Electrotherapeutic Modalities, Physical Agents, and Mechanical Modalities Flashcards
What are 7 modalities and physical agents than can be used to enhance wound healing?
- Wound irrigation
- Whirlpool
- Pulsed lavage
- Electrical stimulation
- Ultrasound
- Negative pressure wound therapy
- Hyperbaric oxygen
What can be defined as the use of fluid to remove loosely adhered debris, bacteria, exudate, draining residue and residual topical agents?
Wound Irrigation
What are 3 advantages to wound irrigation?
- Facilitates debridement
- Assists with achieving and maintaining a moist wound environment
- Enhances wound healing
Irrigation after whirlpool removes _ times more bacteria than whirlpool alone
4
Wound irrigation is an acceptable intervention for all types of wounds and is the only direct wound intervention for what type of wound?
healing granular wounds
In what type of wound is irrigation contraindicated?
Wounds with active, profuse bleeding
Wound irrigation should use _-__ psi of pressure
4-15
Recent recommendations for irrigation suggest that pressures between __-__ psi are most effective for preventing infection
10-15
What are 6 advantages to wound irrigation?
- simple
- quick
- inexpensive
- effective
- can use for wound in any location
- can be used in any setting
What is the main disadvantage to wound irrigation?
Irrigant runoff may soil bed lines or patient clothing, which may result in the clinician using less irrigant solution than necessary, making the treatment less effective
What are 3 alternatives to wound irrigation?
- Soak wound with saline-moistened gauze
- whirlpool
- pulsed lavage
Whirlpool is a form of _______ (selective/nonselective) mechanical debridement
nonselective
What are the 7 main purposes of whirlpool?
- debrides loosely adherent devitalized tissues, foreign debris, and surface bacteria
- softens necrotic tissue and eschar
- hydrates the wound bed and promotes moist wound healing
- promotes circulation
- associated with decreased patient pain complaint during wound care procedures
- eases ROM for patients with burn injuries
- can help soak off adherent wound dressings
Whirlpool is indicated in what 4 types of wounds?
- infected wounds
- nondraining wounds
- wounds with thick eschar
- wounds with loosely necrotic tissue or thick exudate
Whirlpool is contraindicated in what 4 types of wounds?
- Clean, granulating, or epithelializing wounds
- Edematous, draining, or macerated wounds
- Wounds with tunneling, undermining, skinfolds that can’t be effectively irrigated
- Active bleeding wounds
What should you be cautious of when treating arterial insufficiency ulcers with whirlpool?
lower the temperature
In what type of patients is whirlpool contraindicated?
- patients with edema or lymphedema
- incontinent patients
- patients who are hydrophobic, confused, combative, with seizures
- patients with multiple open wounds
__% of burn units using whirlpool therapy use the immersion method
81
Small whirlpools should be filled with water between __ to __ degrees Fahrenheit. Larger whirlpools need to be slightly warmer, but should never exceed ___ degrees
92-98
102
Whirlpool treatments should be completed in __-__ minutes
10-20
What are 3 advantages to whirlpool treatment?
- provides a comfortable environment to perform ROM exercises
- promotes moist wound healing
- available in most clinical settings
What are 4 disadvantages to whirlpool treatment?
- the irrigation pressure cannot be calibrated
- there is potential for maceration, edema, and cross-contamination
- time intensive for setup and cleanup
- expensive
What can be defined as the delivery of wound irrigant under pressure by an electrically powered device?
Pulsed Lavage
What are the 4 positive effects of pulsed lavage?
- Irrigates wound bed with precisely calibrated pressure
- Assist with obtaining/maintaining moist wound environment
- Facilitates debridement
- May enhance granulation tissue formation, epithelialization, and tissue perfusion
In what type of wounds is pulsed lavage indicated?
- arterial insufficiency wounds
- venous insufficiency wounds
- diabetic ulcers
- pressure ulcers
- small burns
- surgical wounds
- wounds with tunneling/undermining
When is pulsed lavage contraindicated?
- in wounds with exposed arteries, nerves, tendons, capsules, or bone
- on facial wounds
- recent grafts or surgical procedures
- wounds that are actively bleeding
Patients with a _____ allergy should not be treated with pulsed lavage
latex
What are 3 situations in which pulsed lavage should be used with caution?
- patients taking anticoagulants because of the potential for hemorrhage
- insensate patients to decrease the risk of unperceived trauma
- patients with deep tunneling wounds to prevent damage from the probing wound tip
If the pulsed lavage pressure is greater than 15 psi what is the risk?
increased bacteria penetration into wound tissues
Depending on the wound size and severity there should be anywhere around ____-____ mL of irrigant in the irrigant reservoir and should be between ___-___ degrees Fahrenheit.
1000-3000
102-106
What is the appropriate PPE requirement while performing pulsed lavage and why?
