Debridement Flashcards
Purpose of debridement
decrease bio burden and risk of infection
Increase effectiveness of topicals
Improve bactericidal activity of leukocytes
shorten inflammatory phase
Decrease energy required by the body to heal
Eliminate physical barriers
Tissue protection or exam
Decrease wound odor
Prepare a weed for grafting, skin substitutes, or surgical closure
Non-viable tissue
necrotic- black
Slough- yellow
viable tissue
Granulating-red
Epithelial -pink
when do you refer to an MD
when you need to remove live tissue
Large amount of non-viable tissue
Infection
Contraindications for debridement
arterial compromise
Viable tissue
Granular tissue
Electrical burns
Deeper tissues
sharp debridement
fast
Skilled intervention
Painful- can be
Often combined with other forms of debridement
Selective forceps scissors scalpel curette
at least notify MD
Precautions for sharp debridement
anticoagulants/clotting issues or pain
Immuno suppression
Unable to be still
Contraindications for sharp debridement
PT comfort skill level
Cannot see or identify tissue
Consent not consistent with POC
Ischemic ulcers
Hyper granulation- live tissue
pyoderma gangrenosum
when to stop and warning signs for sharp debridement
Patient request or pain control issues
Wound is clean
Practitioner is nervous, tired, or unsure
Impeding exposure of named structures
Holes you cannot see the bottom
Unexpected infection or purulence
Extensive undermining
Excessive bleeding
Controlling bleeding during sharp debridement
elevate pressure for 10 minutes and use silver nitrate (MD)
pain control- 30 minutes prior topicals deep breathing music distraction
contact MD if bleeding has a pulse and won’t stop
If there is fever, chills downhill course, no improvement, impending exposure of named structures, unexpected abscesses, or gross purulence
Blisters with clear fluid that can easily be protected from rupture
you leave intact
Consider
location and size of blister
Health of individual with blister
Daily activities and occupation
Blister with blood brown, or cloudy fluid
unroofing may be needed to determine extent of damage
Consult with MD
in the case of burns
It is recommended to unroof and debride and use topical silver dressing to minimize the risk
Never unroofing blister caused by
Frostbite
No matter how it looks
Referred to MD
how to debride
Secure with forceps
Release tension carefully
Make cut at skin or blister line
gently cut away epidermis
Clean away residue can appear like jelly
Apply topical and secondary dressing
mechanical debridement
Nonselective
Soft abrasion
hydrotherapy
Wet to dry or wet to moist
Low frequency contact ultrasound
enzymatic debridement
Selective
Physician prescription
Pain-free
Easy to apply once daily
Can be used on infected wounds
Do not use with silver or iodine products
Collagenase santyl
how does enzymatic debridement work
denatured collagen filaments anchored debris to the wound bed
Collagenase digest these collagen filaments
Do not use with dressings containing
Silver
Iodine
Hydrogen peroxide
Acetic acid
adverse effects for enzymatic
Burning, stinging or allergic reaction
periwound irritation
-highly exudated wounds contact with skin
Contraindications for enzymatic
Time frame takes too long
Not for deeper wound
Facial burns
Autolytic debridement
selective
Conservative
Least painful easy
Cheaper but takes time
Maintains favorable wound environment
occlusive dressings, moist warm
Transparent films
Hydrocolloid
foams
Hydrogels
indications for autolytic
Pain
Palliative treatment
Can’t be still
contraindications for autolytic
infection
Dry gangrene
Deep cavity wounds
Other methods more appropriate
disadvantages for autolytic
Odor upon removal
Time
Infrequent visualization
biosurgical biologic debridement
maggot therapy larval debridement therapy
selective, quick painless
ingest non-viable tissues and decrease odor
release enzymes that degrade nonviable tissue and biofilm
Antimicrobial
maggots
sterile non-reproducing
Free range or contained
Do not travel around and body
Used for osteomyelitis, infection, poor candidate for surgery or unable to tolerate other forms of debridement
Contraindication for bio surgical
near the eyes upper G.I. or upper respiratory tract
Allergy to fly larva, brewers yeast or soy
exposed blood vessels connected to deep vital organs
Decrease perfusion
Malignant wounds
Biosurgical precautions
drown in heavy exudate
Squished by pressure
Patient with bleeding disorders
Indications for surgical debridement
complexity of wound
Gross infection, or high risk of infection
When amount of non-viable tissue is too much within acceptable timeframe
Extensive undermining
Unknown death or abscess
Involves fistula
Named structures
Bleeding tendency, extreme pain or trauma
Ultrasound debridement
contact and noncontact
Separates viable and nonviable tissues
antimicrobial effects
