Week 1 Flashcards
1
Q
What are the phases of wound healing?
A
- Inflammation
- Proliferation
- Maturation/re-modeling
2
Q
What are the types of responses we get in the inflammation phase of healing?
A
- Vascular response
- Cellular response
3
Q
What is the goal of the vascular response of the inflammation phase of healing?
A
Control bleeding, fight infectious agents
4
Q
What are the events that occur during the vascular response of the inflammation phase of healing?
A
- Transudate leaks out of vessel walls: local edema
- Local blood vessels reflexively constrict
- Platelets aggregate and are activated: forms a plug to wall off affected area and closes off lymphatic channels creating more edema, release chemical mediators necessary for wound healing
- Within 30 minutes of vasoconstriction, vasodilation occurs: localized redness, warmth, edema
5
Q
What are the cardinal signs of the vascular response of the inflammation phase of healing?
A
Edema, redness, warmth, pain, decreased function
6
Q
What are the events that occur during the cellular response of the inflammation phase of healing?
A
• Increased leakiness of vessel walls: pushes polymorphonuclearneutrophils (PMNs) to sides of vessel walls
(Margination)
- PMNs: 1st to site of injury (12-24 hours), kill bacteria, clean
wound, secrete matrix metalloproteases (MMPs)- degrade debris
• Macrophages arrive: kill pathogens, direct the repair process
• Mast cells: produce histamine and secrete enzymes to accelerate
riddance of damaged cells
7
Q
What are the key cells present in the cellular response of the inflammation phase of healing?
A
- Platelets
- PMNs
- Macrophages
- Mast cells
8
Q
What are the events that occur during the proliferation phase of healing?
A
• Angiogenesis- formation of new blood vessels
• Granulation tissue- Fibroblasts lay down extracellular matrix
(eventually replaced by scar tissue)
• Wound Contraction – myofibroblasts pull wound margins
together
• Epithelialization- keratinocytes and epidermal appendages
multiply and migrate across wound bed
9
Q
What are the key cells present in the proliferation phase of healing?
A
- Angioblast
- Fibroblast
- Myofibroblast
- Keratinocyte
10
Q
What are the events that occur during the maturation phase of healing?
A
• Granulation tissue must be strengthened and reorganized
• Rapid collagen synthesis
• Up to 2 years following wound closure
- Greatest change in first 6-12 months
• 80% of full tissue strength
• Unable to sweat- loss of sweat glands
• Less sensitive to touch and temperature
11
Q
What are the type of factors that can affect wound healing?
A
- General
- Local
- Clinician
- Systemic
12
Q
What are the general factors that can affect wound healing?
A
• Mechanism of Onset • Time since onset – Acute vs Chronic • Location- consider blood supply, bony prominences, typical skin thickness • Wound Dimensions- Circular is slower than square or rectangle is slower than linear • Temperature (37-38 degrees C is best) • Wound Hydration • Necrotic tissue • Infection
13
Q
What are the local factors that can affect wound healing?
A
- Circulation
- Sensation
- Mechanical Stress
14
Q
What are the circulation local factors that can affect wound healing?
A
- Macro(checking pulses) and Micro
* Sympathetic nervous system responses to: cold, fear, and pain
15
Q
What are the sensation local factors that can affect wound healing?
A
- Decreased knowledge of pain
* Additional trauma to area
16
Q
What are the mechanical stress local factors that can affect wound healing?
A
- Friction
- Shear
- Weight bearing
- Pressure
17
Q
What are the systemic factors that can affect wound healing?
A
- Age: normal physiologic changes
- Nutrition
- Comorbidities
- Medications
- Behavioral Risk Taking
18
Q
What are the “age” systemic factors that can affect wound healing?
A
- Slowed immune response
- Decreased collagen synthesis
- Epidermal and dermal atrophy (thinner skin)
- Less sweat and oil glands (dryer skin)
- Decreased pain perception
- Decreased inflammatory response
- More co-morbidities
- More susceptible to infection
- More medications
19
Q
What are the “nutrition” systemic factors that can affect wound healing?
