Integ. Unit 6 Management of Non-viable Tissue Flashcards
What is Debridement? What are its benefits?
The removal of dead, damaged, or devitalized tissue
-Removing tissue from wound bed
- Encourages the wounds healing process
- Reduces chronic inflammation by means of removing necrotic tissue
- Promote keratinocyte growth
When should a clincian debride?
- Initial removal of necrosis (escahr, slough)
- Maintenance debridement if warranted
- Hx taking:
-review lab values
-Pharmacological agents (ie blood thinners, pain meds, etc)
-Pain - Obtain vascular studies/ABI
What are the Precautions/Contraindications for Debridement?
- Arterial/Ischemic Ulcers (ABI < 0.4)
- Dry gangrene or dry ischemic wounds
- Elevated temperature (systemic disease)
- Cellulitis (bacterial skin infection) or infection of other etiology
- Wound failure to progress
- Viable exposure to bone, tendon, prostetic device
- Evidence of abscess/extreme undermining
- Stable eschar in arterial insuffiiency/Diabetes
What are the different types of debridement?
Biological agent
- Maggot/Leech therapy
Autolytic
- Using the bodys natural healing mechanisms to debride non viable tissue
Exzymatic
- Using a chemaical to remove nonviable tissue
Mechanical
- Application of some outside force or energy to dislodge the nonviable tissue
Sharp
- Involves instruments to remove nonviable tissue
What is Autolytic Debridement? What are the steps for this?
Endogenous healing of the wound
Steps:
- Cleansing
- Maintance of a moist environment
- Cross hatch eschar
- Cover with appropriate dressing to promote healing
What are the Advantages and Disadvantages of Autolytic Debridement?
Advantages
- More rapid improvement
- Selective (wont harm healthy tissue)
- Can combine with other debridement types
Disadvantages
- Caregiver education
- Slower than sharp
- Increased risk of infection
What is Enzymatic Debridement? What are the steps for this?
Enzymes used to prepare the wound bed by allowing them to break down the nonviable tissue
Steps:
- Obtain physicians order for a collagenase
- Clease wound appropriately
- Apply enzyme directly to the nonviable tissue
- Cover with appropriate dressing (moist gauze)
- Apply 1x/2x per day
What are the Advantages and Disadvantages of Enzymatic Debridement?
Advantages
- Selective
- Used in combination with other debridement mechanisms
Disadvantages
- Costly
- Slow to notice improvement
Used when wounds may be infected
What is Mechanical Debridement? What are the different types?
This refers to some outside source to remove the non-viable tissue
- Wet to Dry Gauze dressings
- Scrubbing
- Hydrotherapy
- Low frequency ultrasound
- Pulsatile Lavage (Pressurized fluid irrigation)
-Gold Standard = 35-50cc syringe with a 19 gauge catheter to create 4-9psi
avoid > 15 psi
What are the Advantages and Disadvantages of Mechanical Debridement?
Advantages
- Used in a variety of settings
- Decreased bacteria
- Alternative to sharp debridement
Disadvantages
- Painful!!
- Non-selective (May remove healthy tissue as well, Wet-to-Dry)
- May cause maceration
What is Sharp Debridement? What are the steps for this?
- The most rapid form of debridement
- May require multiple/sequential treatments to clean the wound bed
Steps:
- Pre-medicate as needed with lidocain/oral medication under supervision of physician
- Assemble necessary equipment including agents to stopn excess bleeding
- Clease wound
- Use scalpel blades (No. 10 or No. 15), curettes, scissors and/or forceps for removal or nonviable tissue
What are the Advantages and Disadvantages of Sharps Debridement?
Advantages
- Selective
- Speed
Disadvantages
- Painful
- Requires experience
- Increased potential for complications
What should be done if there is excess bleeding during Sharp Debridement?
- Apply pressure for 5-10 min
- Elevation
- Topical agents (Surgical, calcium alginate, silver nitrate)
- Electro cautery (available to surgeons only)
