Hydrocolloid dressings are suitable for a wide range of wounds and are designed to absorb wound fluid (exudate), promote a moist wound healing environment and aid debridement.
On contact with exudate, the hydrocolloid absorbs liquid to form a gel. This enables the dressing to create a moist wound environment, soften any hard or dead tissue and provide a barrier to microorganisms (Ousey et al, 2012). Some hydrocolloids form a cohesive gel that is contained within the structure of the dressing, while others form a less adhesive gel which can migrate over the wound bed.
The gelling agents in hydrocolloid dressings are made from different substances, including cellulose and gelatin (Ousey et al, 2012), which are often combined with adhesives and contained in a carrier, often a foam or a film.
What kind of wounds should a hydrocolloid dressing be used on?
Hydrogel dressings can be used on a wide variety of wound types, including:
- Pressure ulcers (stages 1 and 2)
- Leg ulcers
- Surgical wounds
- Minor burns.
Hydrocolloid dressings can cope with different volumes of exudate, from light to heavy (Fletcher, 2005). As the gelling process progresses, the dressing’s permeability to water vapour will increase, thus allowing it to absorb more exudate (Thomas and Loveless, 1997).
Hydrocolloids can also be used in granulating wounds (where new tissue is forming), and wounds that contain a high percentage of slough (yellow, fibrous tissue) or necrosis (dead tissue) (Morris, 2006).
Because hydrocolloids are waterproof, they can also be used as secondary dressings to prevent other dressings from becoming contaminated (Ousey, et al, 2012).
Thinner versions of hydrocolloid dressings can also be used on drier wounds, or those with lower volumes of exudate (Ousey et al, 2012).
There are a number of hydrocolloid products available — how can I choose the correct one?
Each patient will have different wound care needs that need to be considered when choosing the right product. The following questions will help with dressing selection.
Do you need the dressing to absorb exudate?
The ability of different hydrocolloids to absorb exudate depends partly on the thickness of the dressing and its properties, for example, the type of gelling agent used. Always check the manufacturer’s instructions before choosing a dressing to see what is recommended.
Is the patient at risk of pressure damage?
The smooth outer surface and fitted edges of some hydrocolloid dressings will help to protect fragile skin against pressure, shear and friction (Ousey et al, 2012).
Do you need to provide a moist wound environment?
Because of their gelling action, hydrocolloids can retain a certain amount of moisture underneath the dressing. Maintaining a moist rather than a dry environment in the wound bed helps to promote wound healing, as it will prevent dehydration of tissue and subsequent cell death, promote angiogenesis (the growth of new blood vessels), and help to erode dead tissue (Field and Kerstein, 1994).
Does the wound need to be debrided?
Hydrocolloid dressings can help to facilitate a form of debridement known as autolytic debridement. This is where the body’s own moisture and enzymatic activity are used to hydrate, soften and eventually remove necrotic tissue and slough, and occurs by using a dressing that keeps the wound fluid in contact with the necrotic tissue. Autolytic debridement is useful in that it only removes necrotic tissue and is painless.
It is also important to notify patients that the wound may enlarge initially due to autolytic debridement, as slough and necrosis is removed (Ousey et al, 2012).
Are you concerned about infection?
Hydrocolloids are designed to be occlusive (air and water-tight) and so are generally impermeable to bacteria (Fletcher, 2005). The waterproof barrier also helps to prevent the risk of cross-infection, for example, one study showed how they were used to prevent the spread of meticillin-resistant Staphylococcus aureus (MRSA) (Thomas, 1992). However, hydrocolloids should not be used on wounds that are already infected.
Is the patient in pain?
As hydrocolloids are easy to remove, they can help to reduce the amount of pain experienced by patients on dressing removal. If a patient is experiencing pain, it may be better to choose a hydrocolloid that does not have an adhesive barrier, but always check the manufacturer’s recommendations.
Is the wound in an awkward position?
Some wounds, such as on the heel, sacrum or elbow, can be difficult to dress. Hydrocolloid dressings come in a range of sizes and shapes that are designed to cater for these difficult-to-dress anatomical areas. Also, flat sheets of hydrocolloid dressing can be cut to fit difficult areas (Fletcher, 2005).
Can hydrocolloids protect the periwound area?
Some hydrocolloid dressings overlap the edges of the wound, thus providing protection for the periwound area (Ousey et al, 2012). Similarly, some hydrocolloids have an adhesive border that can help to prevent maceration of the periwound skin.
Points to remember when applying a hydrocolloid dressing
A hydrocolloid can be gently warmed between the hands before application, as this will help the dressing adhere to the wound (Fletcher, 2005). It is also important to leave a small margin around the wound (up to 2cm) and, where possible, make sure that the patient does not put any weight on the wound for a small time period (up to 20 minutes if possible). This will help the dressing to adhere (Fletcher, 2005).
The gelling action of a hydrocolloid can be mistaken by some patients or inexperienced practitioners as discharge from the wound. It is important to reassure patients that this is, in fact, a normal effect.
When should a hydrocolloid not be used?
A hydrocolloid dressing should not be used in the following circumstances (Ousey et al, 2012):
- Infected wounds
- Where there is exposed bone or tendon
- Deep burns
- Ulcers (resulting from diabetes, fungal infection, tuberculosis, or syphilis)
- If the patient has vasculitis
- Sinus tracts.
Although cost-effectiveness is important, choosing the cheapest hydrocolloid dressing is not necessarily the best thing to do, as dressing choice should always be guided by the patient’s needs. If a dressing fails to perform well, more frequent dressing changes will be needed, incurring greater nursing time
Patient choice and preference should always be considered. This helps to build up a good nursing–patient relationship and is in line with national policy.
- Fluid-handling capacity
- Moist wound healing
Fletcher J (2005) Understanding wound dressings: Hydrocolloids. Nurs Times 101(46): 51
Morris C (2006) Wound management and dressing selection. Wound Essentials 1: 178–83
Ousey K, Cook L, Young T, Fowler A (2012) Hydrocolloids in practice made easy. Wounds UK 8(1): 1–6
Thomas S (1992) Hydrocolloids. J Wound Care 1(2): 27–30
Thomas S, Loveless P (1997) A comparative study of the properties of twelve hydrocolloid dressings. World Wide Wounds. Available online.