A
- Carbohydrates for energy
* Protein for cellular repair/regeneration (most imp)
20
Q
What are the “comorbidities” systemic factors that can affect wound healing?
A
• Those affecting O2 perfusion - PVD, anemia, COPD, heart conditions • Immunocompromised - HIV/AIDS, diabetes • Activity limitations
21
Q
What are the “medications” systemic factors that can affect wound healing?
A
- Steroids
- Chemotherapy
- NSAIDS
22
Q
What are the “behavioral risk taking” systemic factors that can affect wound healing?
A
- Smoking
* ETOH
23
Q
What are the clinician induced factors that can affect wound healing?
A
- Inappropriate Wound Care
* Appropriate Wound Care
24
Q
What are the “inappropriate wound care” clinician induced factors that can affect wound healing?
A
- Prolonged or inappropriate use of antiseptics
- Wrong dressing selection (macerates or dries out)
- Failure to detect/treat infection
- Inappropriate irrigation, debridement, compression, etc.
- Poor wound exploration
- Poor temperature management
25
What are the "appropriate wound care" clinician induced factors that can affect wound healing?
* Initial use of antiseptics to kill everything
* Maintenance care when wound healing is not priority
* Use of iodine to encourage/maintain non-viable tissue desiccation
26
What are the types of wound closure?
* Primary (Primary Intention)
| * Secondary (Secondary Intention)
27
What are the events of primary wound closure?
* Wound edges are approximated without/little formation of granulation tissue.
* Not typically seen by PT unless preparing for delayed primary closure
28
What are the events of secondary wound closure?
* Wound edges unable to be approximated
* Granulation tissue fills in wound bed
* PT more likely to be involved
29
What are the benefits of moist wound healing?
• Enhance wound healing and promote new tissue growth
• Low moisture levels… lead to necrosis and eschar formation,
hindering wound re-epithelialization and closure
• Moisture balance of the wound bed is critical for wound healing
30
What is one of the major roles of the PT in wound healing?
Wound Bed Preparation
31
When does the PT perform wound bed preparation?
After comprehensive examination : Assessment
32
What are the events that occur in the assessment of a wound?
• Determine the ability of the wound to heal (includes underlying cause, pt
status, complicating factors, etc. "broad picture")
- Healable (address underlying cause)
- Maintenance (potential but barriers)
- Non-healable/palliative (irreversible causes/illnesses)
• Once status determined, appropriately dose care
33
What should be done if a wound falls into the "healable" assessment of a wound?
```
• Address underlying cause
• Move to “local wound care” or DIME
- Debridement
- Inflammation/infection
- Moisture balance
- Edge effect
```
34
What is DIME used for?
Use to determine approach to local wound care & wound assessment
– If you have no idea where to start, start here!
35
What are the components of "debridement" in DIME?
What tissues are present, safe to debride, type, frequency
36
What are the components of "inflammation/infection" in DIME?
What stage of healing, immunocompromised, activity, s/s of infection, s/s out
of proportion for phase of healing
37
What are the components of "moisture balance" in DIME?
Tissue type/quality, maceration, activity, infection, dressing schedule, out of proportion, add or absorb moisture
38
What are the components of "edge effect" in DIME?
Progressing, stalled/rolled, callus, clean
39
Where is patient history gathered from?
From patient, medical record, family, caregivers etc.
40
What are the components included in the patient history?
* General Demographics
* Lifestyle and Functional Status
* Past and Current Medical History
* Past and Current Wound History
* Systems Review
41
What is included in the general demographics portion of the patient history?
* Age
* Sex
* Ethnicity
* Primary language
* Education
42
What is included in the lifestyle and functional status portion of the patient history?
* Living environment
* Prior and current level of function
* Employment
* Health habits (smoking, ETOH, nutrition, sleep, stress)
43
What is included in the past and current medical history portion of the patient history?
