Dobór właściwego antyseptyku będzie uzależniony od rodzaju rany. Nie każdy preparat odkażający będzie skuteczny w leczeniu ran, błon śluzowych czy skóry. Jak zatem dobrać odpowiedni środek niszczący drobnoustroje?
Których antyseptyków nie należy pozostawiać w tkankach? Które środki należy wypłukać z rany?
Wśród preparatów, których nie można pozostawić w tkankach, a po zabiegu należy je usunąć bądź wypłukać są m.in. antyseptyki powierzchniowo czynne, których nie wolno stosować na odsłonięte chrząstki i kości. Wśród nich są preparaty zawierające w swoim składzie PHMB, srebro jonowe i oktenidynę.
Wśród środków odkażających, które należy usunąć z rany po aplikacji są również preparaty zawierające jod, które można stosować na układ kostny. Wśród nich są antyseptyki, których substancją czynną jest powidon jodu i kadeksomer jodu.
Które antyseptyki penetrują do tkanek?
Do grupy antyseptyków, które nadają się do odkażania wszystkich tkanek i jam ciała zalicza się środki na bazie wodnego roztworu oksydantów/ roztworu ponadtlenków (super-oxidized solution) oraz kwasu podchlorawego. Można tu zastosować również izoosmotyczny roztwór na bazie płynu Ringera z dodatkiem poliheksanidu w stężeniu 0,02%, jednak nie nadaje się on do odkażania kości, chrząstek i ośrodkowego układu nerwowego.
Natomiast wśród tych preparatów, które mają zdolność penetracji do tkanek, jednak nadają się jedynie do ran niegojących się, ran głębokich czy przetok są antyseptyki na bazie kwasu podchlorawego HOCl i podchlorynu sodu NaOCl w stężeniu 0,03%, 0,08% podchlorynu sodu, miodów medycznych, żywicy świerku, srebra nanokrystalicznego i siarczanu srebra.
Jak dopasować antyseptyk z uwagi na etiologię rany?
Antyseptyki należy również odpowiednio dobrać pod kątem etiologii rany. Inne preparaty odkażające stosuje się do ran pourazowych, a inne do pooperacyjnych czy oparzeniowych.
W antyseptyce ran pourazowych odpowiednie będą preparaty na bazie PHMB, oktenidyny, podchlorynu, miodów medycznych, jak również preparatów z żywicą oraz jodem, których nie należy łączyć z innym środkiem.
Rany pooperacyjne z przetoką należy odkażać środkami, w których głównym środkiem są podchloryny niskostężone bądź miody medyczne.
Natomiast w leczeniu ran oparzeniowych o niewielkiej powierzchni stosuje się preparaty antyseptyczne na bazie PHMB, oktenidyny, podchloryn oraz preparaty z jodem, których nie należy łączyć z innymi środkami. Ponadto do odkażenia tego rodzaju ran doskonale nadaje się maść z żywicy i preparaty ze srebrem.
Jak dobrać odpowiedni antyseptyk do rodzaju rany?
Dobór środka odkażającego będzie uzależniony również od tego, czy rana jest płaska, głęboka z ubytkiem, przetoką, zaczerwienieniem wokół rany, odsłaniająca kości i ścięgna czy charakteryzuje się dużą ilością wysięku.
Do ran płaskich stosuje się preparaty odkażające na bazie PHMB, oktenidyny, podchloryn, miodów medycznych oraz preparatów z jodem, których nie należy łączyć z innym preparatem. Ponadto w antyseptyce tego rodzaju ran stosuje się również maść z żywicy oraz preparaty ze srebrem.
Rany głębokie z ubytkiem, w których zasłonięte są kości i stawy, a drenaż jest utrzymany mogą być odkażane takimi samymi preparatami jak przy antyseptyce ran płaskich. Stosuje się wówczas środki na bazie PHMB, oktenidyny, podchloryn, miodów medycznych, żywicy, srebra oraz jodu.
W antyseptyce ran z przetoką stosuje się podchloryny, miody medyczne, maść z żywicy, a także preparat ze srebrem w postaci siatki bądź taśmy.
Rany, którym towarzyszy zaczerwienienie należy odkażać preparatami, których głównym składnikiem jest PHMB, oktenidyna czy podchloryny. W antyseptyce tego rodzaju ran sprawdzają się również maść z żywicy oraz środki z jodem.
Rany, w których doszło do odsłonięcia kości i ścięgna należy odkażać za pomocą podchloryn, miodów medycznych, maści z żywicą bądź preparatów z jodem.
W przypadku ran z dużą ilością wysięku do odkażania stosuje się preparaty ze srebrem lub jodem.
Należy pamiętać, iż preparatów z jodem nie należy stosować łącznie z innym środkiem.
Źródło: Opracowanie autorstwa mgr Elżbiety Szkiler
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