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Integ - PTH 703 - Unit 1 > Debridement and Dressings > Flashcards

Debridement and Dressings Flashcards

1
Q

What is the ultimate goal of wound management

A

Full wound closure!

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2
Q

What are the most effective methods for controlling wound colonization? (2)

A

Debridement and irrigation

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3
Q

What is the interim step of wound management?

A

Obtain a clean, moist, warm, granular wound bed while protecting the periwound and intact skin

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4
Q

How do you maintain moisture balance?

A

Primarily through dressings

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5
Q

Is necrotic tissue a medium for bacterial growth?

A

Yes. It is also a barrier to wound contraction, granulation, and re-epithelialization

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6
Q

What is the rating (0-4) for a palpable pulse?

A

2+. User doppler, MRA, or angiogram if you have to. Listen for type of sound too

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7
Q

What meds must you find out if the patient is on before debridement?

A

Anticoauglants

Also check if infection is present?

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8
Q

Should you debride if non-viable tissue is present?

A

Yes, if slough or eschar is noted. Do not if it is all healthy tissue

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9
Q

Should you debride a dry, stable, uninfected would in the heel?

A

No

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10
Q

What do you ask yourself after determining the wound is in another location other than the heel?

A

Is sharp debridement appropriate?

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11
Q

If sharp debridement is NOT indicated, then what 2 questions must you ask yourself?

A

Is the wound infected?

Is the wound covered completely (100%) by non-viable tissue?

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12
Q

What debridement do you do if the wound is infected?

A

You do enzymatic debidement (autolytic debridement is CONTRAINDIATED!) *if it is not infected, then you can do autolytic

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13
Q

What debridement do you do if the wound covered completely (100%) by non-viable tissue??

A

Mechanical debridement is OK. If there is viable tissue present, consider ezymatic (infected) or autolytic (non-infected)

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14
Q

When can you NOT use enzymatic debridement?

A

If deeper tissues are exposed (bone, ligament, tissue)

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15
Q

What are the 7 contraindications to sharp debridement? (others Kathy Leahy listed in a separate slide are also listed)

A 
Cannot visualize wound bed (tunneling, undermining, etc)
Uninfected ischemic ulcers
Connective / structural tissues
Patient has poor tolerance (pain, agitation)
Patient is taking anticoagulants
Too much risk to viable tissue
Practitioner not competent/not skilled in sharp debridement, or not allowed to perform by law
---
Ischmeic tissue
Wound bed not visible (tunneling)
Deeper tissue
Surgical debridement imminent
Electrical burns (Sue Reeder)
Protective eschar
Pyogderma gangenosum - body attacks itself; looks life ulcer;treat w/steroids
Confusion, agitation
Precaution:anticoagulation meds
Precaution:Low platelet counts
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16
Q

Should wounds get bigger before they get better?

A

Yes, they may still get bigger even after you treat it. Must document wound size progression to get reimbursed. But bleeding in sharp debridement should me minimal; it’s dead.

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17
Q

What is sharp debridement appropriate for?

A

Appropriate for wounds with eschar, loose slough, or adherent fibrin. Speed is an advantage, but anything sharp may cause damage to unintended structures

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18
Q

What instruments are used in sharp debridement?

A

Foreceps
Scissors
Scalpels
Curette - ice cream scoop

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19
Q

What might Pyoderma Gangrenosum be confused with?

A

Venous leg ulcer

1 in 100000
pts in 40s and 50s

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20
Q

What is the most selective form of debridement?

A

Autolytic

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21
Q

How does autolytic debridement work?

A

Uses body’s own enzymes to digest necrotic tissue (enzymes released by macrophages and neutrophils)
Use of moisture retentive dressing

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22
Q

How long does dressing cover wound bed in autolytic debridement? What are 3 examples?

A

SEVERAL DAYS! Examples include: Hydrogel sheets, hydrocolloids, transparent films (tegaderm (use over IV site) is most transparent and duoderm is least transparent)

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23
Q

What is the minimum amount of time to keep a hydrocolloid on?

A

3 days minimum for hydrocolloids

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24
Q

What takes longer, sharp debridement or autolytic?