Everyone in the room is required to wear PPE in order to protect them from splash injury and aerosolization
In order to prevent cross-contamination what are the environmental requirements while performing pulsed lavage?
- room with four walls and a door
- cover IV sites/open areas not being treated
- wipe down all horizontal surfaces
What are the 6 advantages of pulsed lavage treatment?
- encourages thorough irrigation
- can be used in any setting and on a wound in any location
- quick
- low risk of cross-contamination
- decreased pain
- ergonomical
What are the 4 disadvantages of pulsed lavage treatment?
- messy
- expense
- not appropriate for large wounds
- some parts are “one-time use”
It has been shown that electrical stimulation can increase the rate of wound healing by ___% compared to standard care
144
Typical wound care electrical stimulation uses ____ volt pulse current
high
What are the 7 purported ways in which electrical stimulation is thought to facilitate wound healing?
- restores the current of injury
- causes galvanotaxis
- stimulates cells
- increases blood flow
- increases bactericidal abilities
- reduces edema
- facilitates debridement
Normally, the epidermis is electro____ with respect to the dermis creating a skin “battery”. A break in skin integrity disrupts this battery making the wound electro____ compared to the surrounding tissues
negative
positive
What is galvanotaxis?
the stimulation of cells to move along an electrical current
Electrical stimulation-mediated angiogenesis may be mediated by what activation of what?
vascular endothelial growth factor (VEGF)
Does the antibacterial effect seem to be greatest under the anode or cathode?
cathode (negative electrode)
______ stimulation is believed to facilitate autolytic debridement
Negative/Cathodal
Electrical stimulation is indicated as an adjunct to would healing for what type of wound?
chronic or recalcitrant wounds that are clean or infected, granular or necrotic
According to the Center for Medicare and Medicaid Services electrical stimulation should be considered in patients with stage __ or __ pressure ulcers that fail to respond after 30 days of standard care
III or IV
What are the 4 contraindications to using electrical stimulation as an adjunct to wound healing?
- simple, uncomplicated wounds
- untreated osteomyelitis
- not in combination with topical agents containing heavy metals
- wounds that are actively bleeding
In what type of patients should electrical stimulation be used cautiously?
Patients with sensory neuropathy
What are the 3 techniques for applying electrical stimulation to facilitate wound healing?
- direct
- immersion
- periwound
Describe the direct technique
A saline or hydrogel moistened gauze is placed within the wound bed and covered with a carbon electrode.
The return electrode should be placed approximately 15-20 cm proximally or on the opposite body surface
If there is a decline in wound status or if there is no improvement after _ weeks electrical stimulation, alternative interventions must be considered.
2
In what type of patient is the immersion technique best used for?
Patients with multiple and or foot ulcers
Describe the immersion technique
The wound is placed in a nonmetal basin filled with water. The treatment electrode is then placed contact side down within the basin, essentially making the entire water-filled area the treatment electrode.
What are the advantages to the periwound technique?
- the wound dressings can be kept in place
- decreased potential for wound contamination
E-Stim Parameters
Frequency: __-___Hz
80-115
E-Stim Parameters
Intesnity: __-___ Volts
75-200
comfortable parenthesia (submotor)
E-Stim Parameters
Interpulse Interval: __-___ microseconds
50-100
Is the anode or cathode used to decrease wound infection?
cathode
Is the anode or cathode used to restore the normal current of injury, promote granulation tissue formation, and enhance epithelialization?
anode
Due to the varying effects of e-stim polarity when should the cathode be used?
the first several days of treatment because it may reduce bioburden (even in wounds that are not infected)
How long should e-stim treatment sessions be?
45-60 minutes or as little as 30 minutes if performed BID
How many times per week should e-stim be performed in IP and in OP?
IP: once or twice daily
OP: 3 times per week
What are the 4 advantages to e-stim?
- research supports its efficacy
- can be used in any setting due to its portability
- painless
- less setup and cleanup time than whirlpool
What are the 3 disadvantages to e-stim?
- time consuming
- increased risk of wound contamination
- not appropriate for large, extensive burn wounds
What are 2 alternatives to electrical stimulation?
- ultrasound
- hyperbaric oxygen
There appears to be sufficient evidence that states ultrasound is helpful in facilitating healing in _______ wounds
recalcitrant/chronic
What are the proposed effects of ultrasound?
- enhances all 3 phases of wound healing
- enhances wound contraction
- improves scar pliability
What 3 things does ultrasound increase during the wound healing process?
- collagen deposition
- granulation tissue formation
- angiogenesis
Noncontact low frequency (25-40 kHz) ultrasound in combination with saline mist can help to do what 2 things?
- debride wounds with adherent fibrin
- decrease bioburden within chronic wounds
What are the 4 contraindications to ultrasound for wound healing?