* All the usual information collected (Review of systems)
* Medications
* Allergies
44
What is included in the past and current wound history portion of the patient history?
* Acute or Chronic (How long has the wound been present? When and how did you get the wound?)
* Has the patient had any tests run (labs, wound cultures, vascular studies, radiologic studies)?
* Has the wound improved or is it getting worse?
* Pain
* Other wounds in the past
* Dressing being used and when last changed
45
What are the wound specific tests and measures?
* Location
* Size
* Wound bed (Tissues)
* Wound edges
* Drainage
* Odor
* Periwound
46
How do we use the location of a wound as a test and measure for the wound?
• Correct terminology to describe location
- Be specific & consistent
- Medial/lateral, left/right, proximal/distal, etc.
• Body chart or drawings
• Photos
• Multiple wounds
- Assign numbers
47
How do we use the size of a wound as a test and measure for the wound?
Direct measurement (in cm)
• Length (longest)
• Width (perpendicular to length)
• Depth (deepest)
Clock Method: 12-o’clock in area of wound closest to head, but
can be assigned a different position by clinician
• Length (12-6)
• Width (9-3)
• Depth (various clock positions, 2,4,8,10, or others)
48
How do we use the wound bed as a test and measure for the wound?
Tissue Identification- Describe in percentages present
49
What are the types of tissue that can be present in a wound bed?
• Granulation tissue
• Necrotic or non-viable
• Fascia, adipose, muscle, tendon, joint capsule, bone, new
epithelium
50
What is the granulation tissue that can be present in a wound bed?
Temporary scaffolding of vascularized connective tissue; healthy granulation is bright beefy red; if pale or dusky, blood supply may be poor or may be infected.
**This is the type of tissue we want**
51
What is the necrotic or non-viable tissue that can be present in a wound bed?
* Slough- yellow or tan, stringy or mucinous
| * Eschar- black necrotic tissue, soft or hard, wet or dry, adherent or nonadherent to the wound bed
52
What is undermining?
When the - tissue under wound edge is gone, similar to a cave under the skin, “waggle room”
• Documentation example: undermining of 4 cm from 10-12 o’clock
53
What is a tract?
Narrow passageway, tube like extension of wound
| • Documentation example: Tract at 5 o’clock 7 cm.
54
What is a tunnel?
Entrance and exit
| • Document location and length
55
What are the ways that a wound edge can be?
* Well defined (demarcated) or defuse
* Thick or thin
* Attached to wound base(preferred) or raised or rolled (epibole: new epithelium is rolling over itself, requires surgery to correct)
* Color
* Evidence of epithelialization
56
How is the drainage of a wound described?
Type, Color, Consistency, Amount
57
What are the characteristics of serous drainage seen on a wound?
* Protein rich fluid with white blood cells
| * Clear-pale yellow, watery
58
What are the characteristics of sanguineous drainage seen on a wound?
* Blood or drying blood
| * Red-dark brown, consistency of blood or slightly thickened water
59
What are the characteristics of purulent drainage seen on a wound?
* Indicator of infection
| * White-pale yellow, viscous or creamy consistency
60
What are the characteristics of the amount drainage seen on a wound?
None, minimal, moderate, copious
| • Must consider dressing used and when last changed
61
When is the odor of a wound assessed?
Assessed after irrigation
| • Present or absent
62
What causes the odor of a wound?
* Wound infection
* Non-viable tissue
* Old dressing
* Hot weather
63
What are the components that needs to be assessed in a periwound?
• Palpation - induration, fluctuance, general edema, increased
temp, etc.
• Maceration (macerated), healthy, intact, dry/peeling, etc.
• Skin: color, texture, dryness, hair, etc.
• Callus
• Local signs & symptoms of infection
• Sensation
• Circulation
64
What are healthcare-associated Infections (HAI)?
Infections patient get while receiving treatment for medical or surgical conditions
65
What are the most common healthcare-associated Infections (HAI)?
