Modalities Used in Wound Care Flashcards
List some modalities used in wound care.
Hydrotherapy, E-stim, Hyperbaric oxygen, compression, Negative wound therapy, ultrasound
What are the benefits of whirlpool treatment?
softens adherent necrotic tissue increases blood flow and metabolic rate proliferation and granulation tissue and epithelial cells exudate removal to decrease infection wound cleansing
What are the negatives of whirlpool treatment?
Maceration, dependent position, potential for burns, cytotoxic additives
What are the contraindications for whirlpool treatment?
CHF/LE edema pulmonary disease acute phlebitis lethargy gangrene renal failure
What are the treatment parameters for hydrotherapy?
92-96 degrees F
10-15 minutes
Why do you use pulsed lavage with suction?
Used for cleansing and debridement (cleaning wound and removal of toxic residuals)
What are the treatment parameters for pulsed lavage?
10-15 minutes
What are the precautions and considerations of pulsed lavage?
Precautions: tissue damage can occur if pressure is too high
Considerations: can be done at bedside, can be expensive
How does electrical stimulation affect wounds?
stimulates fibroblasts to enhance collagen and DNA synthesis
increases number of receptor sites for growth factors
alters the direction of fibroblast migration, activates cells in the wound site, improves tissue perfusion, decreases edema
increases cutaneous oxygen transport
controls infection
stimulates wound contraction and scar healing
What are the indications to use e-stim?
pressure ulcers stage 1-4, diabetic ulcers, venous ulcers, traumatic wounds, surgical wounds, ischemic wounds, donor sites, flaps, burn wounds
What are contraindications for e-stim treatment?
osteomyelitis, pregnancy, malignancy, pacemaker, over the carotid sinus or across heart, laryngeal musculature, along regions of phrenic nerve, over topical substance containing metal ions, over povidine iodine or mercurochrome
Can you apply e-stim directly to the wound or periwound?
Yes
Will medicare pay for e-stim as your very first wound care treatment?
No.
Only after the wound is not progressing following traditional treatment for 30 days
What are the settings for e-stim?
Pulse width: 20-200 microseconds
Pulse frequency: to 100 pulses per second
What are the different characteristics of polarity for e-stim?
Cathode (-): used during the inflammatory phase for bacteriostatic effect and to dissolve necrotic tissue
Anode (+): used during the proliferative phase to accelerate wound healing, increase fibroblastic formation, increase epithelialization, stimulate protein and DNA synthesis
What is the timing of use for e-stim? (days)
In the proliferation phase you use the cathode for 1-5 days, then change to the anode until healed
In the maturation phase you alternate between the cathode (3 days) and the anode (3 days)
What are the parameters for e-stim treatment?
45-60 minutes
5-7 times per week
Voltage/Intensity: 100-150 volts
What are the effects of hyperbaric oxygenation?
Hyperoxygenation and decreases edema
toxin inhibition, antibiotic synergy
restores body’s defense against infection, increases the rate of killing some common bacteria, inhibits growth of anaerobic organisms
angiogenesis
What are the indications of hyperbaric oxygenation?
acute burns, chronic wounds, radiation induced injury, necrotizing infection, sepsis, chronic osteomyelitis, carbon monoxide poisoning
Must be well debrided
What are the contraindications of HBOT?
claustrophobia, pneumothorax, COPD, seizure disorders, upper respiratory infection, optic neuritis, malignant tumors, acidosis, drugs (steroids, alcohol, nicotine)
What are the treatment guidelines for HBOT?
2.0 ATA oxygen x 90 minutes
5x/week for 4 weeks = 20 sessions
What are the goals of negative pressure wound therapy (NPWT)?
increase blood flow, decrease bacteria colonies, able to measure and assess wound fluid, increase granular tissue base, contraction of wound, epitheliazation
What are the indications for NPWT?
acute wounds, PTW/FTW from burns, surgical wounds/incisions and dehiscence, diabetic wounds, venous/arterial wounds, pressure ulcers, graphs/flaps, enteric fistulas
What are the contraindications for NPWT?
necrotic tissue with eschar, malignancy, untreated osteomyelitis, exposed blood vessels or organs, non-enteric or unexplored fistulas, acute bleeding
What are the settings for NPWT?
Dressings are changes every 48-72 hrs Must be ON for 22-24 hrs Pressure between 75 mmHg and 150 mmHg intermittent versus continuous white foam, black foam, silver foam
How long does someone receive NPWT, and when is it discontinued?
treatment usually lasts 4-6 weeks
should be discontinued when goals are met, no progress in healing for 1-2 weeks, patient is non-compliant
What are the indications of ineffective VAC therapy?
Minimal changes in wound size, deterioration of the wound, changes in wound color, wound appears white, excessively moist or macerated, wound odor
What are the indications for intermittent/pneumatic compression?
primary/congenital lymphedema, secondary lymphedema from lymph node resection after cancer, chronic venous insufficiency, venous stasis, venous ulcers, reduce and control peripheral edema
What are contraindications of compression therapy?
phlebitis, CHF, PE, DVT, increase of venous/lymphatic return is not desired, caution in using on extremity with lack of sensation to pain
What are the settings for compression therapy?
Daily to BID tx
30-60 minutes per tx
pressure from 0-80 mmHg (set 20 below diastolic BP)
monitor BP pre and post therapy
Why do we use a Unna boot?
used in AMBULATORY patients to aid the calf muscle pump
What are the layers of the unna boot?
first layer is gauze impregnated with zinc oxide, glycerine, and calamine, outer layer is gauze and/or self-adherent or compressive bandage
What are the treatment parameters of the unna boot (time, precautions)?
Leave it on for ~ 1 week
Do not get it wet
What is MIST ultrasound?
A non-contact US which administers continuous US energy via an atomized saline solution
Used for cleansing and debridement
What does Ultrasound (US) do physiologically?
accelerates acute inflammatory phase, stimulates fibroblasts to secrete collagen, provides heat to deeper tissue prior to stretch, accelerates wound contraction, promotes strong, more elastic scars, increases blood flow
What are contraindications to US?
thrombophlebitis, actute infection, pregnancy, malignancy, over the eye, hemophiliacs not covered by factor replacement, concurrent or post radiation, over bony prominence
What are the indications for US use?
colonized wounds, arterial/venous wounds, diabetic foot ulcers, chronic leg ulcers, pressure ulcers, burns, acute wounds, post operative wounds, sickle cell ulcers
What are the parameters for US treatment?
Use a hydrogel dressing or sterile saline
1-2 minutes for area 1.5x the size of applicator
What are the settings for US treatment?
Frequency: 3 MHz Duty cycle: 20% Intensity: <.5 watts (thermal) Duration: 1-2 minutes per zone TxFreq: 1-2 times per day until inflammation subsides, then decrease to 2-3x/wk
How are leeches used?
used to diminish venous congestion with reattachment surgery
saliva of leeches has anticoagulant properties
feed for 20 minutes at a time
How are maggots used?
selectively debride necrotic tissue
48-72 hours, 2 times per week
