Week 11 Irrigation/Physical Agents/ Wound Management Flashcards

1
Q

T/F wound irrigation is just wound cleansing

A

False

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2
Q

Wound Irrigation: Definition

A
  • Using fluid to remove dressing residue/residuals form topical agents and loosely adhered devitalized tissues as well as surface bacteria from a wound bed
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3
Q

T/F every wound should be irrigated after removal of dressing?

A

True

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4
Q

Goal of Irrigation

A

To remove necrotic tissue/debris/bacteria

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5
Q

Angiocath/Waterpik

A
  • 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
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6
Q

Pulsed Lavage

A
  • 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
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7
Q

Whirlpool

A
  • 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
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8
Q

Whirlpool Contraindications

A
  1. Venous Insufficiency
  2. Edematous extremities
  3. Acute phlebitis
  4. Acute cellulitis
  5. DVT
  6. Incontinence
  7. Dry gangrene
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9
Q

PPE for Pulsed Lavage

A
  1. Face shield
  2. Mask
  3. Fluid proof gown
  4. Fluid resistant shoe covers
  5. Gloves
  6. Hair covers
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10
Q

Electrical Stimulation for Wound Healing Theory

A
  • 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
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11
Q

Indications for Electrical Stimulation for Wound Healing

A
  • Chronic wounds
  • Recalcitrant wounds ( wounds that won’t heal) clean or infected
  • Stage III/IV pressure ulcers
  • Recalcitrant stage II pressure ulcers
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12
Q

What are the Medicare Guidelines for Electrical Stimulation for Wound Healing

A
  • 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
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13
Q

Electrical Stimulation For Wound Healing Protocol Negative

A

Cathode
- Inflammatory phase
- Pulse rate 100-128pps
- Intensity 100-150 volts
- Duration 60 minutes 5-7x a week

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14
Q

Electrical Stimulation For Wound Healing Protocol Positive

A

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

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15
Q

Electrical Stimulation for Wound Healing Contraindications/Precautions

A
  1. Malignancy in wound
  2. Osteomyelitis
  3. Thrombophlebitis
  4. Pacemaker
  5. Over carotid sinus
  6. Over uterus
  7. Where there are metal ions (silver dressing)
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16
Q

Negative Pressure therapy: Macrostrain

A

-Pulls edges together
- Evenly Distributes negative pressure
- Removes exudate and infectious material

17
Q

Negative Pressure therapy: Microstrain

A
  • Decrease Edema
  • promotes profusion
  • promotes granulation tissue formation by facilitating cell migration and proliferation
18
Q

Negative Pressure therapy Indications/Potential Drawbacks

A

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

19
Q

Negative pressure wound therapy parameters

A
  • 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
20
Q

Negative Pressure Wound Therapy Contraindications

A
  • 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
21
Q

Ultrasound what does it do?

A
  • Increases: collagen deposition, granulation tissue formation, angiogenesis
  • enhances wound contraction
  • Improves scar pliability
  • Low frequency: wound debridement
22
Q

Ultra sound prarmeters

A
  • 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
23
Q

Low Frequency Ultrasound

A

-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

24
Q

T/F hyperbaric oxygen is 14x greater oxygen dissolved in plasma

A

True

25
Q

Transcutaneous Oxygen Monitoring Ranges

A

Normal= 50 mmHg
Normal for wound healing= >40 mmHg
Supports healing= >35 mmHg
Unlikely to heal even with HBO= <30 mmHg

26
Q

Hyperbaric Oxygen is for:

A

Chronic or slow healing wounds
- Requires a physician to be on site
- cost is very expensive

27
Q

Indications for Hyperbaric Oxygen

A
  1. Wagner 3 diabetic foot wounds
  2. failed grafts/flaps
  3. necrotizing fasciitis
  4. Late effects radiation wounds
  5. H/o severe anemia
  6. Crush injuries
  7. Compartment syndrome
  8. Thermal burns
  9. Gas gangrene
  10. Acute traumatic peripheral ischemia/arterial insufficiency
  11. Decompression sickness
28
Q

Contraindications for Hyperbaric Oxygen

A
  1. CHF
  2. DVT
  3. Claustrophobia
  4. Pregnancy
  5. Severe arterial insufficiency
  6. Relative COPD
  7. Non-complicated wounds
29
Q

Protocol for Hyperbaric Oxygen

A

Chamber 1.5-2.5 ATM for 90-120 minutes
2x-3x a week
10-60 sessions

30
Q

hello

A

hi :)