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Integ Fall 2024 > Physical agents in Wound care > Flashcards

Physical agents in Wound care Flashcards

1
Q

What is the type of irrigation based on?

A
  • purpose of irrigation
  • wound presentation
  • wound etiology
  • intervention availability

can use saline or water

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2
Q

What is wound irrigation?

A
  • 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

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3
Q

What is angiocath/waterpik?

A

Angiocath: 35ml syringe and 19 gauge angiocatheter

Waterpik: low setting (6psi)

pressurized canisters at 4-15psi

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4
Q

What are the disadvantages of angiocath/waterpik?

A
  • messy
  • not for profusely bleeding wounds
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5
Q

At what PSI will damage or traumatize the wound bed?

A

> 15 PSI

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6
Q

What is pulsed lavage?

A
  • 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)
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7
Q

What are disadvantages with pulsed lavage?

A
  • NOT for wounds with exposed deep tissue/body cavities
  • anticoagulant precaution
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8
Q

What is whirlpool?

A
  • 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)
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9
Q

What are disadvantages of whirlpool?

A

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

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10
Q

What are the goals of irrigation?

A
  • remove necrotic tissue, debris, and bacteria
  • do not traumatize healthy wound bed
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11
Q

What is the PPE that should be used to pulsed lavage?

A
  • face shield
  • mask
  • fluid proof gown
  • fluid resistant shoe covers
  • gloves
  • hair covers
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12
Q

When should you discontinue pulsed lavage?

A
  • no increase in granulation tissue after 1 week
  • no decreased necrotic tissue for 1 week
  • wound closed
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13
Q

What is electrical stimulation for wound healing?

A
  • use of positive and negative polarity current in wound bed with electrodes or aluminum foil with use of dispersive pad
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14
Q

What is HVPC stand for?

A
  • Hi-Volt pulse current
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15
Q

What is the theory behind ES for wound healing?

A

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

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16
Q

What is ES indicated for?

A
  • chronic or recalcitrant wounds that are clean or infected
  • stage III or IV pressure ulcers
  • recalcitrant stage II pressure ulcers
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17
Q

What is the protocol for the inflammatory phase of ES?

A
  • pulse rate 100-128pps
  • intensity 100-150volts
  • duration 60 minutes
  • frequency 5-7x/week
18
Q

What is the protocol for the proliferation phase of ES?

A
  • pulse rate 100-128pps
  • intensity 100-150 volts
  • 60 minutes
  • 5-7 x/week
19
Q

What is the protocol for promoting epithelialization of ES?

A
  • 60-64pps
  • 100-150 volts
  • 60 minutes
  • 3-5 x/week
20
Q

What are contraindications of ES for wound healing?

A
  • malignancy in wound
  • osteomyelitis
  • thrombophlebitis/DVT
  • pacemaker
  • over carotid sinus
  • over uterus if pregnant
  • where there are metal ions (silver dressings)
21
Q

What are the two physiological effects of negative pressure therapy?

A

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

22
Q

What are the indications for negative pressure therapy?

A
  • VI ulcers
  • traumatic wounds
  • skin grafts
  • pressure ulcers
  • partial thickness burns
  • flaps
  • diabetic ulcers
  • dehisced wounds
  • chronic wounds
  • acute wounds
23
Q

What are the potential drawbacks to negative pressure therapy?

A
  • painful dressing changes
  • tethered to machine
24
Q

What are the treatment parameters for negative pressure therapy?

A
  • 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

25
Q

What are the contraindications of negative pressure therapy?

A
  • 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

26
Q

What does ultrasound help with when it comes to wound healing?

A

Increases:
- collagen deposition
- granulation tissue formation
- angiogenesis

Enhances wound contraction
Improves scar pliability

Low frequency = wound debridement

27
Q

What is low frequency ultrasound used for?

A
  • 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

28
Q

What is hyperbaric oxygen?

A

100% O2 administered at >1.5 ATM
14x great oxygen dissolved in plasma
Uses transcutaneous oxygen monitoring to find good candidates for HBO

29
Q

What are some indications for HBO?

A
  • 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)
30
Q

What are some contraindications for HBO?

A
  • CHF
  • DVT
  • Claustrophobia
  • pregnancy
  • severe AI
  • relative COPD
  • non-complicated wounds
31
Q

What is the protocol for HBO?

A
  • chamber at 1.5-2.5 ATM for 90-120 minutes
  • 2 x/day for 3x/week
  • 10-60 sessions
32
Q

What is ultraviolet light therapy at 280-400nm for?

A
  • psoriasis
33
Q

What is ultraviolet light therapy at 200-290nm for?

A
  • germicidal
  • increases vascular permeability and epithelial cell turnover
  • enhances cell proliferation and granulation tissue formation
  • promotes growth factor release
34
Q

What is ultraviolet light therapy recommended for and what might it assist in healing?

A

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

35
Q

What is infrared light?

A

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

36
Q

What is laser for?

A
  • shown effects of improving healing in a variety of ways from stimulating cells to improving tensile strength of scars
37
Q

What kind of physical agents or irrigation systems would you use on granular draining tissue?

A
  • pulsed lavage w/ suction
  • whirlpool
  • E-stim
  • low frequency US

possibly HBO

38
Q

What kind of physical agents or irrigation systems would you use on granular non-draining tissue?

A
  • Pulsed lavage w/ suction
  • E-stim
  • ultrasound

possible HBO

39
Q

What kind of physical agents or irrigation systems would you use on necrotic draining tissue?

A
  • whirlpool
  • pulsed lavage w/ suction
  • E-Stim
  • Periwound US
  • Low-frequency US

possible HBO

40
Q

What kind of physical agents or irrigation systems would you use on necrotic non-draining tissue?

A
  • Whirlpool
  • Pulsed lavage w/ suction
  • E-stim
  • low-frequency US
  • HBO

Integ Fall 2024 (8 decks)

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