Pediatric challenge: hydroconductive dressing for peristomal skin injury

Skin breakdown and ulcerations are common complications of peristomal skin in children with tracheostomies. Maintenance of skin integrity can be challenging as increased secretions, perspiration, drooling, skin folds and immobility contribute to increased moisture &friction related injuries.  Pressure injuries from the flanges, ties and stoma may exacerbate the severity of moisture- related breakdown. Despite the protocoled use of polyurethane foam barrier and non-alcoholic skin polymer preventative products, our patients developed progressive irritant moisture dermatitis, leading to significant erythema, erosions and weeping lesions in addition to peristomal granulation tissue formation.
We describe successful use of the hydroconductive, non-adherent wound dressing with the ability to draw exudate, debris and proteases in the cohort of 8 infants. Dressing’s porous absorbent material provides capillary, hydroconductive and electrostatic action. Small porous material allows the pores to act as capillaries, with intermolecular forces attracting exudate into the surface against the force of gravity. Electrostatic action refers to negatively charged bacterial attraction to positively charged surface of the dressing. Hydroconductive action refers to ability of fluid to flow through porous media, against the gravity, both vertically and horizontally. Patients ranged from preterm neonates born at 23-week gestation to 2 yo. Their injuries included moisture or friction-associated dermatitis, erosions and pressure injuries. Dressing was changed every 3-5 days, depending on the exudate level. All wounds improved; granulation tissue diminished. Caretakers commented on the ease of placement of the pre-cut tracheostomy dressing, comfortable fit and decreased need for frequent changes. 2 challenging patients were discharged home with the dressing; their parents continue to use it when inflammations develop. 2 patients developed peri-gastrostomy break down; hydroconductive dressing contributed to improved moisture management and healing enhancement. We recommend considering this dressing in the peri-stomal (both tracheostomies and gastrostomies) injuries in neonatal and pediatric population.

Trademarked Items (if applicable): Drawtex® tracheostomy dressing (Urgo Medical, Fort Worth, TX)

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