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Integumentary > Wound Bed Preparation > Flashcards

Wound Bed Preparation Flashcards

1
Q

Purposes for Debridement

A

Decreases bacterial concentration within the wound bed and risk of infection
Increase effectiveness of topical antimicrobials
Shorten inflammatory phase
Decrease odor
Eliminate barrier to wound healing
Improve bactericidal activity of leukocytes
Decrease energy needed for wound healing

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2
Q

General Indications for Debridement

A

Removal of necrotic tissue, foreign material, debris, senescent cells
Removal of biofilm
Correction of wound edges including callous, hyperkeratosis, non viable borders, epibole
Removal of residual topical agent

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3
Q

Red–yellow–black system

A

Black eschar, full-thickness
Yellow draining wound with slough
Red granular wound
Wounds may present with combination

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4
Q

Slough- yellow fibrin debris :

A

moderate to high water content. Lies on top of wound and is generally moderately to lightly adhered

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5
Q

Eschar- brown to black necrotic tissue

A

May be soft or hard. Occurs with full thickness tissue destruction

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6
Q

Biofilm

A

Polymicrobial
Reach bacterial levels of critical colonization
Present in 60% of chronic wounds
Invisible, wound bed appear pink/red and viable

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7
Q

General Contraindications

for Debridement

A

Avoid trauma to viable tissue
Do not debride heel ulcers with eschar if they do not have edema, erythema, fluctuance, drainage
Wounds that require surgical debridement
Electrical burns prior to physician assessment

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8
Q

General Considerations

for Debridement

A

Characteristics of wound
Status of patient
Existing practice acts
Clinician’s knowledge and skill level

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9
Q

Methods of Debridement

A 
Autolytic
Enzymatic
Mechanical
Biological
Sharp
Surgical
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10
Q

Selective Debridement

A

Sharp
Autolytic
Enzymatic

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11
Q

Nonselective Debridement

A

Mechanical

Surgical

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12
Q

What is autolytic debridement?

A

Body’s own enzymes

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13
Q

What wounds would use autolytic debridement?

A

Stage III or IV wounds with light to moderate drainage

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14
Q

How is autolytic debridement performed?

A

Performed by occlusive or semi-occlusive dressings (hydrocolloids, hydrogels, or films) which keep wound fluid in contact with necrotic tissue

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15
Q

What tissue is targeted with autolytic debridement?

A

Selective, only necrotic tissue is liquefied
Painless
Slower than surgical debridement.
May macerate surrounding tissue.

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16
Q

Indications of autolytic debridement:

A

All wounds with necrotic tissue
Patients who cannot tolerate other forms of debridement
Commonly used in home or long-term care settings

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17
Q

Contraindications of autolytic debridement:

A

Infected or deep cavity wounds

Wounds that require sharp or surgical debridement

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18
Q

Autolytic Debridement:

Procedure

A

Crosshatch eschar
Moisture-retentive dressings
Protect periwound

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19
Q

Moisture-retentive dressings

A

~2 cm larger than wound

Keep on for 72–96 hours

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20
Q

What is enzymatic debridement?

A

Form of selective debridement
Requires physician’s prescription
Selectively digests protein, collagen, and fibrin.

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21
Q

Which wounds would use enzymatic debridement?

A

Wounds with a large amount of necrotic debris or eschar formation
Less painful for patients unable to tolerate sharp debridement

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22
Q

What enzyme is used for enzymatic debridement?

A

Collagenase - only enzyme currently FDA approve

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23
Q

Drawbacks to enzymatic debridement?

A

Expensive, requires prescription, requires frequent re-application and dressing changes
May cause inflammation or discomfort
Slower process than sharp debridement
Can be applied by caregiver not skilled in sharp debridement

24
Q

Enzymatic Debridement Indications

A

Infected and uninfected wounds with necrotic tissue
Appropriate if cannot tolerate sharp debridement
Appropriate in-home or long-term care

25
Q

Enzymatic Debridement Contraindications:

A 
Wounds with exposed deep tissues
Facial burns
Calluses
Wounds free of necrotic tissue
Exogenous enzymes should not be applied to wounds being autolytically debrided
26
Q

Enzymatic Debridement:

Procedure

A 
Follow manufacturer’s guidelines
Physician’s prescription
Crosshatch eschar
Moist environment
Observe for infection
Topical antimicrobial therapy as needed
Collagenase is deactivated by silver and iodine ions
Apply 2mm thick
Must be applied daily
Must have a moist environment
27
Q

Mechanical Debridement

A

Use of force to remove devitalized tissue, foreign material, and debris
Nonselective

