Wound Debridement Skills

Question 1

Wound healing depends on what 3 things

Answer 1

• adequate vascularity
• adequate nutrients
• adequate oxygen (stimulates growth factors)

Question 2

normal wound healing is inhibited by:

Answer 2

• poor vascularity (PVD)
• inadequate nutrients (poor protein consumption)
• poor oxygenation (smoking, pulmonary conditions)
• continued injury (pressure, etc)
• medications (steroids)
• devitalized tissues (infection)

Question 3

4 characteristics of necrotic tissue

Answer 3

• 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

Question 4

what is debridement?

Answer 4

One of the best methods for advancing the healing process in the wound with necrotic tissue

Question 5

what does debridement do?

Answer 5

• 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

Question 6

types of debridement

Answer 6

• Autolysis
• Enzymatic
• Mechanical
• Sharps
• Surgical

Question 7

what is autolysis used for?

Answer 7

• Superficial to full thickness wounds with min/moderate exudate
• Superficial eschar

Question 8

advantages of autolysis

Answer 8

• selective
• safe
• painless
• effective

Question 9

disadvantages of autolysis

Answer 9

• slow process
• potential for infection

Question 10

enzymatic debridement

Answer 10

• Partial and full thickness
  wounds
• Penetrates eschar

Question 11

advantages of enzymatic debridement

Answer 11

• fast process
• fairly selective
• many products

Question 12

disadvantages of enzymatic debridement

Answer 12

• expensive
• MD orders
• possible adverse reaction
• many products

Question 13

mechanical debridement

Answer 13

• superficial slough
• small, visible foreign matter (dirt, gravel, etc)

Question 14

advantages of mechanical debridement

Answer 14

easy
low cost

Question 15

disadvantages of mechanical debridement

Answer 15

• not everything is as superficial as it seems
• sometimes painful

Question 16

sharps debridement

Answer 16

• Patrial and full thickness
  wounds with large
  amounts of necrotic
  tissue
• Scoring of eschar

Question 17

advantages of sharps debridement

Answer 17

• very selective
• fast
• very effective

Question 18

disadvantages of sharps debridement

Answer 18

• MD orders
• possible pain
• possible bleeding
• special training and equipment

Question 19

surgical debridement

Answer 19

-Any extensive tissue removal
- Remove of necrosis around functional structures (tendons, nerves, etc.)

Question 20

advantages of surgical debridement

Answer 20

• very selective
• fast
• very effective

Question 21

disadvantages of surgical debridement

Answer 21

• $
• decreased functional status
• may not return to therapy immediately

Question 22

indications for debridement

Answer 22

1. Soft/ hard necrotic tissue
2. Loosely adherent necrotic tissue
3. Stringy necrotic tissue

Question 23

debride as a means to:

Answer 23

• Help topical agents work
• Properly stage a wound

Question 24

patient contraindications to debridement

Answer 24

• Bleeding disorder or on an anticoagulant therapy
• Medical condition the precludes procedure (shock, ischemic extremity)

Question 25

wound contraindications to debridement

Answer 25

• Densely adherent necrotic tissue
• Dry gangrene
• Visible vital structures
• Questionable tissue
• A wound with previous problems with debridement

Question 26

black color concept

Answer 26

• Necrotic tissue
• Black eschar
• May have pus or fibrin associated

Question 27

black color concept therapy

Answer 27

Debridement
(mechanical, sharps,
surgical, chemical) to
remove necrotic tissue

Question 28

yellow wound

Answer 28

• pus, debris, fibrin, yellow exudate

Question 29

therapy for yellow wound

Answer 29

• cleansing
• minor debridement
• topical antimicrobial

Question 30

red wound

Answer 30

• read and ready to heal
• definite borders
• granulation present

Question 31

therapy for red wound

Answer 31

• keep wound moist and clean

Question 32

what should you debride?

Answer 32

• Mostly stage partial and full thickness wounds
• Yellow and black
• Visible necrosis or slough (yellow clingy stuff)

Question 33

blunt tip scissors

Answer 33

avoids injury to deeper structures

Question 34

curved blade scissors

Answer 34

easy to change direction (get under necrosis)

Question 35

short handle scissors

Answer 35

easier to control

Question 36

serrated blade scissors

Answer 36

grips tissue well

Question 37

scalpel

Answer 37

• # 15 blade (all purpose)
• # 3 handle (fits hand well)
• disposable handle - safety

Question 38

forceps

Answer 38

• Fine toothed tips: Precise, secure tissue grip with minimal injury to tissue
• light spring action: good control and minimizes user fatigue

Question 39

“Mosquito” Hemostat

Answer 39

• Precise application
• Holds well with minimal tissue injury
• Good for bleeding control

Question 40

holding the scissors

Answer 40

• 3 points of fixation
• Thumb and ring finger through rings
• Index finger guiding blade
• Always visualize tips (usually point tip upward)

Question 41

holding the forceps

Answer 41

• Use thumb and index
  finger
• Rest back end on web
  space
• Use minimal force

Question 42

holding the scalpel

Answer 42

• Like you would hold a
  pencil
• Three finger precision
  grip

Question 43

if tissue is dry and leathery, consider:

Answer 43

• saline irrigation
• covering with occlusive dressing for a day
• scoring eschar

Question 44

preparation for sharps debridement

Answer 44

S elect patient and wound
H ave all equipment ready
A ssess tissue to be removed
R emove necrotic tissue
P ain/bleeding addressed

Question 45

address bleeding with

Answer 45

• hemostat
• silver nitrate
• pressure