* Central line-associated bloodstream infections
* Catheter-associated urinary tract infections
* Surgical site infections
* Ventilator-associated pneumonia
66
_____ is key towards healthcare-associated Infections (HAI)
*Prevention* is key towards healthcare-associated Infections (HAI)
67
What are the ways to prevent healthcare-associated Infections (HAI)?
* Wash hands
| * Prevent contamination from one patient to the next
68
The opportunities for handwashing are before and after what...?
- Wearing Gloves
- Patient Contact
- Any Patient Procedure
- Environmental or equipment contact
69
What is the procedure for washing with soap and water?
• Thoroughly wet hands with warm water
• Apply soap and rub hands together using friction for at least 15 seconds
• Be sure to wash backs of hands, between fingers, fingertips, and around
jewelry
• Rinse hands with warm water being sure to avoid splashing and with your hands pointed in a downward direction
• Dry with paper towel and then use paper towel to turn water faucet off
70
When must the hands be washed with soap and water?
* Hands are visibly dirty
* After using the restroom
* Leaving a patient/environment with Clostridium difficile (C. diff) infection
71
When can alcohol hand rub be used?
Use when hands are NOT visibly soiled
72
What is the procedure for washing with alcohol?
* Get enough product to saturate all parts of your hands
* Rub hands together for 15 seconds
* Allow product to dry
73
What are the items included in a Personal Protective Equipment (PPE)?
* Gloves
* Gown
* Mask
* Glasses
* Face shield
* Shoe Covers
74
Who provides PPE for employees?
OSHA requires employers
| to provide PPE for employees
75
What are standard precautions used for?
* All patients, all settings
* Primary strategy for prevention of HAI
* Protect you and the patient
76
What are transmission precautions used for?
* Contact
* Airborne
* Droplet
77
What is a standard precaution?
A combination of universal precautions and body substance isolation
78
What do all standard precautions assume?
All blood, body fluids, secretions, excretions (except sweat), nonintact skin, and mucous membranes contain transmissible infectious agents
79
What does a standard precaution include based on anticipated exposure?
* Hand hygiene
* Gloves
* Gowns
* Face shields/masks
* Eye protection
80
When are transmission precautions used?
* Used when route of transmission is not covered by standard precautions alone
* Always used in addition to standard precautions
* More than one can be combined for those agents that have multiple modes of transmission
81
What are contact precautions used for?
• Prevent transmission of infectious agents that are spread by direct or indirect contact with the patient, equipment, patient’s
belongings, or patient’s surface environment
• Also used when environmental contamination from excessive
wound drainage, fecal incontinence, and other body discharges may be present
• Private rooms should be utilized if available or at minimum >/ 3 feet of separation b/w beds to avoid sharing of equipment and touching of surfaces
82
What is the common mode of infection transmission?
Contact
83
What are the PPEs used during a contact precaution?
* Gloves
| * Gown
84
What are the contact precautions?
* Wash hand before entry
* Don after entry into the room
* Doff before exiting the room
* Wash hands after exiting room
85
What are the common infectious diseases requiring contact precautions?
• MDROs (Multi-drug resistant organisms)
- MRSA- Methicillian-resistant Staphylococcus Aureus
- VRE- Vancomycin-resistant Enterococci
• CRE – Carbapenem-resistant Enterbacteriaceae
• Ebola
• C. difficile
• Norovirus
• RSV
• Rotavirus
• Herpes Zoster (Shingles)- in some cases
• Scabies
86
What are droplet precautions used for?
• Prevent spread of infectious agents by close mucous or
respiratory membrane contact
- Usually passed through a cough, sneeze, or talking
• Private room preferred but if not available, spatial separation of >/ 3 feet needed and curtain drawn between patients
87
What are the PPEs used in a droplet precaution?
Mask on healthcare provider or on patient if transport
outside of the room necessary
• Don upon entry , Doff before exit
88
What are the common infectious disease needing droplet precautions?
