practitioners there are still many who are unfamiliar with this techmque so we prefer to follow up our bums patients in the Emergency Department. Of the 95 patients who were followed up in the Emergency Department, 2 patients (2%) developed wound infections. One of these patients was drug dependent and did not wash the dressing at all. The other patient was an elderly lady with burns to her inner thighs who also admitted she did not wash the dressings as often as directed. All patients report a dramatic reduction in pain about half an hour after application of the dressing (I speak from personal experience) and feel minimal discomfort whilst the dressing ts in situ. In the majority of cases full healing occurs between 7-14 days. The maximum time to healing was 3 weeks. We use Mefix frequently to relieve pain from sunburn. Mefix has also been used on deeper burns after the initial period of heavy exudate has settled eg Day 7 or Day 10.
Photos Nol to No 5 are examples of the types of burns Mefix dressings are suited to.
m
Photos No 6 and No 7 are of I0 day old burns which are ready for Hefix. Photo No 8 is of a 5 day old burn that is ready for Hefix.
m
Photos No 9 to No II demonstrate the app)ication of Hefix.
M
Advantagesof Mefix RetentionDressings
Disadvantages
Removal of Mefix
• Porous nature allows exudate to escape and prevents maceration of underlying tissue.
• Poor patient compliance can lead to rapid build up of smelly exudate and possible infection.
• Easily moulded to suit any shape.
Applicationof Mefix
• Allows free joint movement due to low bulk and stretchiness. The fact that it adheres to the skin means the dressing moves with the patient thus elimmating friction.
After debriding and cleaning the burn, pat dry. Apply Mefix directly onto the burn. Include a 2-3cm border of good skin. Do not stretch the Mefix when applying it. Limit any overlap of Mefix to 1-2cm. Bums to the hand are best managed with a glove cut out of a large piece of Mefix.
The 1,beral use of oil to 'neutralise' the adhesive cannot be emphasised enough. Mefix must never be removed from a burn without the use of od. Attempts to remove it m this manner may lead to further skin loss.
• Quick, easy and painless to apply. • Excellent pare relief. • Reduces the itch associated with a healing burn. • Cheap, low maintenance, weekly dressing. Patients, children in particular, are not subjected to frequent painful dressing changes. • Painless to remove. • Minimal disruption to patient's lifestyle. • Well tolerated by patients. Patients frequently express their amazement at such a simple concept being so effective.
Hairy patients will need the hair clipped around the edge of the bum. Sometimes hairs within the burn will need to be clipped to allow Mefix to stick directly to the skin. The dressing remains in place for one week. Patients are asked to present to the Emergency Department for review on Day 7. It is safe to leave tt for 10 days if this is more convement. All patients are given written instructions on how to care for their dressings. See Appendtx A. for Discharge Advice for Mefix Dressings.
The dressing needs to be saturated m oil for a minimum of 2 hours prior to removal. Any clean oil can be used eg olive oil, vegetable oil, baby oil. The Mefix should then come off without difficulty. The area is then washed, dried and moisturising cream applied before the patient leaves the department.
Follow up Care Generally all that is required is avo,dance of direct sunlight and molsturising cream massaged into the new tissue 2 or 3 times a day. If the burn is not completely healed then another week of Mefix may be required. The oil must be thoroughly washed off the skin with a mild soap before applying new Mefix otherwise it won't adhere to the skin.
AENJ VOLUME
1 NO. 4 MAY 1998
31
N~
SUMMARY APPENDIX A
Mefix has been used successfully in the Emergency Department, Paediatric Surgical and Plastics Wards of The Canberra Hospital for nearly 3 years. It is extremely cost effective and very "customer friendly".
The CanberraHospital EmergencyDepartmentDischargeAdvice For Mefix BurnsDressings Mefix dressings have been applied to your burns. To get the best results please closely follow these instructions.
BIBLIOGRAPHY
@ N~
1. Leave the dressing mtact for 7 days. If it comes loose please return to the Emergency Department to have it re-inforced.