28
Q

Kinds of mechanical debridement:

A 
wet-to-dry dressings
scrubbing
wound cleansing
wound irrigation
pulsatile lavage
whirlpool
hydrogen peroxide
29
Q

Benefits of mechanical debridement:

A

Wounds with moderate amount of necrotic debris

Low cost

30
Q

Drawbacks to mechanical debridement:

A

May traumatize healthy tissue

Painful

31
Q

Wet-to-Dry Dressings

A 
Apply saline-moistened gauze
Allow to dry 
Tear away dressing
Prior standard dressing
Now many better options
Only indicated for wounds with 100% devitalized wound bed
32
Q

Scrubbing:

A

High-porosity sponge, brush, or gauze
Water or saline
Contraindicated for granulating wounds
Best used for highly contaminated superficial wounds/burns

33
Q

Temperatures for whirpool non-thermal

A

80-90

34
Q

Temperatures for whirpool neutral

A

92-96

35
Q

Temperatures for whirpool thermal

A

96-104

36
Q

Whirpool

A

Removes dirt and foreign contaminants
Removes toxic residuals from topical agents
Softens & rehydrates necrotic tissue
Removes toxic residuals from topical agents

37
Q

Drawbacks to whirpool

A

Additives may be cytotoxic (proper concentration?)
Force from jets may be traumatic (no evidence)
Nonspecific mechanical debridement
Appropriate for non-venous wounds with thick exudate and slough or infected wounds/abscesses

38
Q

Pulsative Lavage

A 
Removes dirt and foreign contaminants,
Softens necrotic tissue
Removes toxic residuals from topical agents
Nonspecific mechanical debridement
4-15 PSI
39
Q

Contraindications to pulsative lavage:

A

Contraindicated over granulation tissue

Caution/contraindication if on blood thinners

40
Q

Jet-ox

A

Mist of saline delivered by pressurized oxygen
Gentle to wound
Rehydrates necrotic tissue and gently debrides

41
Q

US Mist

A

Mist created by US
Rehydrates necrotic tissue and gently debrides
May provide benefits of US for wound healing as well as debride
Possible aerosolization of contaminants

42
Q

Low Frequency Contact US

A

Utilizes currete with saline spray as coupling medium
Low frequency US is powerful enough to liquefy adipose tissue and disrupt biofilm
New units include suction

43
Q

Biological Debridement:

A

magoot therapy
FDA-approved live medical device for debridement
Seldom used in the U.S.

44
Q

How maggot therapy works:

A

Larvae release enzymes that degrade necrotic tissue
Larvae ingests necrotic tissue and bacteria
Larvae are unaffected by antibiotics

45
Q

Benefits of maggot therapy:

A

Faster than autolytic and enzymatic debridement
May decrease odor and exudate
May increase granulation and epithelialization

46
Q

Sharp

A

Selective, necrotic tissue only
Use of forceps, scissors, or scalpel
Fastest, most aggressive form of debridement
May also be used to correct improperly healing edges, epiboly

47
Q

Indications of sharp debridement:

A

Large amount of necrosis, callus, advancing cellulitis, sepsis, eschar
May be used on wounds with any amount of necrotic tissue
Chronic wounds

48
Q

Contraindications of sharp debridement:

A

When area cannot be adequately visualized
Material to be debrided is unidentified
Lack of clinician competency
Infected ischemic ulcers with low ABIs

49
Q

Precautions for sharp debridement:

A

immunosuppressed, thrombocytopenic, or on anticoagulants
Wound closure is not consistent with POC
Hypergranular tissue

50
Q

Sharp Debridement:

Termination

A

Lack of pain control
Patient tolerance to technique
Extensive bleeding

51
Q

Sharp Debridement:

Procedure

A

Scalpel and scissors parallel to surface
Debride in layers
Rinse wound with saline and reassess

52
Q

Surgical Debridement

A

Use of scalpels, scissors, or lasers in sterile environment
Selective
May be performed in OR or at bedside
Typically large amount of necrotic or non-viable tissue or purulence
May involve removal of viable tissue
Often performed due to active infection

53
Q

Drawbacks of surgical debridement:

A

Painful
Expensive
Performed by physician or podiatrist
Allows for extensive exploration of wound bed and debridement of deeper structures

54
Q

Indications for surgical debridement:

A

Ascending cellulitis, osteomyelitis, extensive necrotic wounds, undermining
Necrotic tissue near vital organs/structures

55
Q

Contraindications for surgical debridement:

A

Patients who are unlikely to survive procedure

Patients with palliative care plans

Integumentary (18 decks)

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