```
• Ebola
• Pertussis (Whooping Cough)
• Influenza
• Rhinovirus
• Pneumonia
- Adenovirus
• Streptococcus Group A
• Rubella
```
89
What are airborne precautions used for?
Prevent spread of disease that remain infectious over long
| distances
90
What are the room precaution used for airborne precautions?
If possible pt. should be placed in an airborne infection isolation room (air)
• Negative pressure relative to the surrounding area
- Patient room with an ante room. Both doors are kept closed . When pt. room door is opened the air is sucked into the room rather than escaping out of the patient room.
• If not possible, private room, door closed until patient can be
transferred to an air
91
What are the PPEs used in a airborne precaution?
Respirator (N95)
• Must be fit tested
• Don in ante room prior to entering patient room
• Doff in ante room after patient door is closed
92
What are the common infectious disease needing airborne precautions?
* Tuberculosis
* Measles
* Chickenpox
* Smallpox
93
OSHA requires ____ or all chemicals and substances used in work facilities
OSHA requires *Safety Data Sheets (SDS)* for all chemicals and substances used in work facilities
***These were formerly known as Material Safety Data Sheets
(MSDS)***
94
What information is included in the Safety Data Sheets (SDS)?
* Product, manufacturer, distributor
* Hazards of the chemical
* Ingredients
* First aid measures
* Handling and storage
* Protection required
* And more!
95
What are some additional safety tips used for infection control?
• Always dispose of sharps in a sharps container
- Never recap a needle or scalpel
- Never take a sharp out of a sharps container
• Do not blind sweep bed linens
• Protect breaks in the skin
• Do not eat, drink, handle contact lenses, apply cosmetics or lip balm in patient care areas
• Use mouthpieces, resuscitation bags, and ventilation devices for CPR
96
What is wound irrigation?
The use of fluid to remove loosely adherent cellular debris, surface bacteria, wound exudate, dressing residue, and residual topical agents.
97
What are the functions of wound irrigation?
* Facilitate debridement
* Maintain moist wound environment
* Enhance wound healing
98
What are the indications for wound irrigation?
* All types of wounds with a few exceptions
| * Perfect treatment for a healing granular wound
99
What are the contraindications for wound irrigation?
```
• Do not immerse/soak
- Recent skin grafts
- Recent surgical incision sites
- Diabetic feet
• Active profuse bleeding wounds
• Dry Gangrene
```
100
What are the different types of irrigation solutions used?
* Normal saline (0.9% sodium chloride)
* Sterile water
* Tap water
* Wound Cleansers
101
What are the characteristics of normal saline irrigation solution?
• Can be made at home
• Refrigerate but warm before use
- Wounds heal best when kept under warm conditions
102
What are the characteristics of sterile water irrigation solution?
Must use with silver dressings
103
What are the characteristics of tap water irrigation solution?
Caution with the immunocompromised
104
What are the characteristics of wound cleansers irrigation solution?
* Shur-Clens® - surfactant (oil, grease)
* Vashe® - hypochlorous acid – antimicrobial, Rx
* Wound Wash
105
What are the characteristics of other irrigation solutions?
Antiseptics- use cautiously
• Acetic Acid: Pseudomonas
• Chlorhexidine gluconate (Hibiclens): intact skin, surgical scrub
• Dakin’s solution (sodium hypochlorite, bleach): inanimate objects
• Chloramine-T (Chlorazene): heavily colonized or infected wounds
• Hydrogen peroxide: Cleanse around pin sites and sutures
• Povidone-iodine (Betadine): surgical scrub, very short term acute
106
What are the different types of irrigation?
* Gentle irrigation and rinsing
* Safe and effective psi
* Low pressure capsules
* psi 4-8 max 10
107
What are the types of debridement, deep cleaning, tissue stimulation used for irrigation?
```
• Low pressure lavage
• Whirlpool (WP)
• Pulsed lavage with suction
- PLWS
- “Pulsatile lavage”
```
108
What are the characteristics of low pressure lavage?
