Physical agents in Wound care Flashcards
What is the type of irrigation based on?
- purpose of irrigation
- wound presentation
- wound etiology
- intervention availability
can use saline or water
What is wound irrigation?
- using fluid to debride residual dressing, necrotic tissue, etc. from the wound bed
NOT WOUND CLEANSING
- cleansing is using a chemical to clean the wound
What is angiocath/waterpik?
Angiocath: 35ml syringe and 19 gauge angiocatheter
Waterpik: low setting (6psi)
pressurized canisters at 4-15psi
What are the disadvantages of angiocath/waterpik?
- messy
- not for profusely bleeding wounds
At what PSI will damage or traumatize the wound bed?
> 15 PSI
What is pulsed lavage?
- irrigant delivered under controlled pressure (4-15psi) with suction using hand-held device
- 8 psi is typical
- suction provides negative pressure removing irrigant and pathogens
- PPE required
- may enhance granulation tissue formation, epithelization and perfusion
- good for wounds with tunneling/undermining (Can use different tips)
What are disadvantages with pulsed lavage?
- NOT for wounds with exposed deep tissue/body cavities
- anticoagulant precaution
What is whirlpool?
- used to be commonly used on ALL wounds
- whole limb in water
- appropriate for patients with eschar from burns
- water temp 92-102 F for 10-20 minutes
- can have turbine agitation and water additives (chloramine T, bleach, VERY diluted)
What are disadvantages of whirlpool?
NOT for:
- VI
- edematous extremities
- acute phlebitis or cellulitis
- DVT
- incontinence
- Dry gangrene
Leads to maceration of periwound and leg being in dependent position leads to swelling and edema
What are the goals of irrigation?
- remove necrotic tissue, debris, and bacteria
- do not traumatize healthy wound bed
What is the PPE that should be used to pulsed lavage?
- face shield
- mask
- fluid proof gown
- fluid resistant shoe covers
- gloves
- hair covers
When should you discontinue pulsed lavage?
- no increase in granulation tissue after 1 week
- no decreased necrotic tissue for 1 week
- wound closed
What is electrical stimulation for wound healing?
- use of positive and negative polarity current in wound bed with electrodes or aluminum foil with use of dispersive pad
What is HVPC stand for?
- Hi-Volt pulse current
What is the theory behind ES for wound healing?
Use of bioelectric current attracts cells to increase wound healing (galvanotaxis)
- simulate cell migration
- stimulate cell proliferation
- increases bactericidal effects
- promotes autolytic debridement
Restores positive potential to wound
Increases blood flow
Reduces edema
What is ES indicated for?
- chronic or recalcitrant wounds that are clean or infected
- stage III or IV pressure ulcers
- recalcitrant stage II pressure ulcers
What is the protocol for the inflammatory phase of ES?
- pulse rate 100-128pps
- intensity 100-150volts
- duration 60 minutes
- frequency 5-7x/week
What is the protocol for the proliferation phase of ES?
- pulse rate 100-128pps
- intensity 100-150 volts
- 60 minutes
- 5-7 x/week
What is the protocol for promoting epithelialization of ES?
- 60-64pps
- 100-150 volts
- 60 minutes
- 3-5 x/week
What are contraindications of ES for wound healing?
- malignancy in wound
- osteomyelitis
- thrombophlebitis/DVT
- pacemaker
- over carotid sinus
- over uterus if pregnant
- where there are metal ions (silver dressings)
What are the two physiological effects of negative pressure therapy?
Macrostrain:
- pulls edges together
- evenly distributes negative pressure
- removes exudate and infectious material
Microstrain:
- decreases edema
- promotes profusion
- promotes granulation tissue formation by facilitating cell migration & proliferation
What are the indications for negative pressure therapy?
- VI ulcers
- traumatic wounds
- skin grafts
- pressure ulcers
- partial thickness burns
- flaps
- diabetic ulcers
- dehisced wounds
- chronic wounds
- acute wounds
What are the potential drawbacks to negative pressure therapy?
- painful dressing changes
- tethered to machine
What are the treatment parameters for negative pressure therapy?
- 50-175 mmHg (max increase of BF at 125 mmHg)
- dressings change 48-72 hours
- continuous or intermittent cycle (usually continuous)
wound must be at least 80% clean and not actively bleeding
What are the contraindications of negative pressure therapy?
- foam in direct content with exposed blood vessels, anastomotic sites, organs, or nerves
- malignancy wounds
- untreated osteomyelitis
- non-enteric & unexplored fistulas
- necrotic tissue with eschar present
blood thinners are precaution
What does ultrasound help with when it comes to wound healing?
Increases:
- collagen deposition
- granulation tissue formation
- angiogenesis
Enhances wound contraction
Improves scar pliability
Low frequency = wound debridement
What is low frequency ultrasound used for?
- emerging as a method of wound bed preparation and healing
- for debridement and Bioburden reduction
- uses saline mist as medium to transmit energy
PPE required
What is hyperbaric oxygen?
100% O2 administered at >1.5 ATM
14x great oxygen dissolved in plasma
Uses transcutaneous oxygen monitoring to find good candidates for HBO
What are some indications for HBO?
- chronic or slow healing wounds
- wagner 3 diabetic foot wounds
- failed grafts/flaps
- necrotizing fasciitis
- late effects radiation wounds
- H/o severe anemia
- crush injuries
- compartment syndromes
- thermal burns
- gas gangrene
- AI
- decompression sickness (BENZ)
What are some contraindications for HBO?
- CHF
- DVT
- Claustrophobia
- pregnancy
- severe AI
- relative COPD
- non-complicated wounds
What is the protocol for HBO?
- chamber at 1.5-2.5 ATM for 90-120 minutes
- 2 x/day for 3x/week
- 10-60 sessions
What is ultraviolet light therapy at 280-400nm for?
- psoriasis
What is ultraviolet light therapy at 200-290nm for?
- germicidal
- increases vascular permeability and epithelial cell turnover
- enhances cell proliferation and granulation tissue formation
- promotes growth factor release
What is ultraviolet light therapy recommended for and what might it assist in healing?
May assist healing in:
- venous, arterial, pressure & neuropathic ulcers
Recommended for short term use to reduce bioburden in critically colonized stage III/IV pressure ulcers
What is infrared light?
Monochromatic infrared energy:
- delivers near-infrared energy at 890nm wavelength to skin via flexible diode pads
- shown to improve circulation up to 400%
minimal research
What is laser for?
- shown effects of improving healing in a variety of ways from stimulating cells to improving tensile strength of scars
What kind of physical agents or irrigation systems would you use on granular draining tissue?
- pulsed lavage w/ suction
- whirlpool
- E-stim
- low frequency US
possibly HBO
What kind of physical agents or irrigation systems would you use on granular non-draining tissue?
- Pulsed lavage w/ suction
- E-stim
- ultrasound
possible HBO
What kind of physical agents or irrigation systems would you use on necrotic draining tissue?
- whirlpool
- pulsed lavage w/ suction
- E-Stim
- Periwound US
- Low-frequency US
possible HBO
What kind of physical agents or irrigation systems would you use on necrotic non-draining tissue?
- Whirlpool
- Pulsed lavage w/ suction
- E-stim
- low-frequency US
- HBO