A

Autolytic. 6 days longer than sharp

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25
Q

When is autolytic debridement contraindicated?

A

If wound is infected or covered with dry gangrene

use enzymatic if infected

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26
Q

What is the most clinically supported topical agent for debridement? (will be on test and NPTE per Kathy Leahy)

A

Enzymatic debridement (requires physician level script)

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27
Q

What are types of topical agents for enzymatic debridement?

A

Collagenase: digest necrotic collagen / deeper (e.g. Santyl)
Protease: digest protein tissue / superficial (will not harm live protein, only denatured ones)
Fibrinolysins: digest fibrin containing clots

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28
Q

Should you do enzymatic debridement for draining wounds?

A

No, it will wash right off.

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29
Q

How do you apply ezymatic debridement?

A

Prepare wound bed first, then apply exogenous enzymes

USE TO PRODUCT SPECIFICATION and discontinue when wound is clean with red granulation tissue

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30
Q

What does cross-hatching do during enzymatic debridement?

A

Gaps in eschar allow ointment to soak into surface

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31
Q

What is maggot therapy?

A

“Very graphic.” -Kathy Leahy, September 30, 2015

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32
Q

What is the benefit to wet-to-dry gauze dressings?

A

Inexpensive, but not favored

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33
Q

How does Soft debridement/Wound scrubbing work?

A

Semi-selective removal of moist, non-adherent necrotic tissue

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34
Q

What is used for Soft debridement/Wound scrubbing?

A

Gauze sponge or calcium alginate-tipped swab

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35
Q

When is Soft debridement/Wound scrubbing contraindicated?

A

For adherent, dry necrotic tissue

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36
Q

What type of solution do you use for syringe irrigation (hydrotherapy)?

A

Saline or tap water

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37
Q

What PSI do you use for irrigation?

A

4-15 psi is appropriate but 10-15 psi is most effective

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38
Q

When is irrigation contraindicated?

A

Only for wounds with profuse bleeding

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39
Q

What equipment can be used for irrigation? (3)

A

Syringe w/ needle

Canyons Wound Irrigation System (syringe system w/o needle)

Pulsed Lavage with or without suction

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40
Q

What is the most common type of hydrotherapy used in wound care?

A

Pulsed Lavage WITH suction

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41
Q

On what wounds can you use Pulsed Lavage with Suction?

A

Any type of wound (but can burst blood vessels). Shown to promote formation of granulation tissue

It is very versatile and like why it is the most common type of hydrotherapy used in wound care. Good for those with MRSA

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42
Q

Can you use Pulsed Lavage with Suction for tunneling?

A

Yes. It also provides non-selective debridement as well as cleansing and irrigation

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43
Q

Does Pulsed Lavage with Suction promote granulation tissue formation?

A

Yes, as mentioned earlier.

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44
Q

What PSIs do you use for Pulsed Lavage with Suction?

A

Tunnels 2-6 PSI
Most wounds 8-12 PSI
Infected wounds 12-15 PSI

45
Q

What level of evidence does Whirlpool have?

A

Level C

46
Q

What are 3 rationales for selecting whirlpool? (what does it do//why is it good?)

A
  1. Reduce wound contamination and infection by softening and removal of debris and exudate
  2. Increase local tissue perfusion
  3. Stimulate cellular activities for regeneration to facilitate neuronal mechanisms for analgesia for pain relief and increased mobility
47
Q

What are 4 benefits of whirlpool?

A

Increase O2 transport
Increase nutrient transport
Remove waste products
Treat multiple wound sites at one time

48
Q

What are contraindications to using whirlpool? (18)

A 
Moderate to severe extremity EDEMA
Lethargy
Unreponsiveness
Maceration
Febrile conditions
Traction
Casted extremities
ICU
Obesity
Compromised CV or pulmonary function
Acute plebitis
Renal failure
Dry gangrene
Incontinence 
Contractures
Ostomies
IV placements
Combativeness/restraints
49
Q

Precautions to whirlpool?

A 
Clean, granulating wounds
Epithelializing wounds
New skin grafts
New tissue grafts
Non-necrotic diabetic ulcers
Edematous limbs
50
Q

Adaptations to whirlpool?

