Multilayering of superabsorbent polymer dressings has no place in wound care.

This article is reprinted from the British Journal of Community Nursing, Vol 20, No 9, Community Wound Care September 2015 Dear Editor, In spite of many years of research and teaching, I have come to realise that some clinical practices are difficult to eradicate. One particular practice is the use of multilayered combinations of wound dressings often made up of components with very different functions. No doubt, the multilayering of dressings is ostensibly for the convenience of the clinician and with no, or little, consideration for the patient. Carefully considered, clear guidelines for the appropriate selection and use of dressings have been published widely (e.g. Thomas, 1997; Young, 1997; Day et al, 1998; Loftus and Wheatley, 2000; Clarkson, 2007; Stephen-Haynes, 2011) We have encountered dressing ‘sandwiches’ over many years, despite the complete lack of evidence. The layering of fibrous, absorbent dressings, together with antimicrobial dressings is one example of a dressing ‘sandwich’. Antimicrobial dressings will only exert their effect when in direct contact with the wound bed, not when superimposed on one or more absorbent products. Such practice is unjustified in clinical and economic terms. We have also observed, with increasing regularity, the multilayering of superabsorbent polymer dressings (SAPs). Evidence tells us that these products can absorb large quantities of exudate (Tarlton and Munro, 2013; Wiegand and Hipler, 2013) and, by inference, swell and become heavy. Care should be taken to ensure that the dressing does not reach saturation point, as this may lead to damage of the peri-wound area and the development of maceration and wound enlargement. While evidence for their use under compression bandaging is sparse (Cook, 2011), there is no evidence regarding sub-bandage pressures generated when SAPs are layered. This practice has the real potential to cause damage, and should be avoided