- untreated osteomyelitis
- wounds with active profuse bleeding
- severe AI
- DVT
What are the 3 application techniques for ultrasound?
- direct
- immersion
- periwound
Describe the application of direct ultrasound
Deep wounds should be filled with amorphous hydrogel or normal saline to allow for the transmission of energy into the wound bed.
The wound must be covered with a barrier to prevent contamination from the conductive gel.
Apply ultrasound gel over the barrier.
What type of barrier transmits the greatest amount of ultrasound energy?
sheet hydrogels
True or False
It is appropriate to use varying barriers when treating wounds with ultrasound.
False
They should use the same type of barrier to ensure a consistent treatment dosage
When performing immersion ultrasound how should the sound head be held in respect to the wound?
0.5 to 1.0 cm away from the surface of the wound and periwound
Ultrasound Parameters
Frequency: __ MHz for superficial wounds and __ MHz for deep wounds
- 0
1. 0
Ultrasound Parameters
Intensity: __-__ W/cm squared
0.5-1.0
no greater than 1.5 for remodeling closed wounds
Ultrasound Parameters
Pulse Rate: __-__%
20-25%
The treatment area for ultrasound should be divided into zones equal to __ times the area of the sound head.
1.5
Each ultrasound treatment zone should be treated for _ minutes initially, increased to 30 second intervals until reaching _ minutes of treatment per zone.
2
3
How many times per week should ultrasound be performed in acute wounds and in chronic wounds?
acute: once or twice daily
chronic: 3 times per week
Noncontact low-frequency ultrasound Parameters
Frequency: __-__ kHz
25-40
Noncontact low-frequency ultrasound Parameters
Treatment Time: __-__ seconds per cm squared with a minimum of _ minutes for wounds less than 15 cm
20-60
4
What are the 5 advantages to using ultrasound as an adjunct for wound healing?
- can be used in any setting
- quick
- less setup and cleanup time
- does not hyperhydrate
- does not require dependent positioning
What are the 4 disadvantages to using ultrasound as an adjunct for wound healing?
- not as much research support
- not appropriate for large wounds
- may be painful or difficult to perform
- increased risk of contamination
What are the 8 proposed effects of negative pressure wound therapy?
- increase local blood flow
- decrease wound/periwound edema
- increase granulation tissue formation
- increase angiogenesis
- increase epithelialization
- decrease wound bioburden
- promote cell proliferation
- maintain moist, warm wound environment
What are 3 examples in which NPWT can be used on a wound?
- postsurgical wounds and grafts
- wounds with exposed deep tissue or hardware
- traumatic wounds
In what type of wounds is NPWT contraindicated?
- dry wounds
- necrotic wounds
- wounds in body cavities
- wounds over malignancies
- in the presence of exposed blood vessels
- untreated osteomyelitis
Caution should be used with applying NPWT to what type of patient?
patients on anticoagulants or with wounds that are actively bleeding
What is black polyurethane foam used to do?
enhance granulation tissue formation and wound contraction
What is white PVA foam used to do?
enhance epithelialization
How much pressure is applied during NPWT?
50–175 mm Hg
125 mmHg is optimal
How long is the NPWT dressing left in place?
12-72 hours
What are the 3 advantages to using NPWT?
- may cost less over time
- can be used in any setting
- helps maintain a warm, moist wound environment
What are the 7 disadvantages to using NPWT?
- no standard for use
- possibly painful
- may hinder patient mobility
- noisy
- challenging to obtain an air-tight seal
- may cause skin damage and ulceration due to negative pressure
- expensive
Tissue partial pressure of oxygen must be greater than __ mm Hg for normal healing
40
What are the 4 ways in which hyperbaric oxygen may enhance wound healing?
- increases the oxygen concentration gradient
- reduces bacterial growth
- increases angiogenesis, granulation tissue formation, epithelialization, and wound contraction
- reduces edema
What are the 7 indications for hyperbaric oxygen?
- gas gangrene
- peripheral ischemia
- crush injury
- Wagner grade 3 or higher
- progressive necrotizing fasciitis
- osteomyelitis
- osteoradionecrosis
What are the 6 contraindications to hyperbaric oxygen?
- DVT
- congestive heart failure
- claustrophobia
- pregnancy
- severe AI
- noncomplicated wounds
When patients are in a hyperbaric oxygen treatment they are breating 100% at __-__ atm
2.0-2.5
If wound size does not decrease by 50% after __ hyperbaric oxygen treatments, the wound is unlikely to respond to this modality.
10
What is the main advantage of systemic HBO?
the TCOM test can be used to help the HCP determine the potential for improvement with therapy
What are 2 disadvantages to using hyperbaric oxygen?
- extremely high cost
- extensive treatment time