A

Reduce aeration or shut off (becomes soaking)
Change water temp
Change length of treatment time
Follow-up care post whirlpool - rinsing, sharp, debridement, compression wraps

51
Q

What are considerations (disadvantages) to using whirlpool?

A

Infection control: cleaning of equipment practices and potentials
Time (set up, procedure, take down)
Disadvantages of soaking, dependent position, and transporting patient off IP units
Tank size and ability to submerge body part
Too much necrotic tissue - use alternative method

52
Q

Do many facilities use whirlpools?

A

No

53
Q

What 4 factors lead to the optimal environment for wound healing?

A

Moisture level (balance b/t wet and dry)
Bacterial control
pH
Temperature

54
Q

Should you use enzymatic debriders on necrotic wounds?

A

Yes

55
Q

What is Platelet Derived Growth Factor (REGRANEX)

A

VERY expensive and not easily reimburseable
Used as a catalyst for angiogenesis
Usually requires expensive, multi-layer daily dressings
Needs to be refrigerated
Use on clean, granulating wounds

56
Q

What is the average pH of the blood?

A

7.1

57
Q

What is the average pH of a wound

A

5.8-6.6

58
Q

What can lower the pH in a wound? (4)

A

Urine, stool, fistula drainage, chemicals/topical agents

59
Q

Do you want wound dressings to have a high or low pH?

A

Low, may facilitate wound healing.

60
Q

What is a temperature of a wound relative to the body?

A

In absence of infection/other factors, wound have LOWER temps secondary to evaporative moisture loss

61
Q

Do you want the temp of a wound to be warm or cold?

A

Warm! Colder temps lead to slower cell migration which lead to slower healing

62
Q

How does an arterial wound present and what does it need?

A

Usually dry - needs moisture

63
Q

How does a venous wound present and what does it need?

A

Usually wet - needs absorption

64
Q

How does a diabetic wound present and what does it need?

A

Varies but often needs collagen

65
Q

How does a pressure wound present and what does it need?

A

Needs pressure relief first then appropriate moisture

66
Q

How does a surgical/traumatic wound present and what does it need?

A

Various needs

67
Q

What dressing provides moisture, is generally changed daily, and needs a primary cover dressing over the gel?

A

Hydrogel

Examples: Nomrlgel, Woun’dres

68
Q

What is a cross-linked polymer primary cover that is non-adherent and provides minimal absorption? This dressing may stay in place for 7 days, usually changed every other day (depends on the amount of dressing present)

A

Hydrogel sheets.

Examples: Clearsite, Nu-gel

69
Q

What dressing covers and protects and usually has a petroleum base? This is a non-adherent primary cover dressing

A

Impregnated

Examples: Xeroform, Adaptic, Mesalt

70
Q

What dressing is a sheet or foam, utilizes Safe-Tec technology and does not cause microtrauma to wound base with removal?

A

Silicones

Examples: Mepitel, Mepilex, Allevyn Gentle, Restore Contact Layer

71
Q

What dressing non-absorptive and covers/protects? It is non-permeable to bacteria and other fluids, permeable to water vapor and gas, and may stay on for 7 days (depending on drainage)

A

Films/Transparent Adhesives

Example: Tegaderm

72
Q

What is non-permeable in a film?

A

non-permeable to bacteria and other fluids

73
Q

What is permeable in a film?

A

Water vapor and gas

74
Q

What dressing is occlusive (good at sealing, not at absorbing), adheres to wound and surrounding tissues, and may stay in place for 5-7 days (or at least 3 days)?

A

Hydrocolloids

Example: Duoderm

75
Q

What dressing provides min-mod absorption, can be a primary or secondary dressing, and leaves no residue in wound or on surrounding tissues?

A

Foams

Examples: Copa, Lyofoam

76
Q

What dressing is made from seaweed or woven fibers, and offers mod-high absorption?

A

Calcium Alginate

Examples: Melgisorb, Fibracol, Maxorb

77
Q

Are calcium alginate dressings used for infected or non-infected wounds?