Sperring, B.J and Wood, F.M. Better Care of the Burnt Hand - "Jelonet" and gauze dressings compared to '%xomull stretch". Primary Intention 1993; November 25-28.
2. Don't wet the dressing for the first 24 hours. Pat any ooze with a tissue. 3. On the second day we would like you to SHOWER OR WASH THE AREA AT LEAST TWICE DAILY USING SOAP AND A WASHER. Just pat it dry with a towel. You can wash or shower the burn several times a day to relieve itching.
Perkins, K. The use of semi- permeable adhesive backed materials in burn scar management of the Adelaide Children's Hospital. ANZBA Bulletin 1987; 1:18-19.
.
Downes, M., Porock, D and Upright, C. Retention tape dressings: An innovative method of promoting comfort in the management of radiation skin reactions. Primary Intentions, 1997; August 16-22.
In the first few days there may be some clear yellow liquid oozing from the dressings. Just use a clean face washer moistened with warm water to wipe the ooze off the dressings. Do this as often as needed.
5. You may need to wear old clothes if it is oozing a lot so you don't stain your good clothes. 6. On the morning of .................. ,2 hours before coming to the Emergency Department, please pour lots of baby oil or olive oil onto the Mefix dressing. Then wrap the dressing in Glad Wrap or similar cling wrap. The oil will help to make the dressing slide off easily. The glad wrap will help protect your clothing from the oil. . Please come to the Emergency Department before 10am. The nurse w111remove the dressing and inspect the burns. All that is generally needed after this is some moisturising cream and avoidance of direct sunlight. 8. If you are at all concerned about the burn eg increasing pain, swelling, smelly discharge or redness around the edge of the Mefix, please return to the Emergency Department or phone (02) 6244 2611.
WANTE, D
'
*L
'
TNCC & ENPC INSTRUCTORS
,
,
'
'L,
•
....
D u e to the increased expansion of both Of these programs, an opportunity exists for current T N C C & /
E N P C providers to undertake an instructors progra m and become part of the expert faculty, i
ESSENTIAL
• CUrrent provider status (if you have u n d e r t a k e n a T N C C prior
•
to [996 y o u w i l l n e e d t o observe t h e n e w p r o g r a m )
•
,
• Commitment
• Extensive relevant experience
APPLICATION
, S u b m i t a letter of application with a current C V
PROCESS
-2
COST
• $300
FURT
HE
R
32
,
, • ,
:
referees :
:
:
• Please do not hesitate to Contact m e on 0419 427 417 ( A H ) . . . . .
•
o r 9688 4937 (answer machine~fax).
1
i
1
'L;
....
to relevant program
:
INFORMATION
•
,
' * :
AENJ VOLUME 1 N O . 4 M A Y 1 9 9 8
•
~
LindaSims
, L* i:
W
Isabel Harvey Clinical Nurse Consultant Department of Emergency Medicme The Canberra Hospital, Fax: 02 6244 3310
INTRODUCTION
DISCUSSION
This paper discusses the use of retention dressings, namely Mefix (Molnlycke), in the management of erythema and superficial partial thickness burns in the Emergency Department of The Canberra Hospital. There are various brands of retention dressings on the market. Mefix happened to be readily avadable at The Canberra Hospital so became the dressing of choice.
The Emergency Department sees approximately 240 bums patients per year. One third of these are children under 13 years of age. The majority of the bums are superficial pamal thickness burns which, with the exception of facial burns, are treated with Mefix The infection rate is negligible and appears to relate solely to poor patient compliance with discharge instructions.
