Debridement Flashcards
what is the definition of wound debridement?
Removal of dead (devitalized), damaged tissue, particulate matter and/or foreign materials from a wound
when is debridement complete?
Debridement is complete when 100% of the wound bed consists of healthy tissue
why do we remove necrotic tissue?
Decrease bacterial load
Increase effectiveness of topicals
Shorten stalled inflammation
Remove physical barrier
Decrease odor
what are the types of debridement?
autolytic
mechanical
enzymatic
surgical
sharp
biologic
chemical-silver nitrate sticks
what are the types of mechanical debridement?
wound scrubbing
pulsed lavage 4-8 PSI
whirlpool
wet to dry
irrigation (8-12 PSI with 35 ml syringe with 19 gauge angiocatheter)
what are the selective types of debridement?
autolytic
enzymatic
sharp by pt
biologic
what are the non selective types of debridement?
mechanical
surgical
chemical
Who and when is sharp debridement done?
its can perform and it only performed where there is non viable tissue showing. If healthy tissue is there let the surgeons handle it
what assessments should be completed prior to debridement?
Complete patient assessment
Wound assessment
Environmental assessment
Social considerations
Pain assessment
Documentation of depth- ALWAYS done
when to deride? what are the indications for it?
Necrotic tissue: impeding wound healing
Barrier to contraction
Inhibiting migration of epithelial cells
Epibole at wound edges
Callus on neuropathic ulcer
Consider hypergranulation
Refer to MD if s/sx of infection
what are the contradictions of debridement
Arterial insufficiency
Systemic infections
Impending exposure of an identifiable structure
Pulsating tissue
Presence of gross purulence
h/o uncontrolled bleeding or clotting disorders
Pt on anticoagulents (ASA)-relative
Extensive wounds where surgical debridement would be more efficient
Thrombocytopenia
HIV/AIDS with T-cell counts too low
what one type of wound do you NEVER debride? why?
NEVER decried an intact black eschar on a heel. there may be poor circulation or are risky
with contours
what are the reasons you would stop debridement?
Clinician/pt fatigue
Bleeding/to viable tissue
Pain
Location of fascial plane
Location of a named structure
Pulsating tissue
High anxiety level (clinician or patient)
Achieved set time limit (15-30 min)
Unexpected finding
how do you stop bleeding?
Direct pressure
Elevation
Nitrate sticks
Calcium alginate
Xylocaine jelly
Gel foam
how do we control pain in patients with debridement?
Pre-med
Actique pop
IFC
Topical analgesics
