Electrotherapeutic modalities Flashcards
Use of fluid to remove loosely adherent cellular debris, bacteria, wound exudate, dressing residue, and residual topical agents
-Facilitates debridement, assists with maintaining a moist environment, and enhances wound healing
Wound irrigation
Wound Irrigation Indications
Acceptable intervention for all types of wounds
Indicated for healing, granular wounds
Wound Irrigation contraindications
Not indicated for active, profuse-bleeding wounds
Wound Irrigation Method
- Wound should be irrigated on IE and with each dressing change.
- 4-15 psi
- May be performed with soaked gauze, water-pik, syringe, pulsed lavage, whirlpool
Whirlpools: Form of _______mechanical debridement
nonselective
Whirlpool: 7 main purposes
Debrides. Softens necrotic/eschar. Hydrates wound bed. Promotes healing/circulation. Decreases patient pain. Eases ROM for burn injuries. Helps soak off adherent dressings.
Indications:
Use on infected wounds.
Use on nondraining wounds to rehydrate wound bed with eschar, adherent necrotic tissue, or thick exudate.
Whirlpool
Whirlpool: Contraindications
-Can prevent wound closure.
-Dependent positioning and warm water = ^ edema.
NOT for:
-ulcers due to venous insufficiency, edema, or lymphedema
-wounds with profuse bleeding
-confused, combative, seizures.
-multiple wounds.
-Tunneling wounds, undermining, and wound in areas of skin folds.
Whirlpool: Immersion technique
Water 92-98 deg. 10-20min
twice daily to 3x/week.
Discontinue when wound is clean and granular.
Whirlpool: Showering technique
Affected area is positioned over the empty whirlpool and sprayed with water.
Whirlpool: use of chemical additives
(Chlorazene, betadine, bleach) -risks of delayed wound healing.
Don’t Use on chemical wounds.
Don’t use on young, elderly, and those with sensitivities to agents.
ONLY recommended in isolated cases
- Involves regular, automatic interruption of fluid flow with handheld device to regulate irrigation pressure.
- Applies (-)pressure to wound bed.
Pulsed Lavage with Concurrent Suction
Pulsed Lavage with Concurrent Suction: Indications
Cleansing or debriding wounds due to arterial or venous insufficiency, diabetes, pressure, small burns, surgery, or trauma
-tunneling or undermining wounds
NOT for:
- exposed arteries, tendons, nerves, capsules, or bones.
- body cavities, facial wounds, recent grafts or surgical procedures, or actively bleeding wounds
- latex sensitivities or allergies
CAUTION on patients taking anticoagulants, insensate patients, and deep tunneling wounds
Irrigation with greater than 15 psi is contraindicated
Pulsed Lavage with Concurrent Suction: Contraindications
Pulsed Lavage with concurrent suction: Treatment freq varies between ___for severely infected or necrotic wounds or wounds with heavy exudate and ___times per week for granular wounds
BID
3x/week
E-stim: 7 ways it facilitates wound healing
- Restores the current of injury which is thought to speed healing
- Causes galvanotaxis
- Stimulates cell proliferation
- Increases blood flow
- Increases bactericidal
- Reduces edema
- Facilitates autolytic debridement – use (-)
E-stim: indications
- Adjunct for chronic wounds.
- Ulcers, traumatic and surgical wounds, and burns
E-stim-Contraindications
Not for:
- simple wounds
- osteomyelitis
- active bleeding
- sensory neuropathy
____Technique
After performing any debridement and irrigation, a saline- or hydrogel moistened gauze is placed within the wound bed and covered with ___electrode.
-The return electrode is placed in any convenient location, __cm proximally….or can be opposite side of extremity
Direct; (Applied directly to wound bed)
Carbon electrode
15-20cm
- sufficient evidence to support use for chronic. -Enhances all three phases of wound healing
- cell membrane permeability due to the nonthermal processes
- low frequency (25–40 kHz) in combination with saline mist (Mist Therapy).
Ultrasound
Ultrasound: Indications
- Chronic wounds that are clean or infected.
- Pressure wounds, venous insufficiency, acute trauma, and recent surgery
Ultrasound: Contraindications
- Presence of osteomyelitis, active bleeding, severe arterial insufficiency, and acute DVT
- Should not be used on untreated infections.
- In large amounts of necrosis, deliver treatment to intact periwound
- NOT indicated for simple wounds
US: Direct Technique
- Apply directly to wound bed (use hydrogel sheet or bacteriostatic gel pads.)
- Deep wounds-amorphous hydrogel or saline.
- Applied over wound, periwound, and scar
US: Periwound Technique
- Applied to periwound-facilitate wound healing
- May be beneficial for chronic leg ulcers and tunneling, necrotic, or painful wounds
- Leave wound dressing in place which lowers risk of contamination
