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Wound Care > Wound Debridement and Dressings > Flashcards

Wound Debridement and Dressings Flashcards

1
Q

What are the different kinds of debridement and cleansing?

A

Autolytic

Enzymatic

Mechanical (scrubbing, whirlpool, pulsed lavage, low frequency US)

Instrument (sharp, surgical, hydrosurgical)

Biological

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2
Q

What is SELECTIVE debridement?

A

Only nonviable tissue removed

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3
Q

What is NON-SELECTIVE debridement?

A

Viable and nonviable may be removed

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4
Q

What are factors to consider prior to debridement?

A

Overall condition of the patient

Etiology of the wound

Types of necrotic tissue present

Potential of wound to close due to local and systemic factors

Ability to achieve pain control during process

PT’s knowledge and skills

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5
Q

What is autolytic debridement?

A

Body’s endogenous enzymes loos and liquefy necrotic tissue

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6
Q

What are the advantages of autolytic debridement?

A

Least painful form

Can be used on all wound types (arterial wounds more difficult)

Minimal technical skill of PT required

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7
Q

What are the disadvantages of autolytic debridement?

A

Slower than other methods (usually taking weeks)

Requires multiple dressing changes
- Need to monitor fluid collection under the dressing

May not be appropriate for older patients with multiple comorbidities, impaired immune system, nutrition, and hydration deficits

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8
Q

What is the only absolute contraindication for autolytic debridement?

A

Infection

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9
Q

What is enzymatic debridement?

A

Uses topical meds designed to break down deviatalized collagen in the wound bed

Presently, collagenase Santyl is the only commercially available enzymatic debridement agent

Best applied daily

Cross-hatch dry and dense eschar

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10
Q

What are the advantages of enzymatic debridement?

A

Selectively targets and destroys devitalized collagen that anchors necrotic debris

Not associated with increased patient discomfort

No known effect on viable tissue

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11
Q

What are the disadvantages of enzymatic debridement?

A

Potential for skin maceration

Denudement of surrounding skin may occur

Can be deactivated (detergents, iodine, silver, mercury)

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12
Q

What is mechanical debridement?

A

Uses external forces or energy to dislodge and remove debris from wound surface

Can be selective or non-selective

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13
Q

What are the types of mechanical debridement?

A

Soft abrasion debridement

Hydrotherapy (whirlpool and pulsed lavage with suction)

Low frequency US

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14
Q

What is soft abrasion mechanical debridement?

A

Uses dry gauze or a cotton swab to gently lift and remove non-adherent debris and congealed exudate

May cause some pain (use topical anesthetic)

Can gently abrade wound edges to prevent epibole

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15
Q

What is wet-to-dry or wet-to-moist mechanical debridement?

A

DO NOT PERFORM WITH NON-SELECTIVE

Open weave gauze is wetted and placed in the wound so that it is in contact with all parts of the wound surface

Let gauze dry and adhere to the tissue which will come with it with removal

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16
Q

What are the disadvantages of wet-to-dry or wet-to-moist mechanical debridement?

A

Removes all types of tissue

Gauze doesn’t have to dry to cause damage

PAIN!!

Gauze as a packing material is often over-packed

Exposed bone, muscle, or tendon is likely to desiccate

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17
Q

Cowan et al (‘09) found what about wet-to-dry mechanical debridement?

A

This method is often inappropriately prescribed for wounds not needing debridement in more than 78% of wounds for which they were ordered

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18
Q

What is the hydrotherapy method of mechanical debridement?

A

DO NOT USE A WHIRLPOOL

This method facilitates cleansing by immersing the patient or body part in a tub that uses a motor to circulate and agitate water and loosen debris

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19
Q

What are the risks of hydrotherapy?

A

INFECTION!!

Biofilm growth in the machine

Cross-contamination

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20
Q

Which wounds may be inappropriate in general for hydrotherapy?

A

Infected wounds

Venous wounds (wet and dependent position)

Diabetic (can’t feel the water temperature; maceration–allows for bacteria to get in)

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21
Q

What is involved with HYDROSURGICAL instrument debridement?

A

Precisely removes non-viable tissue using a high energy water stream

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22
Q

What is the benefit of hydrosurgical instrument debridement?

A

Very little damage done to underlying healthy tissue

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23
Q

What is biological debridement?

A

Maggot debridement therapy (MDT)

Documented use since the 16th century

3 proposed actions:

  • Debridement of necrotic tissue
  • Antimicrobial activity
  • Facilitation of wound healing
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24
Q

What are the factors that influence dressing selection?

