Burn Dressing Guidelines

Burn Dressing GuidelinesPAEDIATRIC

Burn Dressing GuidelinesPaediatricAdminister analgesia prior to commencingwound care. Wound care should be carriedout in a clean area using aseptic technique.SR/October 2008 1

Superficial Dermal 3% should be treated as follows:-1. Deroof blisters and thoroughly debride loose skin2. Cleanse with warmed normal saline or tap water3. Obtain wound swabs4. Where possible apply Biobrane biosynthetic dressing as per application guidelines5. Apply a secondary dressing of gauze swabs and crepe bandage.6. Inspect wounds 24-48 hours after application of Biobrane. Treat any pockets of fluidas per Biobrane guidelines.7. Inspect wounds again at 72 hours post application and remove method of fixation8. When Biobrane is well adhered and no exudate is evident allow the patientto bathe (no sooner than 5 days) and apply tubifast over the wound9. Trim loose areas of Biobrane as the wound heals. Apply moisturiser and massagehealed skin 3-4 times daily.10. If it is not possible to use Biobrane then follow wound care guidelines above.SR/October 2008 2

Deep DermalDeep dermal burn wounds should be treated as follows:-1. Deroof blisters and debride loose skin2. Cleanse with warmed saline/tap water3. Obtain wound swabs4. Apply an anti-microbial, non-adherent dressing (as per local wound formulary)5. Apply a secondary dressing of gauze swabs and crepe bandage6. Re-assess the wound within 24-48 hours7. If the wound is not for surgical management continue to dress with an antimicrobial,non-adherent dressing until healed.8. After wound healing has occurred moisturise and massage the wound 3-4times daily.9. Deep dermal burn wounds will scar and will need review in the scarmanagement/pressure garment clinic.Full Thickness

Full Thickness >1% TBSAFull thickness injuries >1% TBSA should be treated as follows:-1. Admit to the appropriate ward for surgical/plastics review2. Debride loose skin3. Cleanse with warmed saline/tap water4. Obtain wound swabs5. Apply an anti-microbial, non-adherent dressing (as per local wound formulary)6. Apply a secondary dressing of gauze/burns swabs and crepe bandage if required7. A further surgical review should be carried out within 24 hours8. The wounds will continue to be dressed as above until surgical intervention can occurNB If the injury is full circumferential around a limb or is in an area that couldimpede breathing an urgent surgical referral to assess the need for escharotomy shouldbe carried out.Facial woundsFacial wounds will not have a dressing applied. They will be nursed exposed in aheated cubicle. If the wound does not require surgical management the treatmentwould be as follows:-1. Ensure cubicle is warm2. Deroof blisters and gently debride loose skin3. Cleanse wound with warmed saline or tap water4. Obtain wound swabs5. Apply topical ointments if prescribed6. Repeat wound care 2-3 times daily7. Nurse the child in an upright position to reduce swelling8. When the crusts have lifted moisturise and massage the healed skin 3-4 times dailySR/October 2008 4

Hand/feet woundsBurn injuries to hands or feet should be treated as follows:1. Deroof blisters and debride loose skin2. Cleanse with warmed saline or tap water. The hand or foot may be placed intoa basin of warm water for cleansing3. Obtain wound swabs4. If the digits are affected apply individual dressings to each digit5. Dress with a non-adherent anti-microbial dressing6. Apply a secondary dressing of gauze swabs. Bandage hands/feet into a functional position7. An alternative to using dressings is to use a clear poly bag. Apply topical creams/ointmentsif prescribed and place the bag over the hand. Secure the bag using gauze swabs and crepebandage around the wrist. Change the bag daily or more often if there is a large collectionof exudate present.8. If the injury is superficial then a Biobrane glove may be used as an alternativeto dressings or the poly bag9. Reassess wounds within 24-48 hours10. If no surgical intervention is required redress wounds as above until woundhealing has occurred11. After wound healing has occurred the skin should be moisturised andmassaged 3-4 times daily12. Refer to the scar management/pressure garment clinic for assessmentNB All injuries which involve a joint should be assessed by the physiotherapist.Any patient with a burn should be advised to avoid sun exposure or to wear a highfactor sun cream on their healed burn to avoid further damage from U.V rays.Perineal woundsPerineal wounds should be treated as follows:-1. Deroof blisters and debride loose skin2. Cleanse with warmed saline/tap water3. Consider the need for a urinary catheter4. Obtain wound swabs5. Apply topical ointment as prescribed6. Apply a non-adherent wound dressing and burns swabs. If the child wears anappy then put the nappy on over the dressings.7. Renew dressings as child soils or exudate dictates8. Cleanse and redress areas at least twice daily9. Continue with this regime until wound has healed10. After wound healing has occurred the skin should be moisturised and massaged3-4 times dailySR/October 2008 5