```
• Irrigation without suction
• Jetox
- 4-12 psi
- Uses Wall O2 as pressure
- Jet stream tip
```
109
What are the positives of a whirlpool?
* Cleanses
* Agitation
* Additives
* Temperature range
* Tx large areas
* Exercise
110
What are the negatives of a whirlpool?
```
• Risk of infection
- Sterility
- Aerosolization
• Risk of tissue injury
- psi?
- maceration
• Additives
• Expense
- Cleaning, space, water
```
111
What are the contraindication of a whirlpool?
* Clean & granulating
* Edematous, draining, macerated
* Active bleeding
* VI
* Multi-wounds same area
* Uncontrolled seizures
* B&B issues
112
What is a Pulsed Lavage with Suction (PLWS)?
Irrigation with Suction
• Pulsed jets of irrigation with suction
• Creates a negative pressure
113
What are the positives of a Pulsed Lavage with Suction (PLWS)?
```
• Cleaning
• Known psi
• Sterile, no additives
• Temperature range
• Site specific
• Portable
• Disposable – easy
cleanup
• Few contraindications
```
114
What are the negatives of a Pulsed Lavage with Suction (PLWS)?
• Expense
• Aerosolization risk
- Confined space
- Cover horizontal surfaces
115
What are the contraindications of a Pulsed Lavage with Suction (PLWS)?
* Exposed named tissues
* Body Cavities
* Facial wounds
* Recent grafts or surgical procedures
* Actively bleeding
116
What are the purposes of wound debridement?
* Decrease bioburden & risk of infection
* Increase effectiveness of topicals
* Improve bactericidal activity of leukocytes
* Shorten inflammatory phase
* Decrease energy required by the body to heal
* Eliminate physical barriers
* Decrease wound odor
117
What are the goals of debridement?
```
• Conversion from chronic to acute
• Reduction in bacteria
• Improved environment for closure
• Prep for grafting or surgical closure
• Tissue protection or exam
- Callus, blisters
```
118
What are the contraindications for debridement?
```
• Arterial compromise
- Stable, dry, hard eschar
• Others:
- Viable tissue
- Granular tissue
- Electrical burns
- Deeper tissues
```
119
What are the indications for debridement?
The color of the wound:
• Red (granulation, do not debride)
• Yellow (likely pus- debride)
• Black (debride, depending on location and other factors)
120
What kind of tissue can the PT debride?
Non-viable tissue, callus, blister
121
What are the type of tissues that a PT can NOT debride and has to be done by a physician?
Live Tissue
- Large amount of non-viable
- Infection
122
What are the things to consider when deciding whether or not to debride a wound?
```
• Urgency
• Resources
• Skill
• Wound etiology
• Health status of pt
- Medications
- Mobility
- Nutrition
• Consistent with pt goals
```
123
What are the methods of debridement?
```
• Sharp (MDs, PTs, PTAs, Nrsg)
• Mechanical
• Enzymatic
• Autolytic
• Biologic
• Surgical (MDs)
- Named structures, large stage III and IV pressure injuries, significant undermining, tunneling, or sinus tracts, epibole
```
124
What are the characteristics of the sharp method of debridement?
```
• Fast
• Aggressive
- high level of skill
• Painful occasionally
• Often combined w/other forms
• We need specific MD order
• Selective(targeting non viable tissue) - forceps, scissors, scalpel, curette
```
125
What are the different instruments used for the sharp method of debridement?
- Forceps (held in non dominant hand)
- Scissors: Blunt mayo, or iris scissors (held in dominant hand)
- Common scapels (#10 blade, #11 blade, #15 blade)
- Curettes (3mm & 7mm)
126
What are the indications for sharp debridement?
Presence of nonviable tissue/callus
• Amount of nonviable tissue rendering other methods too slow (infection or risk)
• Advancing cellulitis
127
What are the precautions to take for sharp debridement?
* Anticoagulants/clotting issues, pain
* Immunosuppression
* Unable to be still
128
What are the contraindications sharp debridement?
