Lecture 5b - TIME and wound bed prep Flashcards
What does TIME stand for?
Tissue
Infection or Inflammation
Moisture
Edges
Tissue from “TIME”
Debridement & modalities
Infection or Inflammation from “TIME”
Treat local or systemic
Moisture from “TIME”
Treat with barriers, lotions, and dressings
Edges from “TIME”
Treat with barriers, dressings debridement & modalities
What level of evidence does e-stim have?
Level A
What are some indications for e-stim for wounds?
- Pressure ulcers
- Venous insufficiency ulcers
- Arterial ulcers
- Diabetic neuropathy ulcers
- Burns
- Dehisced surgical wounds
- Chronic wounds
What are benefits of e-stim for wound care?
- Restores current of injury
- Causes galvanotaxis
- Stimulates cells
- Increases blood flow
- Increases bactericidal abilities
- Facilitates debridement
- Reduces edema
- Reduces pain
What is the charge typically found in edema?
(-) charge so when using High-Volt to push, put the (-) electrode on/near the edema
What charge does the epidermis have?
Electronegative (-) charge, SO when we have a break in the skin, there is a disruption so a wound has a (+) charge
What is the most common e-stim treatment for wounds?
HVPC
Parameters
* Frequency: 80-125 Hz
* Interpulse interval: 50-100 ms
* Intensity: 75-100 V
* Time: 45-60 minutes
Inpatient tx: 1-2x/day
Outpatient tx: 3x/wk
What are 3 e-stim methods?
- Direct technique (saline-soaked gauze; other electrode is 15-20 cm away; most common)
- Immersion technique (in water; consider risk for contamination or infection)
- Periwound technique (around wound, decrease contamination, don’t have to remove dressing)
What are some roles of the cathode (-)?
- Attracts: neutrophil, fibroblast
- Promote epithelial growth & organization
- Vasoconstrictor
- Denatures protein
- Aids in preventing post-ischemic lipid production
- Attracts macrophages
Do you start with the cathode or anode for treatment?
Begin with cathode for a few days, then switch to anode usually
What are some roles of the anode(+)?
- Attracts: neutrophil, macrophage
- Fight infection
- Decrease edema
- Lyse necrotic tissue - debridement
- Increase blood flow
- Stimulate granular tissue growth
- Angiogenesis
What are the contraindications for e-stim?
- Simple, uncomplicated wounds
- Evidence of osteomyelitis
- Cancer related wounds
- Using any metal (silver) dressing or cream
- Active bleeding
In addition to enhancing all 3 phases of healing, what does Ultrasound do?
- Reduce inflammation
- Enhance granulation tissue
- Increase wound tensile strength
- Improve scar pliability
What are indications for Ultrasound?
- Chronic wounds
- Pressure wounds
- Venous insufficiency
- Acute trauma
- Recent surgery
What are 2 ways Ultrasound may produce cellular changes?
- Cavitation
- Microstreaming
What is Cavitation?
- production & vibration of micron sized gas-filled bubbles
- as bubbles move & condense, they are condensed before moving on
- the movement and compression of bubbles can cause changes in cellular activities of the tissues
What is microstreaming?
AKA acoustic streaming
- unidirectional movement of fluids along cell membrane or bubbles bc of pressure wave associated with US
- may increase permeability in cell membrane or vascular wall
What are the 3 Ultrasound methods?
- Direct technique (fill deep wound with hydrogel/saline; cover wound with barrier then use coupling medium over barrier) nah
- Periwound technique (less effective but don’t have to move dressing; good for painful wounds)
- Immersion technique (immerse wound and sound head underwater; think about positioning)
Review Ultrasound Basics
Superficial: 3 MHz
Deep: 1 MHz
Non-thermal pulsed at 30-35% with low intensity of 0.5-1.0 W/cm^2 for healing
To remodel scar tissue, remove contractures, or improve ROM use thermal setting of 1.5 W/cm^2
Treatment time: 2-3 min for 3-7x/week
