Wound Debridement Skills Flashcards
Wound healing depends on what 3 things
- adequate vascularity
- adequate nutrients
- adequate oxygen (stimulates growth factors)
normal wound healing is inhibited by:
- poor vascularity (PVD)
- inadequate nutrients (poor protein consumption)
- poor oxygenation (smoking, pulmonary conditions)
- continued injury (pressure, etc)
- medications (steroids)
- devitalized tissues (infection)
4 characteristics of necrotic tissue
- Increases the likelihood of infection
- Inhibits white blood cell function
- Encourages an anaerobic environment
- Produces Necrotic Tissue Products (Toxins)
- Inhibits the growth and granulation of tissue
and epithelial growth
what is debridement?
One of the best methods for advancing the healing process in the wound with necrotic tissue
what does debridement do?
- Remove tissue heavily contaminated by bacteria
- Decrease the possibility of infection
- Remove the source of toxins produced in the wound
- Allow phagocytosis to remove remaining bacteria
- Eliminate factors that prevent effective healing
- Reduce wound odor
types of debridement
- Autolysis
- Enzymatic
- Mechanical
- Sharps
- Surgical
what is autolysis used for?
- Superficial to full thickness wounds with min/moderate exudate
- Superficial eschar
advantages of autolysis
- selective
- safe
- painless
- effective
disadvantages of autolysis
- slow process
- potential for infection
enzymatic debridement
- Partial and full thickness
wounds - Penetrates eschar
advantages of enzymatic debridement
- fast process
- fairly selective
- many products
disadvantages of enzymatic debridement
- expensive
- MD orders
- possible adverse reaction
- many products
mechanical debridement
- superficial slough
- small, visible foreign matter (dirt, gravel, etc)
advantages of mechanical debridement
easy
low cost
disadvantages of mechanical debridement
- not everything is as superficial as it seems
- sometimes painful
sharps debridement
- Patrial and full thickness
wounds with large
amounts of necrotic
tissue - Scoring of eschar
advantages of sharps debridement
- very selective
- fast
- very effective
disadvantages of sharps debridement
- MD orders
- possible pain
- possible bleeding
- special training and equipment
surgical debridement
-Any extensive tissue removal
- Remove of necrosis around functional structures (tendons, nerves, etc.)
advantages of surgical debridement
- very selective
- fast
- very effective
disadvantages of surgical debridement
- $
- decreased functional status
- may not return to therapy immediately
indications for debridement
- Soft/ hard necrotic tissue
- Loosely adherent necrotic tissue
- Stringy necrotic tissue
debride as a means to:
- Help topical agents work
- Properly stage a wound
patient contraindications to debridement
- Bleeding disorder or on an anticoagulant therapy
- Medical condition the precludes procedure (shock, ischemic extremity)
wound contraindications to debridement
- Densely adherent necrotic tissue
- Dry gangrene
- Visible vital structures
- Questionable tissue
- A wound with previous problems with debridement
black color concept
- Necrotic tissue
- Black eschar
- May have pus or fibrin associated
black color concept therapy
Debridement
(mechanical, sharps,
surgical, chemical) to
remove necrotic tissue
yellow wound
- pus, debris, fibrin, yellow exudate
therapy for yellow wound
- cleansing
- minor debridement
- topical antimicrobial
red wound
- read and ready to heal
- definite borders
- granulation present
therapy for red wound
- keep wound moist and clean
what should you debride?
- Mostly stage partial and full thickness wounds
- Yellow and black
- Visible necrosis or slough (yellow clingy stuff)
blunt tip scissors
avoids injury to deeper structures
curved blade scissors
easy to change direction (get under necrosis)
short handle scissors
easier to control
serrated blade scissors
grips tissue well
scalpel
- # 15 blade (all purpose)
- # 3 handle (fits hand well)
- disposable handle - safety
forceps
- Fine toothed tips: Precise, secure tissue grip with minimal injury to tissue
- light spring action: good control and minimizes user fatigue
“Mosquito” Hemostat
- Precise application
- Holds well with minimal tissue injury
- Good for bleeding control
holding the scissors
- 3 points of fixation
- Thumb and ring finger through rings
- Index finger guiding blade
- Always visualize tips (usually point tip upward)
holding the forceps
- Use thumb and index
finger - Rest back end on web
space - Use minimal force
holding the scalpel
- Like you would hold a
pencil - Three finger precision
grip
if tissue is dry and leathery, consider:
- saline irrigation
- covering with occlusive dressing for a day
- scoring eschar
preparation for sharps debridement
S elect patient and wound
H ave all equipment ready
A ssess tissue to be removed
R emove necrotic tissue
P ain/bleeding addressed
address bleeding with
- hemostat
- silver nitrate
- pressure
