Methods of Debridement Flashcards
What is Autolytic Debridement?
Auto refers to “self” and lytic is “breakdown”
•The process of using the body’s own mechanisms to debride non-viable tissue
*A wound bed needs to remain moist to promote autolytic debridement.
- Advantages
- Gentle
- Selective (non-viable tissues only)
- Can be used with other types of debridement
- Progress within 7 days
What dressings “go well” with Autolytic Debridment?
Transparent Films, Hydrocolloids, Hydrogels
- Transparent film dressings function best over dry eschar.
They are non- absorptive, rapidly creating a fluid environment.
- Hydrocolloids. These dressings work best over moist wounds with necrosis. They provide minimal absorptive capacity while maintaining a moist wound environment.
- Hydrogels promote autolysis by maintaining a moist wound environment
Who benefits the most from Autolytic Debridement?
- Long term care patients or patients in home health
- All necrotic wounds especially dry eschar
- Not for infected tissues**!
What is Enzymatic Debridement?
A topical ointment or cream used as “chemical” debriders. It binds and digests to non-viable tissue.
IT TAKES THE LONGEST OF ALL KINDS OF DEBRIDEMENT.
Names of ointments are: accuzyme, Panafil, or Santyl
What are advantages to enzymatic debridement?
It is selective (to non-viable tissues)
and
Can be used with infected tissues (except for accuzyme)
Who do I use enzymatic debridement with?
- All necrotic wounds
- Not for clean wounds, dry gangrene or dry ischemic wounds
What is sharps debridement?
Using a tool to debride tissue. “Instrumental debridement”.
The use of a scalpel, forceps, curette, scissors, or other sharp instrument.
*This is the most rapid form of debridement. It can be highly effective and is the preferred method of debridement of necrotic tissue.
What are some advantages of sharps debridement?
Rapid removal of non-viable tissue.
Assists in the removal of thick, adherent eschar and/or large amounts of non-viable tissue.
Who is sharps debridement used for?
All necrotic wounds.
Dry eschar
*Autolytic and enzymatic debridement should be used FIRST to loosen the non-viable tissue.
Special considerations for sharps debridement…
*With pressure ulcers on the heels, it may be left intact if they are inspected daily and are stable without infection signs. If so, debridement should be considered.
and sharps debridement should be limited to 15-30 min
Remember to use brief intense TENS to reduce pain during eschar debridement.
What is Mechanical Debridement?
A physical force to remove necrotic tissue. Wet-to-dry IS a form of mechanical debridement…but now pulsed levage is more common.
Why don’t you want to use wet to dry dressings?
- Non-selective
- Difficult to apply correctly
- Causes pain on removal
- Costly
- Causes maceration of peri-wound
What is pulsed lavage?
A form of mechanical debridement where water is pulsed around the wound bed to remove slough, necrotic tissue, etc.
Guidelines for pulsed lavage?
PPE used is gown, gloves, mask (face shield), once a wound is achieved the PL should be discontinued.
**Duration of treatment is 10-15 min for 4-15psi
Who is PL used for?
- Pressure ulcers
- Diabetic foot ulcers
- Venous insufficiency ulcers
- Deep or tunneling wounds
- Infected surgical sites
- Heavily contaminated wounds
- Burns
- Multiple wounds
*involves the use of a scalpel, forceps, curette, scissors, or other sharp instrument to remove nonviable tissue.
