Debridment Lecture Flashcards
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Why would you chose to do debridement on a patient?
To increase the rate of wound healing.
- Non-viable tissue impairs healthy granulation tissue and migration of keratinocytes
- Necrotic tissue serves as a medium for bacterial growth
- Pockets of space are visualized after debridment
If you see exposed bone on your patient, what should you do?
Referral to a physician to rule out osteomyelitis
Describe the debridement method of Autolytic
Endogenous enzymes interact with moist dressing to soften, re-hydrate and remove tissue/ liquefy hard eschar and slough
Positives about autolytic debridement
Simple, pain-free, doesn’t induce bleeding and uses body’s own mechanisms for debridement, selective (no damage to surrounding tissue)
Negatives about autolytic debridement
- Slow, not as rapid as surgical debridemnt
- Excessive moisture can cause maceration
- Requires careful monitoring for infection
Autolytic is best used for what types of wounds?
Stage III or IV wounds with light to moderate exudate
This type of debridement involves the use of removal of non-viable and viable tissue through the use of sterile, sharp instruments. Causes significant pain and bleeding. Performed by physicians, podiatrists, PA-C
Surgical
Positivies about surgical debidement
- Highly selective
- Rapid Results
Negatives about surgical debridement
- Can cause pain
- Risk of bleeding
- Requires training
Contraindications for surgical method
- Clotting/bleeding abnormalities
- Ischemic tissue
- Impaired arterial flow
- Immunocompromised
- Hands/face
What do you call a force on a body immersed in a fluid equal to the wight of the fluid displaced by the object? (Reduces the force of gravity)
Buoyancy
Surgical method is best to use on what types of wounds?
- Wounds with large amount of necrotic tissue
- Wounds in conjunction with infected tissue
How do you do Mechanical Debridement?
Wet to dry method-allowing a dresing to proceed from moist to wet, then manually removing the dressing causes a form of non-selective debridemnt
*Dr. Lorello hates this method
Disadvantages of Mechanical Debridement
- NON-SELECTIVE and may traumatize healhty or healing tissue
- Time consuming
- Painful
- Macerate wound margins
- Frequent dressing changes are required
Define hemodynamic effects
Local changes in circulation due to the warmth or cooling effects by water
What is hydrotherapy?
NOT aquatic therapy
- Whirlpools-Stainless steel or acrylic tanks of various sizes used to provide therapeutic effects
- Ex: Hubbard tank=large whirlpool designed for full body immersion, can allow patient’s to exercise in the tank, requires a lift
- Ex: Highboy or lowboy tanks
What is this a list of?
-Tx patients in private room/ventilated w/doors that close
-Items in room must be covered
-Tubes, ports, etc must be covered
-Consider masking pt
No family during tx
-Used standard precautions plus hand hygiene
-All disposable must be disposed properly
-After tx disinfect all environmental surfaces
Pulsatile lavage with suction
Advantages of Mechanical effects of Hydrotherapy
- Occurs as the result of agitation
- Force of water can debride loose necrotic tissue
- Cleanse wound of dirt
- Improve circulation to area to increase healing
- Softening effect on tissue
Disadvantages of Mechanical effects of Hydrotherapy
- May cause damage to granulation tissue
- Can macerate the periwound area
List what you should do to protect yourself when doing hydrotherapy
*Protective gear: cap, mask, gown, gloves, goggles or face mask
Personnel are exposed to airborne water vapor, inhalation or contract dermatitis of water droplets containing bacteria presents health risk
Why is pulsatile lavage with suction used?
- Reduces bacterial count
- Promotes granulation tissue formation through negative pressure
*Use the gentle setting for wound cleaning and the stronger setting for debridement
How often do you pulsatile lavage?
- Typically 1 time/day
- Wounds >50% necrotic tissue w/ purulent drainage/foul odor do 2 times/day
- Full granulation base with no odor and no purulent drainage can be treated 2-3 times/week
Name the types of pulsatile lavage with suction
- Small splash shield tips for debridement and irrigation
- Long flexible tips for tunnels and undermining
- Use normal saline for irrigation fluid, antibiotics can be used per physician
What are some advantages of larva therapy? (Maggots consume necrotic tissue)
- Selective
- Rapid
- May be painless’
- Can be used for various wounds
Disadvantages of larva therapy
- Psychological distress
- Deep, tunneled wounds
Advantages of using enzymatic cream (enzymes degrade and remove necrotic tissue)
- Cost effective
- Selective
- Decreased wound trauma
- Patient on anticoagulants
- Infected Wounds
Disadvantages of using enzymatic cream
- Twice a day dressing
- May sting
- May need to cross hatch eschar
- Need physician prescription
What type of tissues can you debride?
- Necrotic
- Foreign
- Debris
- Residual topical agents
- Blisters
- Callus
What type of tissues can you NOT debride?
- Granulation
- Viable
- Stable heel ulcers
- Gangrene, osteomyelitis
- Electrical burns
- Deep tissue
What are steps to do when preparing for debridement?
- ) Assemble equipment and supplies
- ) Position patient
- ) Use proper positioning and body mechanics
- ) Make sure you have good lighting
- ) Wash hand, put on gloves
- ) Remove old bandage
- ) Discard soiled gloves, put on clean ones
- ) Inspect wound, may need to debide
- ) Rinse wound
10) Remove soiled gloves - ) Explain procedure to pt
- ) Ensure adequate pain control
Steps of Debridement
- ) Put on clean gloves
- ) ID tissue
- ) Remove as much of tissue
- ) Rinse wound
- ) Assess any changes in wound status and do wound measurements
Steps after Debridment
- ) Dispose sharps
- ) Remove soiled gloves
- ) Put on clean gloves
- ) Apply appropriate dressing
- ) Remove gloves
- ) Wash hands
- ) Pt edu
- ) Documentation
