ActiFormCool®
Meeting the challenges of wound pain

ActiFormCool is an ionic hydrogel which can respond dynamically to the condition of the wound. It will either donate or absorb fluid to maintain an optimal level of moisture in the wound bed.

ActiFormCool has been successfully used on many painful wounds and skin conditions such as leg ulcers, radiation therapy damage, pressure necrosis and exposed tendons and burns and scalds. It may be used with secondary dressings where appropriate. ActiFormCool can be used under compression on moderate to highly exuding wounds. ActiFormCool has been used safely on neonates and is a low sensitivity dressing
Addressing wound pain continues to be a priority for healthcare professionals and ActiFormCool has been shown to reduce the amount of oral analgesia patients require. Constant wound pain is extremely debilitating for the patient and a source of distress for both the nurse and sufferer alike. Nationwide evaluation tests on ActiFormCool, led by Tissue Viability nurse Sylvie Hampton, have shown a significant reduction in pain and exudate across leg ulcer patients.

Fitting Information
ActiFormCool® is a non adhesive, high water content hydrogel product, with a low sensitizing preservative. The dressing is a two sided, transparent hydrogel formed around a supporting polyethylene matrix. The Gel is permeable to water vapor, gases and small protein molecules, but impermeable to bacteria.

ActiForm Cool® provides a moist environment at the surface of the wound. The dressing will not adhere to the underlying tissue on removal, provided the dressing has not been allowed to dry out. Should a degree of drying take place then simply rehydrate the dressing with saline or water to facilitate removal.
Indications

To manage nociceptive wound pain, to assist in autolytic debridement by hydration of necrotic and sloughy tissue and for absorption of exudate.

Suitable on painful wounds and skin conditions such as leg ulcers, radiation therapy damage, burns and scalds. It may be used with secondary dressings where appropriate. ActiFormCool can be used under compression on moderate to highly exuding wounds. ActiFormCool has been used safely on neonates and is low sensitivity dressing.

Contra indications
ActiFormCool® should not be used as a covering on deep, narrow cavities or sinuses.

Application instructions
1. Remove sterile dressings from the package.
2. For treating larger areas several dressings may be used side by side. For smaller areas/wounds the dressing may be cut to size.
3. Peel off one of the white plastic liners, position on the wound or skin, smooth into place and peel off the remaining half.
4. Secure with a suitable bandage, tape or compression system.
5. Where extra absorbency is required the dressing may be layered by removing the top liner of the first dressing and then applying a second dressing. Absorbent pads may be used.

Frequency of change
ActiFormCool® should be changed as often as the wound/condition dictates.

As with all absorptive dressings, frequent monitoring is required to ensure the dressing does not dry out and adhere to the wound.
The dressing should be changed when it becomes cloudy or opaque from fluid absorption.
The dressing should be changed at the first sign if fluid strike through.
If infection is suspected, frequent changes and monitoring are advised.

Removal instructions
1. Lift one corner and gently peel off the dressing.
2. If needed, the dressing can be soaked with water or saline to rehydrate it, then peeled off as per step 1.
3. As fluid is absorbed into the dressing it takes on a jelly like appearance, taking on the colour of the exudate. This is normal and shows absorption has occurred.

ActiFormCool®
Frequently Asked Questions

How does the dressing work?

