Week 1 Debridement Part 2 Flashcards
what is mechanical debridement
non selective, and soft abrasion or scrub, hydrotherapy, or even wet to dry, and low frequency ultrasound
is mechanical debridement painful
yes, because it does not discriminate between viable and non-viable tissues
the is wet to dry indicated
when 100% not viable
is enzymatic debridement selective? and what is it
yes, selective, and it is pain free way to debride, and easy to apply
can we do enzymatic debridement on infected wounds
yes, in combination with polymyxin B power
can we use enzymes with silver or iodine products
no
what is a name of an enzymatic treatment we use
collagenase santyl
how does enzymatic treatment work
the denatured collagen filaments anchor debris to the wound bed, and the collagenase digests the collagen filaments
what are the 4 dressing types we can never use enzymatic with
silver
iodine
hydrogen peroxide
acetic acid
how much do we apply at a time
thickness of a nickel
what do we cover the enzyme with
saline moist gauze
what happens if it is not clean in 2 weeks
switch to another method
enzymatic is frequently used for
burns
can we use enzymes on the face
no
what are adverse effects of enzymes
burning/stinging
allergic reaction
peri-wound irritation
contraindications for enzymatic
takes too long
not for deeper wounds with tracts, in cavities, or with named tissue
not for the face
what is autolytic debridement
selective and conservative and least painful way to debride its also cheap but takes a while
what is the least painful type of debridement
autolytic
how does autolytic favor a good wound environment
the dressing is kept moist and warm, and cooks the wound. with hydrocolloid, transparent films, foams and hydrogels.
when is autolytic indicated
pain, palliative care, or can’t sit still (like PD)
what are contraindications for autolytic
infection or gangrene, or deep cavities, or when other things are more appropriate
what are the disadvantages of autolytic
odor the removed, time and can’t see the wound
when do you change autolytic
when you see strike through or that it is soiled
what can you combine autolytic with
cross hatching
what 3 things are combined in a combo debridement
sharp (to remove loose tissue, and cross hatch thicker areas)
enzymatic to non-viable areas
autolytic (warm and well insulated and which
what can we educate the patient on
rest, nutrition, habits and lifestyle
what is biological/biosurgical debridement
using maggots or larva to quickly and selectively get non-viable tissues. also, helps to decrease odor
what do maggots and larva do to tissues
releases an enzyme to degrade non-viable tissues and biofilm
what kind of effect does biologic debridement have
antimicrobials, MRSA, STREP, pseudomonas, biofilm, changes the pH and kills and ingests bacteria.
what do biologic excretions help with
stimulate the granulation tissue growth
what are sterile biologic
from Irvine CA, 300 for 98$, and you can only use 10 per cm2 area. NO REPRODUCTING
what are free range or contained
need air, and they cannot be sealed off, so they have a mesh cover over them, and you need to cover them with dry gauze to not kill them
in what kind of population can we use biologic
osteoporosis with infection around the hardware
poor candidate for surgery
can’t handle other forms of debridement
where is biosurgical contraindicated
eyes, GI, respiratory tracts ALLERGY to fly larva or yeast or soy exposed vessels, connecting to organs decreased perfusion malignant wounds
what are precautions with biosurgical
maggots can drown or get squished and patient with bleed disorder
what are indications for surgical debridement
complex wound gross infection or high risk infection too much nonviable tissue lots undermining unknown depth or abscess fistula named structures bleeding tendency, high pain or trauma
how do you determine the type of debridement
what works best for them, makes most sense? safety? cost? risks? combination? can I do it, am I comfortable?
what is ultrasound based debridement
low frequency tissue vibration that has antimicrobial effects. it lifts the dead tissue.
