Wound Debridement

Question 1

What is wound cleansing?

Answer 1

use of a fluid to remove loosely attached cellular debris and surface pathogens contained in wound exudate

Question 2

What should not be used in wound cleansing?

Answer 2

1. no cytotoxic substances (betadine or hydrogen peroxide) kills good tissue and bad
2. no iodine (kills macrophages)

Question 3

What is selective debridement?

Answer 3

removal of dead tissue using pulsed lavage with suction (4-15 psi) or sharp debridement

Question 4

What is non selective debridement?

Answer 4

removal of all tissue good and bad

Question 5

What is purpose of debridement?

Answer 5

decrease bacteria concentration and chance of infxn, increase effectivennes of topical creams, shortern inflammatory phase, decrease eneergy required by wound

Question 6

Indications for wound debridement?

Answer 6

necrotic and foreign debris/tissue, removal or callus, removal of eschar, gross purulent/sloth

Question 7

Contraindications?

Answer 7

red, granular wounds (good healing is occuring), heel ulcers with eschar, patients PVD, larger wounds that require surgical debridement, electrical burns

Question 8

What are types of debridement?

Answer 8

1. surgical/sharp- use of tool
2. enzymatic- topical creams like papain
3. autolytic- breaks everything down like a occlusive dressing or self healing
4. mechanical- pulsed lavage, gauze
5. other- maggots, leeches

Question 9

What are forms of selective debridement?

Answer 9

sharp, enzymatic, autolytic

Question 10

What are forms of non selective debridement?

Answer 10

surgical, wet to dry dressings, whirlpool, pulse lavage???, hydrogen peroxide

Question 11

Who can legally debride?

Answer 11

PT (state to state dep.) , md, pa nurse, np, podiadrist

Question 12

Do you need a md order?

Answer 12

Yes, must say PRN to do whenever

Question 13

What can you debride?

Answer 13

avascular tissue (callus), insensate tissue, odor, dead fat and muscle (brownish grey)

Question 14

What can’t you debride?

Answer 14

sensate, fat, muscle fascia tendons, vessels

Question 15

When should you use enzymatic debridement?

Answer 15

infected or non infected wounds with necrotic tissue, if they cant tolerate sharp, at home care

need prescription

Question 16

When do you stop enzymatic?

Answer 16

once debridement is done, if necrotic tissue fails to decrease in expectec time

Question 17

Contraindications?

Answer 17

wounds with exposed deep tissue, facial burns, calluses

Question 18

Why is autolytic debridement helpful?

Answer 18

with use of moisture retentive dressing or self heal endogenous enzymes like macrophages and neutrophils digest necrotic tissue

Question 19

What is procedure for autolytic debridement?

Answer 19

crosshatch eschar ( to allow meds to get in), dressing should be 2 cm larger than wound

keep on for 72-96 hours

Question 20

What are contraindications of sharp debridement?

Answer 20

arterial insufficiency, gangrene, unidentifiable structures, meds (blood thinners), terminally il

Question 21

When should sharp debridement stop?

Answer 21

clinician fatigues, pain control is inadequete, decline in pt status, extensive bleeding, tunnel or undermining found

Question 22

If bleeding occurs what should you do?

Answer 22

pressure on area for 10 minutes, no interupption or restart timer, elevate, nitrate stick etc. can be used also

Question 23

What can be useful for pain management for pts?

Answer 23

meds 30 mins prior, tens prior

Question 24

What is a medical emergency during debridement?

Answer 24

bleeding where you can not see the source, bleeding you can hear