WK11- Irrigation and Modalities Flashcards
What factors should you consider when selecting irrigation type ?
purpose of irrigation, wound presentation, wound etiology, intervention availability
What PSI can traumatize the wound bed ?
greater than equal to 15psi
Describe infection control for patients and therapists when conducting pulsed lavage on a wound.
Therapists should have full PPE including: face shield, mask, gown, gloves, hair covers
Patient should be masked, visitors should not be present, appropriate ventilation, cover exposed tubes, ports, wounds not being treated, cover wound supplies and personal items
For pulsed lavage what wounds should be done daily ?
most wounds
For pulsed lavage what wounds should be done twice daily ?
greater than 50% necrotic, purulent drainage, sepsis
For pulsed lavage what wounds should be done 3 times/week ?
full granulation base, NPWT being used
When should you discontinue pulsed lavage ?
wound closed, no increase in granulation for 1 week, no decreased necrotic tissue for 1 week
What kind of electrical stimulation is used for wound healing and why ?
HVPC
the use of bioelectric current attracts cells to increase wound healing ( galvanotaxis)
stimulating cell migration, proliferation, bactericidal effects, and autolytic debridement
For what kind of wound is HVPC indicated ?
indicated for chronic or recalcitrant wounds that are clean or infected; stage III or IV pressure ulcers; recalcitrant stage II ulcers
What are the protocols for HVPC ?
Negative Polarity:
inflammatory phase
freq: 100-128pps
intensity: 100-150 V
Duration: 60 minutes, 5-7x/week
Positive Polarity:
promote granulation tissue/ proliferation
freq: 100-128pps
intensity: 100-150 V
Duration: 60 minutes, 5-7x/week
For what conditions is negative pressure therapy indicated ?
venous leg ulcers, traumatic wounds, skin grafts, pressure ulcers, partial thickness burns, flaps, diabetic ulcers, dehisced wounds, chronic wounds, acute wounds
What are the contraindications for HVPC in wounds ?
malignancy, osteomyelitis, DVT, pacemaker, over carotid sinus, over uterus if pregnant, where there are metal ions ( like in silver nitrate impregnated gauzes)
What are the treatment parameters for NPWT?
50-175mmHg
dressing change every 2-3 days
When is NPWT contraindicated ?
foam in direct contact with exposed blood vessels, anastomotic sites, organs, or nerves
malignancy in wounds
untreated osteomyelitis
non-enteric and non-lewis and clarked fistulas
necrotic tissue with eschar present
precautions: blood thinners
Explain the parameters for ultrasound with the purpose of wound healing
Frequency:
Superficial=3.0MHz
Deep Wounds= 1.0Mhz
Intensity:
Pulsed, 0.5-1.0 W/cm squared
Continuous, up to 1.5 W/cm squared
What is a hyperbaric oxygen chamber ?
The administration of 100% oxygen administered at 1.5 ATM for chronic or slow healing wounds
What are the indications of HBO ?
wagner 3s, failed grafts/flaps, necrotizing fasciitis, late effects of radiation wounds, Hx of severe anemia, crush injuries or compartment syndromes, thermal burns, gas gangrene, acute traumatic peripheral ischemia/arterial insufficiency, decompression sickness
What are the contraindications and precautions to HBO ?
uncontrolled CHF, DVT, claustrophobia, pregnancy, severe arterial insufficiency, relative COPD, non-complicated wounds
What is the protocol for HBO ?
Chamber: 1.5-2.5 ATM for 90-120 minutes
2x/day to 3x/week, 10-60 sessions
What are some of the promising modalities ?
UVC ( 200-290nm): has been shown to be germicidal, increase vascular permeability, enhance cell proliferation and granulation tissue formation, promotes GF release
Infrared and Laser: improvement of circulation, healing by stimulating cells and improving scar tensile strength.
For draining and granular wounds what modalities are available ?
pulsed lavage w/ suction, whirlpool, E-stim, low-freq. US, HBO ?
For draining and necrotic wounds what modalities are available ?
whirlpool, pulsed lavage w/ suction, e stim, periwound US, low freq US, HBO ?
For non-draining and granular wounds what modalities are available ?
pulsed lavage, e stim, US, HBO
For non-draining and necrotic wounds what modalities are available ?
whirlpool, pulsed lavage, e stim, low freq. US, HBO