Wound Interventions; Adjunct Treatment Options Flashcards
E Stim - a number of RCTs support the use of estim for what wounds
pressure, neuropathic and venous insufficiency
E stim - Medicare coverage for estim only if
Stage 3 or 4 pressure, arterial, diabetic, and venous ulcers that is being used as adjunctive tx AND there has to have not been any measurable signs of healing for at least 30 days of tx with standard wound care!
E stim contraindications
Malignancy Osteomyelitis (untreated) Use of metal ion therapies Electronic implant effects Not over reflex centers Pregnant uterus
Effects of E stim
Dec pain and edema Inc blood flow and O2 supply (inc cutenaous PP of oxygen) Antibacterial effects Increase ATP Promotes collagen matrix organization
High voltage pulsed current - how is it applied
Can be applied directly to the wound, to peri wound area, or via immersion
High voltage pulsed current - polarity
Neg until progress is made, then switch to positive
If infected, start positive
45-60 min, 3-5 days/week
(time consuming - have home units now)
High voltage pulsed current - negative polarity effects
1 Epidermal proliferation 2 Inc blood flow 3 Fibroblast proliferation 4 Enhanced collagen synthesis 5 Attract neutrophils 6 Lyse necrotic tissue 7 Edema reduction 8 Stimulate granulation 9 Capillary growth 10 Bacteriocidal effect
High voltage pulsed current - positive polarity effects
1 Attract macrophages to area
2 Epithelial growth
3 Stimulate formation of new capillaries
4 Bacteriocidal effect
Ultrasound - what are its effects
It increases angiogenesis Accelerates mast cells and macrophages Inc cellular Ca uptake Inc fibroplastic activity Stimulates NO synthesis which inc vascular perfusion
Ultrasound - application
Cleanse the wound
Apply gel to the peri wound area
Sheet hydrogel applied over the wound area
Ultrasound - parameters
1 or 3 MHz depedning on depth needed 20% duty cycle 0.3 with acute 0.5 with reparative stage up to 1.0 with early remodeling stage Overall lower duty and intensity to minimize thermal effects)
Low frequency ultrasound - frequencies
22.5, 25, 35 kHz are for selective debridement
40 kHz for long wave mist US (non debriding)
Low frequency US - properties
Antibacterial
Contact or non contact transport of US through an atomized vapor mist
40Hz is non contact and non debriding
Disadvantage to low frequency US
Can only be used on smaller wounds
Ultraviolet is what
Form of radiant energy
Follows physical laws of radiant energy - reflection, refraction, absorption, inverse square, cosine law
Ultraviolet - wavelengths
UVA 400-320
UVB 320-280
UVC 280-200
Ultraviolet - Which wavelength has peak bacteriocidal effects
UVC!
So use this for infection
Ultraviolet - depth of penetration with A, B, C
C = stays very superficial on epidermis (melanocytes) B = basale layer of epidermis A = deeper into papillary layer of dermis
Sources of UV rays
Sun - UVC is filtered by ozone
UVA and UVB reach earth though
Mercury/Quartz lamps can be used
Effects of UV rays
Inflammatory response
Stratum corneum thickening
Inc vit D production
Bactericidal effects
Effects of UV rays - inflammatory response
VD, inc permeability, inc cellular activity
Effect of UV rays - Stratum corneum thickening leads to
exfoliation
melanocyte migration
activation of melanin
Effect of UV rays - Inc vit D production which does what
improves calcium and phosphorus availability
Effect of UV rays - bactericidal effects -wich is most effective
UVC
MED is what
Minimal erythemal dose
MED - how to determine
1 - explain to pt and clean area
2 EYE PROTECTION for PT and pt
3 Place MED cutout on area - cover surrounding area
4 Position lamp 30 in away
5 Expose each shape for 15 sec, starting with 75 shape
6 Pt should check area and track the time it takes for each shape to show up and then resolve
MED - Dosage - MED - Time to response? Time to resolution? Skin Reaction?
Response: 4 to 6 hrs
Resolution: within 24 hours
Skin rxn: slightly red
MED - Dosage - E4 - Time to response? Time to resolution? Skin Reaction?
Response: 2 hrs
Resolution: several days
Skin rxn: sig erythema, blistering, exfoliation, pigmentation, edema, exudate
With UVA and UVB what can you use as way to figure out dosage?
What will be the distance between the source and the body part?
MED
Skin typing
about 30 inches
UVC - effects
Treatment parameters
Bactericidal effects
Exposure time in 3 to 5 sec increments, might need up to 30 sec for some pathogens
Distance is determined by equipment
Might also help reduce odor
Negative pressure wound therapy (NPWT) AKA
vacuum assisted closure
Negative pressure wound therapy (NPWT) - how does it work
Wound bed must be 100% granular! Has to be clean!
Sterile foam placed into wound bed
Lightly fill tunnels and undermined areas
Collection canister is connected to pump free end of tubing placed into the wound bed
Film placed over it to seal
Pump turned on (125 mmHg)
Intermittent or continuous
Keep on for 48-72 hours
Negative pressure wound therapy Indications (NPWT) -
Acute and traumatic wounds Subacute wounds (dehisced incision) Pressure ulcers Chronic open wounds (stasis ulcers and diabetic ulcers) Meshed grafts Flaps
Negative pressure wound therapy (NPWT) - small ambulant is recommended for
Venous stasis ulcers LE diabetic ulcers Pressure ulcers Dehisced incisions Grafts LE flaps
Negative pressure wound therapy (NPWT) - Contraindicated for
Fistulas to organs or body cavities
Necrotic tissue in eschar
Osteomyelitis (untreated)
Malignancy in the wound
Hyperbaric oxygen therapy - application
systemic or topical application
Hyperbaric oxygen therapy - how does it work
Inc oxygen concentration gradient
May dec bacterial growth
Limited research to support efficacy
Total contact cast - used to treat
Grade 1 and grade 2 neuropathic ulcers
Total contact cast - how does it work
Allows weight bearing with better distribution of forces
Improves circulation secondary to edema control and warmth
Protects foot and leg from additional trauma
Total contact cast - contraindicated
With infection or gangrene
In conditions with fluctuating edema
ABIs less than 0.5 (she says mayber even 0.7)`
Total contact cast - negatives
Requires training to apply
If improperly applied, there is significant risk of additional skin breakdown and infection! NEUROPATHY!
Total contact cast - steps
1 Apply primary dressing
2 Stockinette
3 Felt is applied in areas of body prominence
4 Cover toes with foam
5 Add thin layer of cast padding
6 Apply fiberglass casting tape
7 Mold cast tape to extremity with use of a moist elastic wrap
8 Use cast shoe if a walking heel was not incorporated into the cast