ReferencesArgirova,M., Hadjiski,O. & Victorova,A. (2007)Acticoat versus Allevyn as a Split-Thickness SkinGraft Donor Site Dressing: AProspective Comparative Study.Annals of Plastic Surgery59 (4): 415 - 422Baker,R.H.J.,Townley,W.A., McKeown,S., Linge,C. & Vijh,V.(2007)Retrospective Study of the Association betweenHypertrophic Burn Scarring andBacterial ColonizationJournal of Burn Care and Research28 (1): 152 – 156DeSanti,L. (2005)Pathophysiology and Current Management of Burn InjuryAdvances in Skin and Wound18 (6): 323 – 332Greenhalgh,D.G. (1996)The Healing of Burn WoundsDermatology Nursing8 (1): 13 -25Klnc,H.D.R., Sensoz,O., Ozdemir,R., Unlu,R.E. & Baran,C. (2001)Which Dressing for Split Thickness Skin Graft Donor Sites?Annals of Plastic Surgery46 (4): 409 - 414Lang,E.M., Eiberg,C.A., Brandis,M. & Stark,G.B. (2005)Biobrane in the Treatment of Burn and Scald Injuriesin ChildrenAnnals of Plastic Surgery55 (5): 485 – 489Mandal,A. (2007)Paediatric partial-thickness scald burns – is Biobrane thebest treatment available?International Wound Journal4: 15 – 19Merz,J., Schrand,C., Mertens,D., Foote,C., Porter,K. & Regnold,L.(2003)Wound Care of the Paediatric Burn Patient.AACN Clinical Issues14 (4): 429 – 441Musgrave,M., Umraw,N., Fish,J.S., Gomez,M. & Cartotto,R.C. (2002)The Effect of Silicone Gel Sheets on Perfusion ofHypertrophic Burn ScarsJournal of Burn Care and Rehabilitation23 (3): 208 – 214SR/October ‘08Peters,D.A. (2006)Healing at Home: Comparing Cohorts of Childrenwith Medium-Sized Burns Treatedas Outpatients with In-Hospital Applied Acticoat toThose Children Treated asInpatients with Silver SulfadiazineJournal of Burn Care Research27: 198 – 201Sargent,R.L. (2006)Management of Blisters in the Partial – Thickness Burn:An Integrative ResearchReview.Journal of Burn Care and Research27 (1): 66 – 81Singh,V., Devgan,L., Satyanarayan,B. & Milner,S.M. (2007)The Pathogenesis of Burn Wound ConversionAnnals of Plastic Surgery59 (1): 109 – 115Trop,M., Novak,M., Rodl,S., Hellbom,B., Kroell,W. &Goessler,W. (2006)Silver-Coated Dressing Acticoat Caused Raised LiverEnzymes and Argyria-likeSymptoms in Burn Patient.Journal of Trauma60: 648 – 652Wiechula,R. (2003)The use of moist wound-healing dressings in themanagement of split-thickness skingraft donor sites: a systematic review.International Journal of Nursing Practice9 (2): S9 – S176