Debridement Flashcards
What can be defined as the removal of necrotic tissue, foreign material, and debris from the wound bed?
Debridement
What are the 2 forms of Debridement?
- selective
- nonselective
What are 5 risks of not debriding?
- infection
- osteomyelitis
- sepsis
- amputation
- death
What are the 7 purposes of debridement?
- decrease bacterial concentration within the wound bed and the risk of infection
- increase the effectiveness of topical antimicrobials
- improve the bactericidal activity of leukocytes
- shorten the inflammatory phase of wound healing
- decrease the energy required by the body for wound healing
- eliminate the physical barrier to wound healing
- decrease wound odor
When determining appropriate interventions in regards to debridement what is the general rule to follow?
the red-yellow-black system
If the wound bed appears pale pink to beefy red and granulation tissue is present, what should you do?
protect the wound, maintain a warm and moist environment, and protect the periwound area.
If the wound bed appears moist and yellow, what should you do?
debride the necrotic tissue, absorb any drainage, and protect the periwound area
If the wound bed appears thick, black, and there is adherent eschar present, what should you do?
debride the necrotic tissue
Under what 3 circumstances should blisters be debrided?
- large, fluid filled blisters
- blisters over joints
- burn blisters
Why should calluses be debrided?
to eliminate localized areas of increases pressure
What are the __ general contraindications for debridement?
- if the wound is red and granular in appearance
- heel ulcers with dry eschar if they do not have edema, erythema, fluctuance, or drainage
- wound that require surgical debridement
- electrical burns prior to physician assessment
What are 4 things the clinician must take into consideration when determining whether debridement is appropriate and what methods to use?
- Characteristics of wound
- Status of patient
- Existing practice acts
- Clinician’s knowledge and skill level
Describe the step-by-step guide for preparing for debridement
1) assemble equipment and supplies that may be needed
2) position the patient comfortably, allowing for visualization of the wound bed
3) use proper posture and body mechanics to allow safe technique and minimize fatigue
4) ensure sufficient lighting of the involved area
5) wash hands and don clean gloves
6) remove the old bandage and discard according to facility policies
7) discard soiled gloves and apply clean gloves
8) inspect the wound to determine if debridement is necessary and, if so, what method is most appropriate
9) remove soiled gloves
10) explain the procedure to the patient
11) don clean gloves and initiate debridement technique
What are the 6 methods of debridement?
- Sharp
- Autolytic
- Enzymatic
- Mechanical
- Biological
- Surgical
Describe sharp debridement
It is the fastest and most aggressive form of debridement in which the clinician uses forceps, scissors, or scalpel to selectively remove devitalized tissue, foreign material, and debris
Who is allowed to perform sharp debridement?
PTs when allowed by law, however it requires a MD order
What are the 3 indications for sharp debridement?
- Large amount of necrosis, callus, advancing cellulitis, sepsis, eschar
- May be used on wounds with any amount of necrotic tissue
- Chronic wounds
What are the 7 contraindications to sharp debridement?
- When the area cannot be adequately visualized because of extensive tunneling and undermining
- Material to be debrided is unidentified
- Lack of clinician competency
- Uninfected ischemic ulcers with low ABIs
- Patients who are immunosuppressed, thrombocytopenic, or on anticoagulants
- Wound closure is not consistent with the POC
- Hypergranular tissue is present
What are the 6 conditions in which sharp debridement should be terminated?
- Clinician fatigues
- Pain is not adequately controlled for patient
- Decline in patient status or tolerance to technique
- Extensive bleeding
- If a new fascial plane is identified
- Nothing remaining to debride
What are the 2 types of sharp debridement according to the APTA?
- Serial instrumental debridement
- Selective sharp debridement
Describe serial instrumental debridement
Form of sharp debridement in which instruments are used to remove loosely adherent necrotic tissue with minimal bleeding and is typically pain free
What is serial instrumental debridement oftentimes referred to as?
maintenance debridement
Who can perform serial instrumental debridement?
- physician
- podiatrist
- PT
- PTA
Describe selective sharp debridement
Form of sharp debridement in which scissors or a scalpel are used to cut along the line of demarcation between the viable and nonviable tissue.