Week 11 Irrigation/Physical Agents/ Wound Management Flashcards
T/F wound irrigation is just wound cleansing
False
Wound Irrigation: Definition
- Using fluid to remove dressing residue/residuals form topical agents and loosely adhered devitalized tissues as well as surface bacteria from a wound bed
T/F every wound should be irrigated after removal of dressing?
True
Goal of Irrigation
To remove necrotic tissue/debris/bacteria
Angiocath/Waterpik
- 35 ml syringe and 19 Gauge angiocatheter
- waterpiks setting at 6psi
- Pressurized saline canister
- Pressure between 4-15 psi but psi is really high be careful
- After WP, is shown to remove 4x amount of bacteria
- messy
- NOT FOR PROFUSELY BLEEDING WOUNDS
Pulsed Lavage
- Irrigant delivered under controlled pressure (4-15psi) with suction using hand-held device
- Suction Provides negative pressure removing irrigant and pathogens
- GOOD for wounds with tunneling and undermining
-NOT for wounds with exposed deep tissue/body cavities - Anticoagulant precaution
Whirlpool
- Are appropriate for very large amounts of necrotic tissue
- appropriate for individuals with eschar from burns
- Treatment time 10-20 minutes
- Turbine/ jet shouldn’t be directly on wound
- Water additives: know why you are doing it not always necessary
- Goal is to get rid of necrotic tissue, debris, bacteria
- Increase in limb size even if they don’t have VI
Whirlpool Contraindications
- Venous Insufficiency
- Edematous extremities
- Acute phlebitis
- Acute cellulitis
- DVT
- Incontinence
- Dry gangrene
PPE for Pulsed Lavage
- Face shield
- Mask
- Fluid proof gown
- Fluid resistant shoe covers
- Gloves
- Hair covers
Electrical Stimulation for Wound Healing Theory
- Use of bioelectrical current attracts cells to increase wound healing
**GALVANOTAXIS -
Stimulate cell migration, proliferation
-Increases bactericidal effects - ***Promotes autolytic debridement
- Restores positive potential to wound
- Increased blood flow
- reduces edema
Indications for Electrical Stimulation for Wound Healing
- Chronic wounds
- Recalcitrant wounds ( wounds that won’t heal) clean or infected
- Stage III/IV pressure ulcers
- Recalcitrant stage II pressure ulcers
What are the Medicare Guidelines for Electrical Stimulation for Wound Healing
- must treat wound conservatively for 30 days prior to initiating,
- must be stage III/IV pressure ulcer
- will cover arterial, venous and diabetic wound treatments
- progress must be documented at 30 days to continue treatment
Electrical Stimulation For Wound Healing Protocol Negative
Cathode
- Inflammatory phase
- Pulse rate 100-128pps
- Intensity 100-150 volts
- Duration 60 minutes 5-7x a week
Electrical Stimulation For Wound Healing Protocol Positive
Anode
- promote granulation tissue (proliferation)
- 100-128pps, 100-150 volts for 60 minutes 5-7 times a week
- Promote epithelialization
- 60-64pps, 100-150 volts, 60 minutes 3-5 times a week
Electrical Stimulation for Wound Healing Contraindications/Precautions
- Malignancy in wound
- Osteomyelitis
- Thrombophlebitis
- Pacemaker
- Over carotid sinus
- Over uterus
- Where there are metal ions (silver dressing)
Negative Pressure therapy: Macrostrain
-Pulls edges together
- Evenly Distributes negative pressure
- Removes exudate and infectious material
Negative Pressure therapy: Microstrain
- Decrease Edema
- promotes profusion
- promotes granulation tissue formation by facilitating cell migration and proliferation
Negative Pressure therapy Indications/Potential Drawbacks
Indications
- Venous leg ulcers
- traumatic wounds
- skin grafts
- pressure ulcer
- partial thickness burns
- Flaps
- diabetic ulcers
- dehisced wounds
- chronic wounds
- acute wounds
Potential Drawbacks
- painful dressing changes
- tethered to a machine
Negative pressure wound therapy parameters
- 50-175 mmHg: max increase in blood flow @125mmHg
- Dressing change 48-72 hours
- Continuous or intermittent cycle
- Wound must be at least 80% clean of necrotic tissue
Negative Pressure Wound Therapy Contraindications
- Foam in direct contract with exposed blood vessels, anastomotic sites, organs or nerves
- Malignancy in wounds
- Untreated osteomyelitis
- Non-enteric and unexplored fistulas
- Necrotic tissue with eschar present
Precautions - Blood thinners
Ultrasound what does it do?
- Increases: collagen deposition, granulation tissue formation, angiogenesis
- enhances wound contraction
- Improves scar pliability
- Low frequency: wound debridement
Ultra sound prarmeters
- Frequency: superficial 3MHz/ deep 1MHz
- Intensity: Pulsed= 0.5-1 W/cm^2
Continuous= up to 1.5 W/cm^2
Protocol= 1.5 x tranducer head - 2-3minutes per zone
- 2x-3x a week
Low Frequency Ultrasound
-Low frequency= 25-40kHz
- emerging as a method of wound bed preparation and healing
- for debridement and bioburden reduction
- Uses saline mist as a medium to transmit energy
- PPE REQUIRED
- Protocol= 20-60 seconds per cm^2 or minimum of 4 minutes for wound’s <16cm^2, 2-3 times a week
T/F hyperbaric oxygen is 14x greater oxygen dissolved in plasma
True
Transcutaneous Oxygen Monitoring Ranges
Normal= 50 mmHg
Normal for wound healing= >40 mmHg
Supports healing= >35 mmHg
Unlikely to heal even with HBO= <30 mmHg
Hyperbaric Oxygen is for:
Chronic or slow healing wounds
- Requires a physician to be on site
- cost is very expensive
Indications for Hyperbaric Oxygen
- Wagner 3 diabetic foot wounds
- failed grafts/flaps
- necrotizing fasciitis
- Late effects radiation wounds
- H/o severe anemia
- Crush injuries
- Compartment syndrome
- Thermal burns
- Gas gangrene
- Acute traumatic peripheral ischemia/arterial insufficiency
- Decompression sickness
Contraindications for Hyperbaric Oxygen
- CHF
- DVT
- Claustrophobia
- Pregnancy
- Severe arterial insufficiency
- Relative COPD
- Non-complicated wounds
Protocol for Hyperbaric Oxygen
Chamber 1.5-2.5 ATM for 90-120 minutes
2x-3x a week
10-60 sessions
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