ActiFormCool® is a sheet hydrogel that works in several ways:
The dressing has a cooling effect which provides pain relief.
It hydrates dry tissue (necrotic or sloughy) to prepare the wound bed for healing. It also improves skin condition by hydrating hyperkeratotic skin. This action is achieved when the dressing top liner is left in place to occlude the wound and skin.
For exuding wounds the dressing works by absorbing fluid and by allowing water vapour to escape through the back of the dressing. In this case, the dressing top liner should be removed to improve moisture vapour transmission.
ActiFormCool® absorbs the exudate in such a way that it spreads within the whole dressing, and does not allow it to sink to the lower part of the dressing with gravity. Some dressings can remain dry at the top and become sodden at the bottom of the dressing which then becomes heavy and dislodges from the skin. It therefore works well even when the patient is upright and on awkward areas of the body.
What is the MVTR (Moisture Vapour Transmission Rate) of the dressing/top liner?
For highly exuding wounds when the film top liner is removed the MVTR of the dressing is 3000 gm/m2 over 24 hours. This is the equivalent of the MVTR of a highly effective film dressing, thus allowing good fluid handling properties. Fluid handling is the amount absorbed by the dressing plus the amount of fluid that passes through the back of a dressing as moisture vapour (Bishop 2003). However, the MVTR is affected by a cover dressing or bandage.
Will the drop in temperature effect healing?
The drop in temperature is only temporary and it is not always the objective to achieve healing at each stage. There are a variety of aims in wound management e.g. pain relief and patient comfort. (Hollinsworth 2002) The case studies on ActiFormCool® demonstrate clearly that the dressing allowed significant healing to take place, often on wounds that had been present for some time, whilst still providing the cooling, soothing, pain relief (ActiFormCool® case studies 2004).
How does it control pain?
Temporary drop in temperature cools and soothes irritated skin, bathes the nerve endings, allows easy removal from wound. The pain relief effect lasts as long as the dressing remains in place because the nerve endings are occluded and bathed.
What evidence is there to support the dressing, and do we need a randomised controlled trial?
There is a 16 patient (20 wound) study that has been presented as a poster presentation at TVS conference in April 2004. The case studies shown in this booklet form powerful evidence to support patient acceptance and efficacy. The dressing is CE marked, demonstrating that it is safe, effective and appropriate for use. ActiFormCool® has also been accepted for DT listing from June 1st 2004.
Can the dressing be used on bleeding wounds?
As with most wound dressings, haemostasis (stopping bleeding) should be achieved prior to use where there is free-flowing bleeding. It can be used on exuding or granulating wounds that have haemoserous (bloody) fluid.
Can the dressing be used on infected Wounds?
The dressing can be used on contaminated and colonised wounds. However clinical infection also requires systemic antibiotics and this should be assessed by the nurse.
Will the dressing remove bacteria from a wound?
We cannot make bacterial handling claims as we have not yet done any bacterial count studies. However, the dressing will absorb exudate with bacteria, and this is evident in the photographs that show the wound with bacteria (noted by its distinctive colour e.g. green pseudomonas), and the subsequent picture with the dressing swollen with exudate of the same colour.
Can the dressing be used under compression?
ActiFormCool® remains conformable and comfortable under compression. The case studies section showed healing with ActiFormCool® and Actico cohesive short-stretch compression bandages.
Can the dressing be used in cavities?
It is not advisable to use the dressing to pack into cavities, as these wounds can often be long, narrow sinuses with no obvious ending. In these cases biodegradable dressings are preferred in case pieces of the dressing become dislodged in the wound.
What about sensitivities associated with the preservatives in hydrogels?
Most amorphous hydrogels have propylene glycol which is a known irritant, and some trusts have taken them off the formularies for this reason.
ActiFormCool® has phenoxyethylene which has not shown sensitivities.
How does the dressing manage to stay intact if it is mainly water?
The hydrogel is held in a blue mesh to give the dressing its integrity and this makes it easy to handle and to apply.
This mesh gives it the characteristic blue colour.
Can the dressing be used with other dressings?
Practitioners should rationalise why they are using dressing combinations e.g. adhesive film dressing cover to provide waterproofing, compression bandaging to address venous problems. There are no known interactions between ActiFormCool® and other dressings (see separate sheet on applications).
How will I know when to change the dressing?