A

BOTH!

78
Q

How long should calcium alginate dressings stay on?

A

Change when saturated
Daily on infected wounds
Up to 7 days in non-infected wounds

79
Q

What dressing offers high absorption and used as a primary dressing? It is expensive but can be cost effective if used correctly.

A

Hydrofiber

Example: Aquacel

80
Q

What absorbs more, calcium alginate or hydrofiber?

A

Hydrofiber - 3x more than calcium alginate

81
Q

How long can hydrofibers stay on?

A

1-3 days, but up to 7 days w/ Aquacel AG

82
Q

What must you do before using a compression dressing?

A

Evaluate for a pulse!!!

83
Q

How do compression dressings work?

A

Supports veins to return blood to the heart. Multiple layers

84
Q

What are examples of Compression Dressings?

A

Unna boots, Profore, Coban 2 Layer

85
Q

What dressing controls broad spectrum gram + and gram - microorganisms? There is a high up-front cost, can be cost-effective.

A

Antimicrobials

Examples: Aquacel-AG,, Silverlon, Kerlix AMD, Hydrofera Blue

86
Q

How often do antimicrobials must be changes?

A

Changed daily to up to 7-14 days

87
Q

What dressing provides a scaffolding matrix for cells to grow? Some have human cells and some have animal cells. There are a variety of products.

A

Bioengineered tissue

88
Q

What bioengineered tissue has human cells?

A

Apilgraf

89
Q

What bioengineered tissue has animal cells?

A

Oasis (the bar that’s full of animals, remember it.)

90
Q

Spray-applied cell therapy?

A

Read the article.

91
Q

What costs more, antimicrobial agents or systemic medications?

A

Antimicrobial agents

92
Q

What two agents are in antibacterial dressings

A

007, jk

Bactericidial (death)
Bacteriostatic (inhbits growth (of the healthy bacteria?))

93
Q

What are common antibacterial agents?

A 
Bacitracin-zinc (sulfa-free)
Gentamicin sulphate
Metronidazole gel
Mupirocin
Polymycin B sulfate
Silver sulfadiazine/Silvadene
Neosporin
94
Q

According to Kathy Leahy, with antibacterials, if you do not see progress by this time, you will never see progress:

A

5 days

95
Q

What are common antifungal agents?

A

Myocostatin
Oxistat
Miconazole

96
Q

For what kind of wounds do you need topical agents?(think very generally)

A

For cleansing a dirty wound (slough, necrosis, contaminated). Clean wounds and beefy red wounds (and dirty wounds) can be cleaned with normal saline, tap water, and VASHE. Use the least traumatic method possible!

97
Q

Why should you not use cleansing agents?

A

They are cytotoxic to healing tissues; they destroy the cell membrane and delay healing.

98
Q

When would cleansers be appropriate?

A

If the wound is covered with necrotic tissue and is already non-viable

99
Q

How long are topical agents used and what are they used for?

A

Used for less than 2 weeks. They are used to decrease bacterial burden, cleansing, and chemical is selected based upon bacterial organism

100
Q

What is VASHE?

A

Hypochlorous acid (0.033%)

101
Q

What is Dakins?

A

Diluted bleach, used during WWI for infections

102
Q

What is the recommended concentration of Dakins?

A

1/16

103
Q

What is the most common concentration of Dakins?

A

1/8

104
Q

What is Acetic Acid primarily used for?

A

Primary use is Pseudomonas. Most common concentration is 0.25%. Strong odor of Vinegar

105
Q

What is a popular strong broad-spectrum topical microbicide (10% providone-iodine)? Most commonly used to manage dry, black, non-infected arterial wounds where surgical intervention is not recommended (stable eschar)

A

Betadine

106
Q

What dressing/agent is most commonly used for the effervescence properties to lift debris from a wound surface?

A

Hydrogen peroxide

107
Q

When should you use hydrogen peroxide?

A

Very short time frame for appropriate use. INITIAL cleansing such as with “road rash.”

108
Q

Can you change which dressing you use over time?

A

Yes, wounds change over time and so should the dressing

Integ - PTH 703 - Unit 1 (9 decks)

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