A

Bacterial profile

Wound characteristics

  • Dry
  • Moist
  • Heavy exudate
  • Malododorous
  • Painful
  • Difficult to dress
  • Bleeds easily

Wound type

  • Depth
  • Etiology/cause

Stage of healing

Tissue types:

  • Necrotic
  • Slough
  • Granulating
  • Epithelialization
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25
Q

What do you want a dressing to do?

A

Rehydrate

Absorb exudate

De-slough

Reduce bacterial contamination

Promote granulation

Promote a moist/dry wound bed

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26
Q

What are characteristics of an ideal wound dressing?

A

Provides moist wound environment

Manages exudate

Facilitates autolytic debridement

Antimicrobial if needed

Minimizes pain

Prevents contamination from environment

Insulates and maintains optimal temperature

Easily applied and removed

Available and cost-effective

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27
Q

What is the goal of primary dressing?

A

Prevent adherence

Correct absorptive capacity
- Moisture additive or moisture retentive as needed

28
Q

What is the role and function of secondary dressing?

A

Placed over the primary dressing

Absorb exudate

Provide cushioning to protect the wound

Possibly act as occlusive barrier to prevent drying or prevent bacteria from entering the wound

29
Q

What are skin protectants?

A

Also called moisture barriers

Wipes, foam applicators, and sprays used to protect skin from mechanical injury caused by tapes and adhesives

Help prevent maceration and tearing of skin

With or without alcohol
- Consideration for inflamed periwound tissue

30
Q

What are contact layers?

A

Barrier between wound surface and a secondary dressing

Can be coated with silicone, oil emulsion, or petrolatum

Usually removed with each dressing change, but can be left in place with heavily draining wounds

Not recommended for dry wounds, third degree burns or other wounds that need contact moisture

31
Q

What are the advantages of contact layers?

A

Protects a wound from trauma

Allows exudate to pass through

Can be cut to fit the wound or allowed to overlap with adjacent skin

Great to use with NPWT

32
Q

What are transparent films?

A

May be applied to heels preventatively to reduce friction and shear

Self-adherent

Allows wound to be observed

Do NOT use on draining or infected wounds–does not absorb exudate

Waterproof, but allows for water vapor to evaporate and oxygen is able to penetrate

Often used as a secondary dressing and with NPMT devices

33
Q

What are hydrogels?

A

Comes in sheet and gel form

High water content facilitates debridement by rehydration–autolytic debridement

34
Q

What are the indications for hydrogels?

A

Burns

Hard to heal wounds

Dry wounds that need moisture

35
Q

What are some contraindications to using hydrogels

A

Heavily exuding wounds

Maceration of the peri-wound area

Infected wounds

36
Q

What are hydrocolloids good for?

A

Wounds with minimal to moderate drainage

37
Q

What are the advantages of hydrocolloids?

A

Self-adherent

Provides cushioning over bony prominences

Maintains a moist wound environment

Facilitates autolytic debridement

Effective under compression wraps

Come in various shapes, sizes, and thicknesses

38
Q

What are the disadvantages of hydrocolloids?

A

Difficult to remove from the fragile skin

May leak or leave a residue on the skin

Require a different primary dressing to fill in spaces

Not effective on wounds with dry eschar

Do NOT use on infected wounds

39
Q

What are the characteristics of foams?

A

Wicks away fluid from wound

Adhesive or non-adhesive

Various shapes and sizes

Extend at least 1 inch onto peri-wound skin

40
Q

What are the uses of foam?

A

Moderate to heavy exudate

With/without granular bed

Can be used on infected wounds, but must be changed daily

41
Q

What are the precautions associated with foams?

A

3rd degree burns

Little to no exudate

Not comfortable

42
Q

What are alginates?

A

Dressings with calcium and sodium fibers made from seaweed spun into a rope or in sheet form

Used to absorb moderate to heavy drainage

Calcium fibers react with exudate or blood to form a gel–keeps the wound moist

May be used on infected wounds or for filling deep cavity wounds–great for cavities

May be used as a hemostatic dressing

Requires a secondary dressing to cover the wound

43
Q

What are the characteristics of hydrofibers?

A

Similar to calcium alginate dressings

Used as a primary dressing in contact with the wound

Converted into gel when in contact with moisture

If infused with silver, it is antimicrobial

Can be worn for several days

44
Q

What are the uses for hydrofibers?

A

ABSORBS EXUDATE!!

Partial thickness burns

Diabetic foot/leg ulcers

Pressure ulcers

Traumatic wounds

45
Q

What are the precautions associated with hydrofibers?

A

Not compatible with oil-based products (petroleum jelly)

46
Q

What are some common Collagens and what are their characteristics?

A

Promogran, Puracol, Fibracol

Sheets, ropes, gel, pad

Collagen promotes wound healing

Moderate absorption of exudate

Non-adherent

47
Q

What are some uses for collagens?