* PT comfort/skill level
* Cannot see (tracts, etc.) or identify tissue
* Consent, not consistent w/POC
* Ischemic ulcers (AI)
* Hypergranulation – live tissue
* Pyoderma gangrenosum
129
What are the warning signs to stop sharp debridement?
* Pt request, pain control issues
* Wound is clean
* You get nervous, tired, unsure
* Impending exposure of named structures
* Holes you cannot see the bottom of
* Unexpected infection/purulence
* Extensive undermining
* Excessive bleeding
130
True or False
When you see slight bleeding during sharp debridement, stop immediately
False
May have slight bleeding – connected to live tissue
131
How do you control bleeding during sharp debridement?
* Elevate, pressure x 10 min, silver nitrate (MD)
| * If structure pulsates, do not cut it!
132
What can you do to help monitor pain control during sharp debridement?
Meds 30 min prior, topicals, deep breathing, music, distraction, etc
133
When do we contact the MD during sharp debridement?
* Bleeding has a pulse, won’t stop, hear it
* Fever/chills, downhill course, no improvement, impending exposure of named structures, unexpected abscesses or gross purulence
134
What is the technique for sharp debridement?
* Hold scalpel/scissors in the dominant hand and forceps in non dominant hand
* Cut parallel to plane of wound tissue
* Remove tissue in thin layers (small slices)
* Can sometimes use a “scrape” technique Take your time, if unsure/tired, etc.
* Lift necrotic tissue w/forceps
* Avoid sawing
135
What are some tips to do when doing sharp debridement?
* Nonviable tissue doesn’t bleed, but is attached to viable
* Opens direct pathway to pt’s vascular system = Increased risk of infection
* Good to take pics before & after
* Warn pts wound will be deeper/bigger
136
What are the indications to debride a blister?
* Larger than nickel
* Area likely to rupture or tear
* Worried about possible tissue injury – burns
* Common sense
* Great medium for bacterial growth
137
What is the technique to debride a blister?
* Secure w/forceps
* Release tension carefully – can be high
* Skin/blister line
* Clean away residue, can appear like jelly
138
What are the criterias used to determine the form of debridement to chose for a patient?
* Use common sense
* What will work best for this patient?
* What can they tolerate?
* Will they need to do this at home?
* Safety concerns
* Cost
* Risks? (speed of removal, etc.)
* Combo?
* Is this something I can handle?
139
What are the characteristics of ultrasound based debridement?
Low-frequency contact US (kilohertz)
• Tissue vibration (unstable cavitation)
• Sonoca 180® (Soring Medical Technology)
• Qoustic Wnd Therapy System™ (Arobella Medical
LLCArobella)
• SonicOne® (Misonix, Inc)
• Antimicrobial effects as well
140
What are the indications for surgical debridement?
* Complexity of wound
* Gross infection or high risk of infection
* When amount of nonviable tissue is too much within acceptable timeframe
* Extensive undermining
* Unknown depth or abscess
* Involves fistula
* Named structures
* Bleeding tendency, extreme pain, or trauma
141
What are the contraindications for biosurgical debridement?
* Near the eyes, upper GI or upper respiratory tract
* Allergy: fly larvae, brewer’s yeast, soy
* Exposed blood vessels connecting to deep vital organs
* Decreased perfusion
* Malignant wounds
142
What are the precautions for biosurgical debridement?
* Drown in heavy exudate, squished by pressure
| * Pts with bleeding disorders
143
What type of debridement is mechanical debridement?
Nonselective: meaning that it doesn't discriminate between non-viable or viable tissue
144
What are the types of mechanical debridement?
* Soft abrasion
* Hydrotherapy (WP: whirlpool, PLWS)
* Wet to dry or wet to moist (only indicated for 100% nonviable wound)
* Low frequency contact ultrasound
145
What are the characteristics of mechanical debridement?
