Alternative Usage Topikal: Adrenalin or Calcium Alginate
Gusti Sumarsih,S.Kp, ETN
Adrenalin is substance that act as arterial vasoconstric and pulse trigger so to improve blood pressure. The betablocer always will inhibit frequency and conducy the heart. The adrenalin too can used for add reaction of time. In indonesia adrenalin many used widely. Adrenalin can use topically to cases such epistaksis, bleeding prevention for teethache, and the others. The effect of adrenalin such as delirum, trigger, headache. Until now author not yet founded the result of research about efektivities adrenalin for the wound.
For the alternative dressing topical and have the same effect with adrenalin. We can use alginate calcium. Alginate dressings, originally derived from seaweed, have been used for many years for a variety of wounds. The substance was used as a haemostatic agent. particularly in dentistry, but no companies now hold product licenses for haemostasis. Highly absorbent, biodegradable alginate dressings are derived from seaweed. They have been successfully applied to cleanse a wide variety of secreting lesions. The high absorption is achieved via strong hydrophilic gel formation This limits wound secretions and minimizes bacterial contamination. Alginate fibres trapped in a wound are readily biodegraded.
Alginate dressings maintain a physiologically moist microenvironment that promotes healing and the formation of granulation tissue. Alginates can be rinsed away with saline irrigation, so removal of the dressing does not interfere with healing granulation tissue. This makes dressing changes virtually painless. Alginate dressings are very useful for moderate to heavily exudating
How do alginate dressings work?
There have been few studies of the effect of alginate dressings on the processes of wound healing. The healing of cutaneous ulcers requires the development of a vascularized granular tissue bed, filling of large tissue defects by dermal regeneration, and the restoration of a continuous epidermal keratinocyte layer. These processes were modeled in vitro in one study, utilizing
human dermal fibroblast, microvascular endothelial cell (HMEC),
These results suggest that the calcium alginatetested may improve some cellular aspects of normal wound healing, but not others.
Alginates have been shown to be useful in a variety of situation; sloughy wounds which also produce a degree of exudate may be dressed with alginate dressings such as Sorbsan, Tegagen, Kaltostat.
Alginates are one of the dressings of choice for any moderate to highly exuding wounds, and studies have demonstrated their value in a variety of wound types:
1. Split skin graft donor sites
Alginates made their first big impression in wound care in the 1980s, as dressings for split skin graft donor sites; they rapidly showed that they were superior to paraffin gauze, the usual dressing for donor sites at that time.
Dressing removal is also an issue with split skin graft donor sites; a study that compared calcium alginate and a silicone-coated polyamide net dressing found no significant difference in the pain associated with dressing changes. However
The dressing removal benefits found in donor site management may also apply in the management of burns too. Surgery can increase complications, both by increasing local bleeding, and adding the risk of skin grafts being removed with the dressing.
3. Cavity Wounds
Alginate dressings are extremely absorbent, making them particularly useful for removal of moderate to large amounts of exudate.This can make the dressings particularly useful for cavity wounds and infected surgical wounds.
4. Pressure ulcers
High grade pressure ulcers often exude considerable amounts of fluid; one study set out to compare a sequential strategy – calcium alginate for four weeks, followed by hydrocolloid dressings – with treatment by hydrocolloids alone. Significantly faster healing was found in the sequential treatment group than in the control group..
5. Diabetic foot lesions
Another study aimed at comparing both the efficacy and tolerance of an alginate wound dressing, with a paraffin gauze dressing, in the treatment of diabetic foot lesions, and found the alginate to be significantly better.
6. Leg Ulcers
Alginates may have a role in heavily exuding leg ulcers, but there is a dearth of helpful clinical studies.
Advantages of Alginates
Alginate dressings were cost-effective because the frequency of dressing change was significantly reduced (compared to contemporary dressings).
Alginate dressings, used in moderate to heavily exuding wounds, maintain a moist environment at the wound, that promotes healing and the formation of granulation tissue, and as the dressing can be rinsed away with saline irrigation, removal of the dressing does not interfere with healing granulation either, a factor that makes dressing changes virtually painless.
Calcium alginates are effective haemostats in wound dressings, acting as calcium ion donors with a potentiating effect on coagulation and platelet activation. The benefit does vary between products, with alginates containing zinc ions having a greater effect. Neither of these studies considered arterial bleeding, in which alginates are contraindicated.
In comparisons with paraffin gauze, the quality of healing has been found to be significantly better when alginate dressings have been used.
Limitations of Alginates
The cellular reactions could be provoked in full thickness wound models without occlusion, where there was an insufficient volume of wound exudate to completely wet the alginate fibres. Similar findings have been reported in animal studies, but clinical reports involving human subjects have proved impossible to find.
A florid foreign body giant cell reaction elicited by an alginate used as a haemostat in a dental cavity, and not removed afterward. This further emphasizes the need to confine alginates to wounds where there is sufficient moisture to form a gel that can easily be flushed away with saline solution; and to remove excess alginate material from dry areas.Alginate have four varieties such as:
1. Alginate dressing – For medium to heavily exuding wounds.
These dressings are not ideal for infected wounds, and should not be used on dry wounds, or those covered with dry necrotic tissue.
2. Alginate Dressing with Absorbent Backing – For medium to heavily exuding wounds.
With similar uses as the standard dressing, absorbent padding is provided for ease of application.
3. Alginate Containing Hydrocolloid Dressing – For medium to heavily exuding wounds.
4. Capillary Action Absorbent Dressing
For low to heavily exuding wounds; these are not appropriate for very vascular wounds (e.g. fungating wounds), or where there is a risk of arterial bleeding (research showing haemostatic properties has focussed on .
The future of Alginates
Alginate dressings have been shown to be useful as carriers of therapeutic agents. Alginate is used a antibacterial, anti-inflammatory and deodorizing success, using a honey-impregnated alginate dressing. This was a case history of a man with challenging venous ulcers.
The value of silver as a topical anti-microbial agent is not in doubt, but the efficacy of specific silver-bearing wound products is remains controversial. Silver sulfadiazine-loaded alginate ‘microspheres’ may be able to deliver silver sulfadiazine in a controlled fashion, controlling infection for extended time period with reduced dressing frequency, while enabling easier assessment of the wound; laboratory studies are ongoing. Silver-releasing dressings for wounds at high risk of infection may influence prognosis; however, the evaluation of these advantages is complex and methodology will need to be refined before proper evaluation can take place.
Alginate is used a bacterial, anti inflammatory and deodorizing success, using a honey impregnated alginate dressing. This was a case history of a man with challenging venous ulcer.
In Indonesia, we often founded usage adrenalin. Adrenalin less effective for topical dressing but it only will effective for clot of blood, because it effect to systemic. As alternative we can use alginate as topical dressing. Alginate is modern dressing that still used. A. nurse must choice a dressing that ideal. Now alginate have many product as paste and powder. Using alginate have to look the wound condition. The wound condition differs so using a alginate too will differ. Base of it contain, alginate can use for type of wound minor bleeding and minor exudates. Even though alginate is more cheap than other dressing, so its most cost effective.
1. Http:www. Free.medical. com. Alginate calcium. (cited. Nov.3, 2008).
2. Blackley. P Practical stoma wound and continence management. Second edition .Research publication Pty
Ltd. Vermont, Victoria, Australia. 2004
3. Carville. K Wound care: manual. 3ed. Edition. St.Osborn Park. Australia 1998