A

In wounds without necrotic tissue

48
Q

What are some precautions associated with collagens?

A

Not for 3rd degree burns, dry wounds, or wounds with eschar

May not be appropriate for patients with sensitivity or cultural restrictions relative to the use of bovine or porcine products

49
Q

What are the characteristics of gauze?

A

Cotton or synthetic

Many sizes, shapes, forms (rolls, pads, strips)

Cheap

Plain or impregnated (Petrolatum is gauze impregnated with petroleum)

50
Q

What are the uses for gauze?

A

Everything–scrubbing, prepping, wiping, protection, absorption, and packing

Saline soaked gauze–keep wound moist as primary dressing

Loose packing of deep wounds (primary dressing for packing)

Can be used as a secondary dressing to absorb exudate

51
Q

What are some precautions associated with gauze?

A

Wet to dry debridement when gauze dries in the wound

52
Q

What are the characteristics of Petrolatum?

A

Non-adherent primary dressing

Vaseline on gauze

53
Q

What are the uses for Petrolatum?

A

Primary layer used to maintain moisture within wound

Inhibit loss of body fluids

Protects wound from contamination

54
Q

What are the characteristics of Telfa pads?

A

Non-adherent primary dressing

Mild absorption of exudate

55
Q

What are some uses of Telfa pads?

A

Dry sutured wounds

Superficial cuts and abrasions

Lightly exuding wounds

56
Q

What are the precautions associated with Telfa pads?

A

Careful using on wounds that produce heavy, viscous exudate (leg ulcers)

May trap exudate and cause maceration or inflammation of periwound skin as telfa pads are not very effective at absorbing fluid

57
Q

What is bioburden?

A

Refers to the effect of organisms within a wound bed that influence wound healing

All chronic wounds have some level of bioburden
- Bacteria does not = infection

Range of bacterial influence:

  • Contamination
  • Colonization
  • Critical colonization
  • Infection
58
Q

What is contamination?

A

Presence of bacteria on wound surface

Bacteria are NOT multiplying

NO host response
- No inflammatory response

59
Q

What is colonization?

A

Presence of bacteria that have attached superficially to the wound

NO invasion of healthy tissue

Bacteria ARE multiplying

NO host response

  • No inflammatory response
  • No signs and symptoms
60
Q

What is critical colonization?

A

Presence of bacteria that have attached superficially to the wound

Bacteria ARE multiplying

Invasion of healthy tissue = local tissue damage

Presence of 1 or 2 signs of infection

61
Q

What is infection?

A

Movement of replicating bacterial from superficial to deep tissues

Signs and symptoms:

  • Local: pain, redness, swelling, heat, odor, purulent drainage
  • Systemic: elevated WBC, fever, confusion (older adults), red streaks from the wound

Bacteria has overwhelmed the host’s immune response

Diagnosed primarily by clinical observation and confirmed with lab tests

62
Q

What is the contamination-infection continuum?

A

See ppt (Part 2, slide 7)

63
Q

What are the topical antimicrobial dressings?

A

Silver

Honey

Methelyne blue

64
Q

What are some characteristics of silver?

A

Most popular for reduction of bioburden

  • Release silver into the wound in the presence of exudate
  • Active against MRSA, Staph A., pseudomonas, VRE

Found in:

  • Hydrogels–gel and sheet
  • Alginates
  • Hydrofibers
  • Foams
  • Silicones
  • Contact layers
  • Wound powders
  • Ointments
  • NPWT foams
  • Irrigation silver nitrate solutions

Should not be used with other antimicrobials

Should only be used for short periods of time (reduce the risk of resistance)

65
Q

What are some characteristics of honey?

A 
Acidic pH (3.5-4) inhibits pathogens
- Promotes autolytic debridement and moist wound healing

MEDICAL grade

Found in:

  • Gels
  • Sheets
  • Ointments

For use on infected or highly contaminated wounds

Do not use if:

  • Allergic to bees
  • Hypersensitivity reactions

Stop when clinical signs of infection are no longer apparent

Conflicting evidence

66
Q

What are some characteristics of Methylene Blue?

A

Lack of conclusive and quality research regarding effectiveness

Removes exudate from the wound bed and creates singlet oxygen (O) and free radicals which impacts the plasma membrane and causes bacteriolysis

Clinically…it has been shown to:

  • Decrease inflammation and pain
  • Improves granulation
  • Reduce wound edge epibole
  • Reduce hypergranulation
67
Q

What are the steps to application of Methylene Blue?

A

See ppt (Part 2, slides 13 & 14)

Wound Care (12 decks)

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