adjunctive therapies Flashcards
what are the advantages to whirlpool?
Softens necrotic tissue
Increases circulation
Cleanses wound of exudate
Loosens debris
Removes residual topical agents
what are the disadvantages to whirlpool
May cause skin maceration
Increase edema
Disrupt new cells
Cannot calibrate pressure
Wash away endogenous enzymes
Painful
Whirlpool additives damage cells
Infection control issues
Time/labor intensive
what are the indications for whirlpool?
Indications
Infected wounds
Reduce bacterial load
Non-draining wounds
Rehydrate wound bed
Thick eschar
Soften necrotic tissue
Loosely adherent slough
Debridement
what are the contradictions to whirlpool?
Venous insufficiency ulcers
Increases edema
Edematous, draining, macerated wounds
Incontinence
Submersion of the perineum
Active profuse bleeding
Increases circulation
Confused/combative patients
Uncontrolled seizures
Multiple open areas
Cross contamination
Clean, granulating wounds
Non-selective debridement
Tunneling wounds, significant undermining, areas of skin folds
Not sufficiently irrigated
Arterial wounds
Lower temperature to increase circulation/limit metabolic demands on tissue
Pregnant/MS
Lower water temperature
Severe hydrophobia
Weight limits for lift
Cardiac instability
what are the purposes for pulsed lavage with concurrent suction?
Irrigates wound bed with precisely calibrated pressure
Assists with maintaining a moist wound environment
Facilitates debridement
May enhance granulation tissue formation, epithelialization and tissue perfusion
what are the indications of pulsed lavage with concurrent suction?
Wounds requiring thorough irrigation or debridement
what are the contraindications of pulsed lavage with concurrent suction?
Wounds with exposed deep tissues
Facial wounds
Recent surgical procedures
Patients with latex allergies or sensitivities
Patients on anticoagulants-precaution
Patients with tunneling or insensitivity-precaution
what are the advantages to pulsed lavage with concurrent suction?
Thorough irrigation
Can be used in any setting
Quick
Less expensive than whirlpool
Low risk of cross contamination
Can be used for any wound location
what are the disadvantages of pulsed lavage with concurrent suction?
Messy
More expensive than wound irrigation
Private room only-no visitors/family
Aerosolization study found increased microorganisms during and after Rx
Can be painful
how is electrical stimulation used in wound care?
Delivery of low level electrical current into chronic wound tissue to enhance wound healing
PVA (Paralyzed Veterans of America) states E-stim is a stand alone intervention and no longer classifies it as an adjunctive therapy
what are the therapeutic effects of electrical stimulation?
Increased blood flow
Increased tissue oxygenation
Decreased wound pain
Increased tensile strength
Decreased diabetic peripheral neuropathic pain
what are the cellular processes and physiological responses to electrical stimulation in wound care?
Stimulation of fibroblasts to enhance collagen and DNA synthesis
Increased number of receptor sites for growth factors
Alteration in the direction of fibroblast migration
Activation of cells in the wound site
Improved tissue perfusion
Decreased edema
E stem currents can be delivered as?
May be delivered as:
Low intensity direct current (LIDC)
High-voltage pulsed current (HVPC)
Transcutaneous electrical nerve stimulation (TENS)
Pulsed electromagnetic energy (PEMF)
HVPC most used in past decade
what are the indications for electrical stimulation use in wound care?
Pressure Ulcers
Venous insufficiency ulcers
Arterial Ulcers
Diabetic neuropathy ulcers
Burns
Dehisced surgical wounds
what are the contradictions to using stem in wound care?
Basal or sqamous cell carcinoma in wound or periwound tissue
Osteomyelitis
Ion residues of iodine or silver in the wound
Rinse well
Over electronic implants or over the heart