BACKGROUND A Burns Special Interest Group was estabhshed at The Canberra Hospital in December 1994. It consisted of Clinical Nurse Consultants from the Plastics Ward, Paediatric Surgical Ward and myself from the Emergency Department, 2 paediatric surgeons and a plastic surgeon. The management of burns at The Canberra Hospital needed to be rationalised so a commonly agreed protocol was formulated for superficial partial, deep partial and full thickness bums. This article will only address the management of superficial partial thickness burns. Following on from work done in the Burns Unit of the Royal Perth Hospital in Western Australia and the Adelaide Children's Hospital in South Australia it was agreed that we would trial a retention dressing on superficial partial thickness burns. As the majority of burns patients were managed in the Emergency Department the trial was conducted in the Emergency Department. The trial of Mefix dressings was conducted over 4 months in early 1995.32 patients including chddren were treated with Mefix. 71% had good results and were satisfied with the use and care of the Mefix dressing. In one patient, the dressing fell off after one day so the patient was unimpressed. This patient had had a grease impregnated dressing applied at the referring hospital prior to transfer to The Canberra Hospital. The grease on the skin probably prevented the Mefix from sticking. 25% of patients failed to present for follow up and were uncontactable. Based on these results we felt confident enough to incorporate Mefix into our burns protocol bearing in mind we would continue to assess the results.
30
AENJ VOLUME 1 N O . 4 MAY 1 9 9 8
In 1996, 135 patients were treated with Mefix dressings. 40 patients (30%) did not have follow up. Reasons for this are varied. Some patients' burns were assessed as being of such a minor nature that follow up was not required and patients were instructed on self removal of the dressing. Some patients were travelling through Canberra and were advised to seek review back in their home state. Some patients were inadvertently referred back to their local doctors for review. A small proportion of patients failed to present for follow up as requested. Mefix use in burns is a relatively new concept in Canberra. Though we have had education sessions with some general practitioners there are still many who are unfamiliar with this techmque so we prefer to follow up our bums patients in the Emergency Department. Of the 95 patients who were followed up in the Emergency Department, 2 patients (2%) developed wound infections. One of these patients was drug dependent and did not wash the dressing at all. The other patient was an elderly lady with burns to her inner thighs who also admitted she did not wash the dressings as often as directed. All patients report a dramatic reduction in pain about half an hour after application of the dressing (I speak from personal experience) and feel minimal discomfort whilst the dressing ts in situ. In the majority of cases full healing occurs between 7-14 days. The maximum time to healing was 3 weeks. We use Mefix frequently to relieve pain from sunburn. Mefix has also been used on deeper burns after the initial period of heavy exudate has settled eg Day 7 or Day 10.
Photos Nol to No 5 are examples of the types of burns Mefix dressings are suited to.
m
Photos No 6 and No 7 are of I0 day old burns which are ready for Hefix. Photo No 8 is of a 5 day old burn that is ready for Hefix.
m
Photos No 9 to No II demonstrate the app)ication of Hefix.
M
Advantagesof Mefix RetentionDressings
Disadvantages
Removal of Mefix
• Porous nature allows exudate to escape and prevents maceration of underlying tissue.
• Poor patient compliance can lead to rapid build up of smelly exudate and possible infection.
• Easily moulded to suit any shape.
Applicationof Mefix
• Allows free joint movement due to low bulk and stretchiness. The fact that it adheres to the skin means the dressing moves with the patient thus elimmating friction.
After debriding and cleaning the burn, pat dry. Apply Mefix directly onto the burn. Include a 2-3cm border of good skin. Do not stretch the Mefix when applying it. Limit any overlap of Mefix to 1-2cm. Bums to the hand are best managed with a glove cut out of a large piece of Mefix.
The 1,beral use of oil to 'neutralise' the adhesive cannot be emphasised enough. Mefix must never be removed from a burn without the use of od. Attempts to remove it m this manner may lead to further skin loss.
• Quick, easy and painless to apply. • Excellent pare relief. • Reduces the itch associated with a healing burn. • Cheap, low maintenance, weekly dressing. Patients, children in particular, are not subjected to frequent painful dressing changes. • Painless to remove. • Minimal disruption to patient's lifestyle. • Well tolerated by patients. Patients frequently express their amazement at such a simple concept being so effective.
Hairy patients will need the hair clipped around the edge of the bum. Sometimes hairs within the burn will need to be clipped to allow Mefix to stick directly to the skin. The dressing remains in place for one week. Patients are asked to present to the Emergency Department for review on Day 7. It is safe to leave tt for 10 days if this is more convement. All patients are given written instructions on how to care for their dressings. See Appendtx A. for Discharge Advice for Mefix Dressings.
