Cleansing and debridement Flashcards
Why is whirlpool no longer a standard of care?
It will damage granulation tissue, cross contaminate, over hydrate tissues, and possibly negatively impact circulation
Irrigation methods
35 mL syringe with 19-gauge needle or angiocatheter used to flush wound
Pulsatile lavage with suction
Pros and cons to irrigation
Pros:
Portability and accessibility
Cons:
Risk of stick
Pressure 8 PSI
Splash risk
Gold standard of irrigation
Pulsatile lavage with suction
How does pulatile lavage with suction (PLWS) work?
System that provides pulsed irrigation and suction of the irrigant, exudate, bacteria, and debris
PLWS PSI settings
Initial session 4-6 PSI
Tunnels 4-6 PSI
Generally use 8-12 PSI
Infection use 13-15 PSI
Decrease PSI for bleeding, pain, or fragile tissue
Increase PSI with excessive necrotic tissue or infection
T/F PLWS should be used twice daily if wound is <50 % necrotic tissue
False, > 50% necrotic should be twice daily
What is debridement?
Removal of devitalized tissue, and/or infected tissue from wound bed
May be selective or non-selective
Sharp debridement definition
Highly selective removal of nonviable tissue with sterile forceps, scissors, or scalpel
Serial instrument debridement
Using instruments to remove loosely adherent necrotic tissue over time, usually with tissue preparation for softening
Selective sharp debridement
Cutting along the border of viable and non-viable tissue in order to remove selected areas of necrosis
PT only, no PTAs
Contraindications of sharp debridement
- Noninfected heel ulcers covered with dry eschar; paint with betadine and remove pressure
- Dry gangrene - circulation is too compromised for healing to occur
- Pts with impaired clotting
- Areas of undermining or tunneling
- Nondraining wounds with limited perfusion
- Hypergranulation tissue (not devitalized so may be considered “surgical”)
Precautions of sharp debridement
Stop if bleeding occurs
Stop with intolerable pain
Stop at patient or clinician fatigue
What should MD be notified of during sharp debridement?
Unexpected exposed tendon, bone, nerves, major blood vessels, evidence of fistula into body cavity, unexpected purulence, clinician concern
What is soft debridement?
Semi-selective removal of necrotic tissue which is soft, moist, and easily removed
Use gauze or swab to remove nonviable tissue
Why is wet-to-dry debridement generally not recommended?
It will remove new granulation tissue as well as necrotic tissue, should only be used for necrotic wounds
What is vacuum assisted closure (VAC)?
A computerized vacuum pump connected by tubing to a foam dressing in direct contact with the wound
Negative pressure provides debridement, draws out drainage, increases tissue perfusion, and draws edges together
What is enzymatic debridement?
Use of topical enzymes to promote enzymatic breakdown of nonviable tissue
Collagenase is used to break down collagen based necrotic tissue
Ex: santyl
Enzymatic debridement steps
Cleanse wound with saline
Remove eschar as possible with sharp debridement
Cross-hatch as needed
Apply thin film of enzymatic agent
Cover with moist gauze; moisture activates the enzymes
What is autolytic debridement?
Occlusive, moisture retentive dressing is applied, environment is created to allow phagocytosis to occur naturally within the wound bed, to digest the necrotic tissue
Contraindications to autolytic debridement
Infected wounds
Cavity wounds
-Slower process so its often used in palliative care
Chemical debridement agents
Hydrogen peroxide (contraindicated) - cytotoxic to granulation tissue
Betadine - cytotoxic and only bacteriostatic
Acetic acid - cytotoxic to granulation tissue, only used on pseudomonas infections
Indications for biological debridement
- Non healing chronic wounds
- Non healing traumatic or post-op wounds
- Pressure ulcers
- Neuropathic foot ulcers
- Chronic venous leg ulcers
