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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
What do you want a dressing to do?
Rehydrate Absorb exudate De-slough Reduce bacterial contamination Promote granulation Promote a moist/dry wound bed
26
What are characteristics of an ideal wound dressing?
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
27
What is the goal of primary dressing?
Prevent adherence Correct absorptive capacity - Moisture additive or moisture retentive as needed
28
What is the role and function of secondary dressing?
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
What are skin protectants?
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
What are contact layers?
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
What are the advantages of contact layers?
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
What are transparent films?
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
What are hydrogels?
Comes in sheet and gel form High water content facilitates debridement by rehydration--autolytic debridement
34
What are the indications for hydrogels?
Burns Hard to heal wounds Dry wounds that need moisture
35
What are some contraindications to using hydrogels
Heavily exuding wounds Maceration of the peri-wound area Infected wounds
36
What are hydrocolloids good for?
Wounds with minimal to moderate drainage
37
What are the advantages of hydrocolloids?
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
What are the disadvantages of hydrocolloids?
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
What are the characteristics of foams?
Wicks away fluid from wound Adhesive or non-adhesive Various shapes and sizes Extend at least 1 inch onto peri-wound skin
40
What are the uses of foam?
Moderate to heavy exudate With/without granular bed Can be used on infected wounds, but must be changed daily
41
What are the precautions associated with foams?
3rd degree burns Little to no exudate Not comfortable
42
What are alginates?
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
What are the characteristics of hydrofibers?
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
What are the uses for hydrofibers?
ABSORBS EXUDATE!! Partial thickness burns Diabetic foot/leg ulcers Pressure ulcers Traumatic wounds
45
What are the precautions associated with hydrofibers?
Not compatible with oil-based products (petroleum jelly)
46
What are some common Collagens and what are their characteristics?
Promogran, Puracol, Fibracol Sheets, ropes, gel, pad Collagen promotes wound healing Moderate absorption of exudate Non-adherent
47
What are some uses for collagens?
In wounds without necrotic tissue
48
What are some precautions associated with collagens?
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
What are the characteristics of gauze?
Cotton or synthetic Many sizes, shapes, forms (rolls, pads, strips) Cheap Plain or impregnated (Petrolatum is gauze impregnated with petroleum)
50
What are the uses for gauze?
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
What are some precautions associated with gauze?
Wet to dry debridement when gauze dries in the wound
52
What are the characteristics of Petrolatum?
Non-adherent primary dressing Vaseline on gauze
53
What are the uses for Petrolatum?
Primary layer used to maintain moisture within wound Inhibit loss of body fluids Protects wound from contamination
54
What are the characteristics of Telfa pads?
Non-adherent primary dressing Mild absorption of exudate
55
What are some uses of Telfa pads?
Dry sutured wounds Superficial cuts and abrasions Lightly exuding wounds
56
What are the precautions associated with Telfa pads?
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
What is bioburden?
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
What is contamination?
Presence of bacteria on wound surface Bacteria are NOT multiplying NO host response - No inflammatory response
59
What is colonization?
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
What is critical colonization?
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
What is infection?
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
What is the contamination-infection continuum?
See ppt (Part 2, slide 7)
63
What are the topical antimicrobial dressings?
Silver Honey Methelyne blue
64
What are some characteristics of silver?
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
What are some characteristics of honey?
``` 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
What are some characteristics of Methylene Blue?
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
What are the steps to application of Methylene Blue?
See ppt (Part 2, slides 13 & 14)

Wound Care (12 decks)

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