Debridement Flashcards
What is the purpose of debridement in wound management?
- reduces bacterial bioburden
- removes non-viable tissue
- increases topical antimicrobial effectiveness
- accelerates wound progression through the inflammatory stage
What are the differences between clean and sterile techniques in wound care?
Clean technique:
- Reduces microorganisms to decrease transmission risk.
Sterile technique:
- Ensures only sterile equipment contacts the wound.
- It is used in surgical debridement, severe burns, and for immunocompromised patients.
What are the general indications for debridement?
- Removal of necrotic tissue, foreign material, debris, senescent cells
- Removal of biofilm
- Correction of wound edges including callous, hyperkeratosis, non-viable borders, epibole
- Removal of residual topical agent
What are the types of debridement?
Selective:
- Sharp = Indicated for wounds with large amounts of necrosis, callus, advancing cellulitis, sepsis, eschar, and/or chronic wounds. Contraindicated when area cannot be adequately visualized.
- Autolytic = Utilizes the body’s own enzymes. Appropriate for wounds with necrotic tissue/adherent slough and light to moderate drainage. Contraindicated for infected or deep cavity wounds.
- Enzymatic = Requires physician’s prescription. Use on wounds with a large amount of necrotic debris or eschar formation. Expensive, requires prescription, requires frequent re-application and dressing changes. Contraindicated for wounds with exposed deep tissues.
Nonselective:
- Mechanical = Use of force to remove devitalized tissue, foreign material, and debris.
- Surgical = Commonly used for rapidly progressing infection.
Describe autolytic debridement, its indications, and contraindications.
Autolytic debridement uses the body’s enzymes to liquefy necrotic tissue.
- It is indicated for wounds with necrotic tissue, patients who cannot tolerate other methods, and home care.
- Contraindications include infected or deep cavity wounds, or wounds needing sharp/surgical debridement.
What is the procedure for autolytic debridement?
- crosshatch eschar
- apply moisture-retentive dressings (2 cm larger than the wound)
- keep on for 72-96 hours
- monitor for infection
What is enzymatic debridement, its indications, and contraindications?
Enzymatic debridement uses collagenase to digest necrotic tissue.
- Indicated for necrotic wounds where patients cannot tolerate sharp debridement; suitable for home care.
- Contraindicated for wounds with exposed deep tissues, calluses, or those without necrotic tissue.
What are the steps in enzymatic debridement?
Follow prescription guidelines, crosshatch eschar, observe for infection, ensure a moist environment, and reapply enzyme daily.
Explain mechanical debridement and its different forms.
Mechanical debridement uses force to remove devitalized tissue and debris.
- Forms include wet-to-dry dressings, scrubbing, wound cleansing, wound irrigation, pulsatile lavage, whirpool, and hydrogen peroxide.
What are the characteristics of wet-to-dry dressings in mechanical debridement?
Nonselective, involves saline-moistened gauze that dries and is torn away, used only for wounds with 100% devitalized tissue.
Describe sharp debridement, including its indications, contraindications, and precautions.
Sharp debridement uses a scalpel or scissors to remove necrosis.
- Indicated for large necrosis, callus, cellulitis, and sepsis.
- Contraindicated when areas cannot be visualized, material is unidentified, or vascular tests indicate poor perfusion.
- Precautions include immunosuppressed or anticoagulated patients.
What are the conditions for terminating sharp debridement?
Termination occurs if pain control is inadequate, the patient cannot tolerate the technique, or extensive bleeding occurs.
Outline the sharp debridement procedure.
Use a scalpel and scissors parallel to the wound surface, debride in layers, rinse with saline, and reassess the wound.
What is surgical debridement, its indications, and contraindications?
- Surgical debridement involves the removal of necrotic tissue using sterile tools, often in the OR or bedside for rapidly progressing infection, osteomyelitis, or undermining.
- Contraindicated for patients unlikely to survive or those with palliative plans.
How does surgical debridement differ from other types?
It allows exploration of deeper wound structures, is painful, more expensive, and must be performed by a physician or podiatrist.
