Lab 2 - Debridement Flashcards
Selective vs Non-selective debridement
Selective removes specific devitalized tissue
non-selective may include healthy tissue aswell
What are the 4 types of selective debridement?
Sharp
Autolytic
Enzymatic
BIological
If there are multiple options of debridement availible, what should be the first choice?
Sharp debridement
When is sharp debridement done?
When there is large amounts of necrotic tissue/callus/or bioburden
What is serial instrument debridement?
Use instrument to remove loosely adherent necrotic tisue
not very painful, sometimes called maintenance debridement
What is selective sharp debridement?
Use tool to cut nonviable tissue ALONG THE BORDER or viable tissue
note: painful, may bleed
When using sharp debridement, keep tool _____ to wound surface and rinse regularly with ________
Parallel
Saline
What are contraindications to sharp debridement?
Arterial insufficiency
pyoderma gangrenosum
Dry stable heel ulcer without signs of edema/fluctuance/drainage
Anything you cannot identify
How does autolytic debridement work?
Natural promotion of liqufacation of tissue by phagocytic cells and proteolytic enzyme that soften tissue and macrophages digest it
Cover wound in appropriate amount of moisture retentive dressing
slow process
Cross hatching can help with what forms of debridement?
Enzymatic and autolytic
What is enzymatic debridement?
Uses Collagenase(Santyl)
Works by digesting collagen from bottom up
Enzymatic debridement is most effective in ________ wound beds
Moist
note: may see increased drainage w/ enzymatic debridement
What are contraindications for enzymatic debridement?
Facial wounds,
emergent cases/ infection
heavy metals in dressing
Enzymatic debridement should be layed on how thick?
Approximately 2mm thick (thickness of a nickel)
What is biological debridement?
Green bottle fly or maggots are placed on wound every 2-3 days
T or F, maggots may harm viable tissue
F
What are contraindications to biological debridement?
life threatening/limb threatening wound
bleeding abnormally
deep tracking wound
location of pressure
T or F, nonselective debridement can increase risk of a wound becoming chronic
T
What are types of mechanical (nonselective) debridement?
Wound irrigation
wound scrubbing
wound cleansing
wet-to-dry
whirlpool
pulse lavage
low frequency contact ultrasound
What is wound irrigation?
Use of saline in a light pressure stream to clean wound surface
gentle enough to not harm viable tissue, appropriate for any wound
What is wound scrubbing
What direction should you scrub?
Use gauze or sponge to get slough off of wound surface
scrub from the center -> outward
What is wound cleansing?
Simular to wound scrubbing but with a cleanser
solution with surfactants that loosen material in wound bed
What is wet-to-dry debridement?
Letting the dressing dry then pulling it out to pull out what tissues are stuck to it
can cause maceration
Gauze can stick and be left behind
Increase infection risk
Very labor intensive (x3 per day)
What is whirlpool debridement
C level evidence
Wound is dipped in thermal whirlpool
increases fibroblast activity w/ heat and bloodflow
risk of maceration
Whirlpool precautions?
Whirlpool contraindications?
precaution- clean granulating wounds, epitheliasing wounds, CHF, new skin graft
Contraindications- maceration, febrile condition, venous insufficiency, diabetic neuropathy
What is the normal temp of the whirlpool?
Normal treatment time?
36.5-40C 37C optimal
10-20 minutes 1-2x per day
What is pulse lavage?
What are the benefits?
What is the normal PSI?
Used gun to provide pressurized saline and then negative suction to remove debris
can effectively get into tunnels and undermining
normal psi is 4-8, dont go over 15
What are pulse lavage contraindications?
Body Cavities
Facial Wounds
Recent Grafts
Near arteries,nerves,tendons,bones
What is low frequency contact ultrasound?
Use of ultrasound for anti-microbial properties
contraindications: pregnant, over gonads, cancer, DVT, spinal cord after laminectomy, hemophiliac w/o medication
What is surgical debridement?
Done by physician or podiatrist
Overall debridement indications
Necrotic tissue
foreign material
debris
callous
blister
overall debridement contraindications?
granular tissue
stable/hard
deeper tissue
needs surgical debridement
unable to see clearly
unable to identify structure
