Debridement Flashcards
Removal of necrotic and/or infected tissues that interfere with wound healing; Decreases risk of infection; Enhances wound healing
debridement
What are the purposes for debridement?
- decreases 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
What are indications to debridement?
- Necrotic tissue, foreign material, debris
- Possibly blisters and calluses
- Red–yellow–black system
system to describe wound bed - pale pink to beefy red, granulation tissue tx goals: - protect wound - maintain warm, moist environment - protect periwound
red
system to describe wound bed - moist, yellow slough; may vary in adherence tx goals: - debride necrotic tissue - absorb drainage - protect periwound
yellow
system to describe wound bed
- thick, black, adherent eschar
tx goals:
- debride necrotic tissue
black
should you pop or not pop blisters?
Newest research suggests that all blisters open and closed be debrided
- blister fluid increases inflammatory response and provides ideal environment for bacterial proliferation
What are the contraindications to debridement?
- Red, granular tissue
- Stable intact heel pressure ulcer
- Urgent need for surgical debridement - Gangrene, Osteomyelitis
- Electrical burns
- Deeper tissue
What are the types of selective debridement?
- Sharp
- Autolytic
- Chemical/Enzymatic
- Biological
- Surgical
What are the types of nonselective debridement?
Mechanical
Endogenous enzymes digest necrotic tissue with moisture-retentive dressing
Autolytic debridement
- hydrocolloid; transparent
What are the advantages of autolytic debridement?
- Least invasive, least painful method
- Doesn’t disrupt healthy tissue
- May be used in conjunction with other methods
- Easy to perform
- Selective
- Requires minimal professional expertise/monitoring
What are the indications of autolytic debridement?
- All wounds with necrotic tissue
- Patients who cannot tolerate other forms of debridement
- Commonly used in home or long-term care settings
What are the contraindications of autolytic debridement
- Infected or deep cavity wounds
2. Wounds that require sharp or surgical debridement
What are the disadvantages of autolytic debridement?
- Time for debridement to occur
- Maceration possible
- Potential for bacterial growth
- Sensitivity to adhesives
- Does not allow for frequent wound visualization
Use of exogenous enzymes to remove devitalized tissue; Form of selective debridement; Requires physician’s prescription
Enzymatic debridement
- Collagenase - only enzyme currently FDA approved
- Santyl
What are the advantages of enzymatic debridement?
- Less skill required
2. Less painful
What are the disadvantages of enzymatic debridement?
- Maceration
- Skin sensitivity
- Pain, erythema, dermatitis, burning/stinging
- Expensive
What are the indications of enzymatic debridement?
- Infected and uninfected wounds with necrotic tissue
2. Pt. unable to tolerate sharp debridement
What are the contraindications of enzymatic debridement?
- Wounds with exposed deep tissues
- Facial burns
- Over calluses
- Wounds free of necrotic tissue
- Should not be applied to wounds being autolytically debrided
Use of force to remove devitalized tissue, foreign material, and debris; Nonselective
mechanical debridement
- Wet-to-dry dressings
- Pulsatile lavage
- Scrubbing
- Whirlpool
- Wound cleansing
- Wound irrigation
Use of scalpels, scissors, or lasers in a sterile environment to remove necrotic tissue, foreign material, and debris; Performed by physician or podiatrist
surgical debridement
Who can perform sharp debridement?
PTs, Nurses, PAs
- Standard of care for open wounds
- need order from physician
- most PTAs cannot perform
Use of scissors or scalpel to cut and remove necrotic tissue; Fastest, most aggressive form of debridement
Sharp debridement
- Hemostatic agents and topical pain medications may be needed
What are indications for sharp debridement?
Large amount of necrotic tissue, callus, advancing cellulitis, sepsis; May be used on wounds with any amount of necrotic tissue; Chronic wounds
What are contraindications for sharp debridement?
- Clotting disorders
- Systemic infection
- Ischemic leg/foot ulcers
- Medically unstable patient
- When area cannot be adequately visualized
- Material to be debrided is unidentified
- Lack of clinician competency – needs more training to feel confident
- Caution: anticoagulants
When should you terminate sharp debridement?
- Clinician fatigues
- Pain is not adequately controlled for patient
- Decline in patient status or tolerance to technique
- Extensive bleeding
- Nothing remaining to debride
How do you stop bleeding?
Pressure with gauze for 5 min Do not check wound Add gauze if blood soaks through Elevate body part above heart Use silver nitrate if needed
