Use of a Soft Silicone Wound Contact Layer to Prevent Procedural Pain at Dressing Changes

Clinical Problem: Procedural pain (PP) during wound dressing changes are well documented.¹ PP often requires a two-pronged approach using both pharmacological and non-pharmacological management. Patient often report dressing change PP as the most intense of their wound pain experience.² While silicone dressings (SDs) have been used to reduce wound trauma in the wound bed and surrounding skin, properties vary among the variety of SDs³, impacting outcomes. Reduction in procedural pain has been reported regarding SDs during dressing changes but primarily in the European literature^1-3 with the US literature focusing on peri-wound trauma effects of SDs and under-appreciating its other qualities. 

Treatment Approach: A SSWCL* was applied to the wound bed of patients who rated prior non-SSWCL dressing change procedural pain greater than 8. The patients usual dressing aimed at providing optimal wound bed moisture was then applied immediately over the SSWCL. Usual dressings included: alginates, DACC, NPWT, hypertonic saline, non-adherent dressings and foams with and without the use of secondary dressings as indicated. Pain assessments were performed prior to and after dressing changes with the SSWCL.

Clinician/Patient Outcomes: Patient satisfaction with the use a SSWCL was very high with pain reduction over 75%. No pharmacological management was needed by any of the patients for dressing changes. The large fenestrations in the SSWCL allowed for the therapeutic use of the patients’ usual dressing. Visit time/cost was reduced as pharmacological intervention was not needed. Wound management goals and healing trajectories were not inhibited by the use of the SSWCL.

Conclusion: Using an SSWCL as a contact layer can reduce pain during dressing changes without affecting the goals of wound management while positively impacting patient satisfaction and reduce pharmacological intervention. Additional evaluation comparing specific SD qualities and its impact are warranted.

*Silflex. Advancis Medical. Nottinghamshire, UK.