9] Modalities Flashcards
Soften adherent necrotic tissue Increase blood flow and metabolic rate Proliferation of granulation tissue and epithelial cells Exudate removal to decrease infection Wound Cleansing
Whirlpool
Detrimental effects of whirlpool therapy
Maceration
Dependent position
Potential for burns
Cytotoxic additives
Contraindications for whirlpool (6)
CHF/LE edema Lung disease Acute phlebitis Lethargy Gangrene Renal failure
Hydrotherapy temperature
92-96 deg F
Hydrotherapy treatment time
10-15 min
Suction, adjustable pump, hand piece, tip
Used for cleansing and debridement
Pulses lavage with suction
Treatment time for pulsed lavage
10-15 min
Indications for pulsed lavage
Clean wound
Remove toxic residuals
Precaution of pulsed lavage
Tissue damage if the pressure is too high
2 considerations for pulsed lavage
Can be done at bedside
It’s expensive
What type of therapy is HPVC
Electrical stimulation
How does HPVC work?
Stimulates fibroblasts to enhance collagen and DNA synthesis
Increases number of receptor sites for growth factors
HPVC
Alters the direction of fibroblast migration,
activates cells in the wound site, improves tissue perfusion, decreases edema
Increases cutaneous oxygen transport
Controls infection
Stimulates wound contraction and scar healing
HPVC
Indications for HPVC (4)
Pressure ulcers stage 3-4
Diabetic, venous and arterial ulcers
Contraindications for HPVC (Estim) (9)
Osteomyelitis Pregnancy Malignancy Pacemaker Over carotid sinus or across heart Laryngeal musculature Along regions of phrenic nerve Over topical substances containing metal ions (remove silver dressings!) Over povidine iodine or mercurochrome
Medicare will only pay or EStim if wound is not progressing after ?
30 days of traditional wound care
In proliferation phase, whats the setting you would use?
(-) polarity for 1-5 days and then change it to (+) until it heals
What are the setting for the maturation phase?
Alternate every 3 days between - to +
Duration in min?
45-60 min
Frequency?
5-7x/week
Intensity/voltage?
100-150 volts
Where do you apply the electrode?
Directly over the wound
Do what for deeper wounds?
Increase distance b/w electrode and dispersive
Do what for more shallow wounds?
Decrease distance b/w electrode and dispersive
Intermittent administration of 100% oxygen inhaled
at a pressure greater than sea level
Hyperbaric oxygen therapy
Effects of hyperbaric oxygen therapy
Hyperoxygenation and decreases edema
Two effects of HBOT
Toxin inhibition, antibiotic synergy and angiogenesis
restoresthe body’s defense against infection;
increases the rate of killing some common
bacteria; inhibits the growth of anaerobic
organisms
Toxin inhibition, antibiotic synergy
increases partial pressure ofthe oxygen tension to allow formation of the
collagen matrix and angiogenesis
Angiogenesis
Indications for hyperbaric oxygen (7)
Acute burns Chronic wounds Radiation induced injury Necrotizing infection Sepsis Chronic osteomyelitis Carbon monoxide poisoning
Major Contraindications for HBOT (4)
Claustrophobia
Pneumothorax
COPD
Malignant tumors
What does NPWT stand for?
Negative pressure wound therapy
Goals for NPWT? (6)
Increase blood flow Decrease bacteria colonies Able to measure and assess wound fluid Increases granular tissue base Contraction of wound Epithelialization
Indications for NPWT (8)
Acute wounds PTW/FTW from burns Surgical wounds/incisions and dehiscence Diabetic wounds Venous/arterial wounds Pressure ulcers Grafts/flaps Enteric fistulas
Major Contraindications for NPWT (4)
Necrotic tissue with eschar/ NO SLOUGH
Malignancy
Exposed blood vessels or organs
Non-enteric or unexplored fistulas
Indicators of Ineffective V.A.C. Therapy (5)
WHEN ITS NOT WORKING:
Minimal changes in wound size Deterioration of the wound Changes in wound color Wound appears white, excessively moistor macerated Wound odors
Intermittent/Pneumatic Compression indications (4)
Primary/Congenital Lymphedema Secondary Lymphedema from lymph node resection after cancer Chronic venous insufficiency, venous stasis,venous ulcers Reduce and control peripheral edema
Contraindications for intermittent/pneumatic compression (6)
Phlebitis CHF PE Suspected DVT Increase of venous/lymphatic return is notdesired decreased sensation
Semi-rigid dressing
Useful in ambulatory patients to aid the calf
muscle pump mechanism (used on lower leg only)
Unna boot
gauze impregnated with zinc oxide, glycerine, and calamine
First Unna boot layer
gauze and/or self-adherent or compressive bandage
Second Unna boot layer
A mechanical vibration delivered at afrequency above the range of human hearing
Ultrasound
Two delivery methods of ultrasound
Contact and no contact
noncontact US which administers
continuous US energy via an atomized saline solution. Used for cleansing and debridement
MIST therapy’s system by Celleration
What does ultrasound do? (6)
Accelerates acute inflammatory phase
Stimulates fibroblasts to secrete collagen
Provides heat to deeper tissue prior to stretch
Accelerates wound contraction
Promotes strong, more elastic scars
Increases blood flow
Contraindications for ultrasound (8)
Thrombophlebitis Acute infection Pregnancy Malignancy Over the eye Hemophiliacs not covered by factor replacement Concurrent or post radiation Over bony prominence
Ultrasound indications (9)
Colonized wounds Arterial & venous wounds Diabetic foot ulcers Chronic leg ulcers Pressure ulcers Burns Acute wounds Post operative wounds Sickle cell ulcers
What does ultrasound use to transmit US energy?
Gel or sterile saline
Used to diminish venous congestion with reattachment surgery
Leeches
Saliva of leeches has?
Anticoagulant properties
Selectively debride necrotic tissue
Maggots
Increases tissue temperature causing an increase in blood flow
Electromagnetic Therapy (Diathermy)
Use electromagnetic therapy (diathermy) with what ulcers?
Arterial, diabetic and pressure ulcers
Contraindications for diathermy (electromagnetic therapy) 3 major ones!!
Pacemaker
Defibrillator
Any hardware
Contraindication for Unna boot?
Can’t use it on someone with ABI less than 0.7 !!
MIST is used with?
In conjunction with your treatment
Wound vac not used for?
Malignancy
If theyre bleeding
If theyre not getting better