* Can be painful
* Can be effective if used correctly
* Familiar to health care workers
146
What type of debridement is enzymatic debridement?
Selective: targets only nonviable wounds
147
What enzyme is used for enzymatic debridement?
Collagenase Santyl
148
What are the characteristics of enzymatic debridement?
```
• Physician prescription
• Pain free – some say it stings
• Easy to apply- once daily
• Can be used on infected wounds (combo)
- Polymyxin B powder added
• Do not use with silver or iodine products
```
149
How does enzymatic debridement work?
* Denatured collagen filaments anchor debris to the wound bed.
* Collagenase digests these collagen filaments
150
Do not use enzymatic debridement with dressing containing ___?
* Silver
* Iodine
* Hydrogen Peroxide
* Acetic Acid
151
What are the parameters to the use of enzymatic debridement?
• Discontinue when “clean”
- Can promote cell migration
• Application: thickness of a nickel, must be kept moist
• cover w/saline moist gauze, Adaptic, hydrogel, etc.
• If not “clean” in 2 wks, switch to other method
• Frequently used for burns, except on face
• May take longer if used alone (combo)
152
What are the adverse effects that may bee seen in enzymatic debridement?
• Burning/stinging, allergic reaction
• Peri-wound irritation
- Highly exudative wounds, contact w/skin
153
What are the contraindications of enzymatic debridement?
```
• Timeframe – take too long
• Not for deeper wounds:
- Tracts, body cavities
- Named tissues (organs, nn, vessels, tendon, bone, ligs)
• Facial burns
```
154
What type of debridement is autolytic debridement?
Selective: allows the body to get rid of non viable tissue
155
What are the characteristics of autolytic debridement?
* Conservative
* Least painful, easy
* Cheaper – but takes time
156
How does autolytic debridement work?
Maintains favorable wound environment
157
What are the indications for autolytic debridement?
Pain, palliative tx, can’t be still
158
What are the most common forms of dressing for autolytic debridement?
* Occlusive dressings, moist, warm - “cook” (most common)
* Hydrocolloid
* Transparent films
* Foams
* Hydrogels
159
What are the contraindications for autolytic debridement?
* Infection, dry gangrene, deep cavity wounds
| * Other methods more appropriate
160
What are the disadvantages for autolytic debridement?
* Odor upon removal
* Time
* Infrequent visualization
161
When is an autolytic debridement changed?
At “strike thru” or soiled
162
When is an autolytic debridement combined with cross hatching?
When there is thick non viable tissue
163
What are the most commonly used combo debridement methods?
```
Sharp – removed loosely adherent tiss
• Cross hatched thicker areas
Enzymatic
• Applied Collagenase to all nonviable areas
Autolytic
• Warm, well insulated, thick dressing
```
164
Biosurgical debridement utilizes what?
```
Maggot Therapy (MT)
• larval debridement therapy (LDT)
```
165
What type of debridement is biosurgical debridement?
Selective
166
How does biosurgical debridement work?
Maggots ingest nonviable tissue & decrease odor and release enzymes that degrade nonviable tissue & biofilm!
167
What are the characteristics of biosurgical debridement?
The maggots are antimicrobial - MRSA, Strep, Pseudomonas, biofilm
• Changes in pH
• Killing (secreted enzymes) & ingestion of bacteria
• Excretions & mvmt stimulate granulation tissue
168
What are the characteristics of the maggots used for biosurgical debridement?
* Sterile, non-reproducing
* 10 maggots for 1cm2 wound surface area
* “Free range” or “contained”
* Don’t travel around in body
169
What are the key to biosurgical debridement?
* Need air – so don’t seal off – nylon mesh cover
* Covered w/dry gauze to absorb drainage & allow air flow
* Change ~ 3 days
170
What is the patient population that are good for biosurgical debridement?
* Osteo, inf around hardware, etc.
* Poor candidate for surgery
* Unable to tolerate other forms of debridement
171
What is the percentage of tissue oxidation increase after 46 hours of not smoking?
10%