The dressing initially becomes transparent, then as fluid is absorbed it becomes swollen and cloudy. The dressing will simply fall apart when it has reached full absorptive capacity. When the dressing is first applied, it should be checked frequently (e.g. daily) as absorption of fluid is usually rapid.
How long can the dressing stay in place?
It depends on the wound and the conditions. If the dressing is being used under compression it can stay in place for as long as the compression bandage (e.g.one week). In the initial stages it should be checked and changed frequently (e.g. daily or on alternate days, according to individual wound needs.
How much fluid will the dressing absorb, and can this be measured in a lab test?
There are no test methods for measuring the fluid absorptive capacity of hydrogels as they will continue to absorb until they fall apart and the best way to assess absorption is in the clinical setting.
How much exudate is High/Moderate/Low?
Individual assessment of patient and cause of exudate production is required as fluid management will vary from patient to patient, wound to wound. The balance between effective fluid management and the prevention of skin maceration is a matter for the practitioner to decide. ?It requires good assessment and critical thinking skills?
(Fletcher 2002)
There are some guidelines on how to assess the volumes of exudate but these are not always accurate as the amount absorbed depends on the dressing.
(Graham 2004)
Will the dressing stick?
At sometime all dressings can stick, and low/non-adherent dressings are preferred to reduce trauma at dressing changes.
(Hollinsworth 2002)
It is recommended that in general highly exuding wounds may need more frequent dressing changes until the levels of exudate reduce.
(Anderson 2002)
When using ActiFormCool® if there is minimal or no exudate the top liner should be left in place for effective hydration.
For highly exuding wounds when the top liner is removed for better absorption, the wound should be checked frequently as the absorption process may be rapid and the wound may become drier than expected.
One of the real benefits of ActiFormCool® is, should the dressing harden it can easily be rehydrated to turn it back to a soft gel that is easily removed without causing trauma.
What is the best way to remove the dressing?
The dressing can be removed in one piece if the gel has not yet formed.
If the gel has formed it can be scooped up, or it can be washed off gently with water or soaked off when washing the legs as is normal practice for leg ulcer management.
Can the dressing be cut?
The dressing can be used on intact skin with no adverse effect, and this is demonstrated in the case study on skin improvement using ActiFormCool®.
For large areas of irritated skin it is recommended that several sheets of ActiFormCool® are placed side by side to cover the whole area. It can also be cut to fit small wounds e.g. necrotic or sloughy tissue to make it more cost effective.
Can ActiFormCool® be used on diabetic wounds?
ActiFormCool® can be used safely on diabetic wounds. However if the toe is black and necrotic, and there is evidence of irreversible arterial disease it is advisable to allow the digit to dessicate. If in doubt refer to the specialist vascular team as healing will be unlikely without adequate perfusion and the risk of infection is greater.
If there are large amounts of frank blood in the wound can I use an alginate as a haemostat with ActiFormCool®?
Combining dressings should always be justified by sound rationale. In this case ActiFormCool® can be used to provide pain relief and a haemostatic product can be used to control bleeding within the wound. When two absorptive products are used more frequent monitoring is advised to prevent undue drying out of the wound.
Can ActiFormCool® be used with maggots?
If the treatment regime requires the use of maggots and pain relief or exudate management, it is safe to use a product that does not contain the preservative Propylene Glycol e.g. ActiFormCool® which contains Polyethylene.
Can dopplers be performed through ActiFormCool®?
No. Special Doppler gel is recommended for accurate conductivity and readings. In this case the dressing can simple be lifted away from the skin and the Doppler gel applied prior to the procedure as normal.
Can ActiFormCool® be used on radiotherapy burns?
ActiFormCool® provides excellent relief for irritated, sore skin post radiotherapy treatment, but because of the high water content it should not be used whilst treatment is in progress. Most topical products affect the delivery of radiotherapy waves, and is is recommended that skin is clean and dry before treatments.

Warnings & precautions
Accurate wound and patient assessment is essential before commencing treatment.
Haemostasis should be achieved proir to dressing application.
The wound should be checked frequently. The absorption process may be rapid with ActiFormCool abd the wound may become drier than expected.
Close nursing supervision is advised when used on lightly exuding wounds.
As with all dressings, skin and wound monitoring is advised, particularly where clinical infection is suspected. In this case, appropriate antibiotics should be given.