The dressing needs to be saturated m oil for a minimum of 2 hours prior to removal. Any clean oil can be used eg olive oil, vegetable oil, baby oil. The Mefix should then come off without difficulty. The area is then washed, dried and moisturising cream applied before the patient leaves the department.
Follow up Care Generally all that is required is avo,dance of direct sunlight and molsturising cream massaged into the new tissue 2 or 3 times a day. If the burn is not completely healed then another week of Mefix may be required. The oil must be thoroughly washed off the skin with a mild soap before applying new Mefix otherwise it won't adhere to the skin.
AENJ VOLUME
1 NO. 4 MAY 1998
31
N~
SUMMARY APPENDIX A
Mefix has been used successfully in the Emergency Department, Paediatric Surgical and Plastics Wards of The Canberra Hospital for nearly 3 years. It is extremely cost effective and very "customer friendly".
The CanberraHospital EmergencyDepartmentDischargeAdvice For Mefix BurnsDressings Mefix dressings have been applied to your burns. To get the best results please closely follow these instructions.
BIBLIOGRAPHY
@ N~
1. Leave the dressing mtact for 7 days. If it comes loose please return to the Emergency Department to have it re-inforced.
Sperring, B.J and Wood, F.M. Better Care of the Burnt Hand - "Jelonet" and gauze dressings compared to '%xomull stretch". Primary Intention 1993; November 25-28.
2. Don't wet the dressing for the first 24 hours. Pat any ooze with a tissue. 3. On the second day we would like you to SHOWER OR WASH THE AREA AT LEAST TWICE DAILY USING SOAP AND A WASHER. Just pat it dry with a towel. You can wash or shower the burn several times a day to relieve itching.
Perkins, K. The use of semi- permeable adhesive backed materials in burn scar management of the Adelaide Children's Hospital. ANZBA Bulletin 1987; 1:18-19.
.
Downes, M., Porock, D and Upright, C. Retention tape dressings: An innovative method of promoting comfort in the management of radiation skin reactions. Primary Intentions, 1997; August 16-22.
In the first few days there may be some clear yellow liquid oozing from the dressings. Just use a clean face washer moistened with warm water to wipe the ooze off the dressings. Do this as often as needed.
5. You may need to wear old clothes if it is oozing a lot so you don't stain your good clothes. 6. On the morning of .................. ,2 hours before coming to the Emergency Department, please pour lots of baby oil or olive oil onto the Mefix dressing. Then wrap the dressing in Glad Wrap or similar cling wrap. The oil will help to make the dressing slide off easily. The glad wrap will help protect your clothing from the oil. . Please come to the Emergency Department before 10am. The nurse w111remove the dressing and inspect the burns. All that is generally needed after this is some moisturising cream and avoidance of direct sunlight. 8. If you are at all concerned about the burn eg increasing pain, swelling, smelly discharge or redness around the edge of the Mefix, please return to the Emergency Department or phone (02) 6244 2611.
WANTE, D
'
*L
'
TNCC & ENPC INSTRUCTORS
,
,
'
'L,
•
....
D u e to the increased expansion of both Of these programs, an opportunity exists for current T N C C & /
E N P C providers to undertake an instructors progra m and become part of the expert faculty, i
ESSENTIAL
• CUrrent provider status (if you have u n d e r t a k e n a T N C C prior
•
to [996 y o u w i l l n e e d t o observe t h e n e w p r o g r a m )
•
,
• Commitment
• Extensive relevant experience
APPLICATION
, S u b m i t a letter of application with a current C V
PROCESS
-2
COST
• $300
FURT
HE
R
32
,
, • ,
:
referees :
:
:
• Please do not hesitate to Contact m e on 0419 427 417 ( A H ) . . . . .
•
o r 9688 4937 (answer machine~fax).
1
i
1
'L;
....
to relevant program
:
INFORMATION
•
,
' * :
AENJ VOLUME 1 N O . 4 M A Y 1 9 9 8
•
~
LindaSims
, L* i: