COMPOSITE DRESSINGS have multiple layers and can be used as primary or secondary dressings. They're appropriate for wounds with minimal to heavy exudate, healthy granulation tissue, necrotic tissue (slough or moist eschar), or a mixture of granulation and necrotic tissue.

Some composite dressings can't be used on infected wounds, so check the manufacturer's instructions. Those with an adhesive border require intact skin around the wound to anchor the dressing.

Use composite dressings cautiously if the patient is dehydrated or has fragile skin. Keep in mind that some insurers won't reimburse a facility or provider if a composite dressing is used as a secondary dressing with a hydrogel or impregnated gauze.

Now let's take a closer look at composite dressings.

Looking at the layers

Most composite dressings have three layers:

a semiadherent or nonadherent layer that touches the wound and protects it from adhering to other material. This layer lets you remove the dressing without disturbing new tissue growth. Exudate passes through it into the next layer, which is absorptive. If you apply a topical agent, such as an antibiotic ointment, on the wound, the dressing's inner layer won't stick to the ointment.

an absorptive layer that wicks away drainage and debris from the wound's surface, which helps prevent skin maceration and bacteria growth and maintains a moist healing environment. This absorptive layer is made of material other than an alginate, foam, hydrocolloid, or hydrogel. Besides protecting the intact skin from excessive moisture, this layer helps to liquefy eschar and necrotic debris, facilitating autolytic debridement.

a bacterial barrier layer that may have an adhesive border. This outer layer allows moisture vapor to pass from the wound to the air and keeps bacteria and particles out of the wound. It also helps maintain the moist healing environment. Unlike gauze, this layer prevents moisture leakage (strike-through) to this outer layer of the dressing, meaning you can change the dressing less often.

Some examples of composite dressings are Alldress (Molnlycke Health Care); Covaderm Plus (DeRoyal); Telfa, Ventex, and Viasorb dressings (all by Kendall); and Tegaderm dressing with absorbent pad (3M Health Care).

Using a composite

Before applying a composite dressing, gently clean the wound with 0.9% sodium chloride solution and gently blot the wound dry with gauze. Apply the dressing following the manufacturer's instructions. Change the dressing when it's nearly saturated, or according to the manufacturer's instructions. At each dressing change, document the wound measurement, color, odor, condition, and amount of drainage.  Medical Supply.