Wound Interventions and Dressings Flashcards
What are 2 types of wound debridement?
Selective debridement
Non-selective debridement
What is selective debridement?
Removal of ONLY non-viable tissue from a wound
What are three types of selective debridement?
Sharp debridement
Enzymatic debridement
Autolytic debridement
What is sharp debridement?
Use of a scalpel, scissors or forceps to remove non-viable tissue or debris from the wound bed
When is sharp debridement used?
When large amounts of thick, adherent, necrotic tissue is present
What is enzymatic debridement?
Application of an enzymatic preparation to necrotic tissue to remove necrotic tissue
When is enzymatic debridement used?
Used on infected and non-infected wounds with necrotic tissue or when autolytic debridement is not effective
What is autolytic debridement?
Use of the body’s own mechanisms to remove nonviable tissue
What are 4 examples of autolytic debridement?
Use of: Transparent films Hydrocolloids Hydrogels Alginates
What is the purpose of autolytic debridement?
Establishes a moist wound environment that rehydrates necrotic tissue and eschar
When is autolytic debridement not used?
On infected wounds
What is non-selective debridement?
Removal of both viable and non-viable tissues from a wound
What are the 3 most common types of non-selective debridement?
Wet-to-dry dressings
Wound irrigation
Hydrotherapy
What is wet to dry dressing application?
Refers to the application of a moistened gauze dressing over an area of necrotic tissue
Describe the debridement process via wet to dry dressing application.
- Apply the moistened gauze over the wound
- Let gauze dry completely
- Remove gauze (necrotic tissue will be adhered to gauze)
What is wound irrigation?
Removal of necrotic tissue from the wound bed using pressurized fluid
What is an example of wound irrigation?
Pulsed lavage
What is the most common form of hydrotherapy?
Whirlpool
What are 3 potential side effects of hydrotherapy?
- Maceration of viable tissue
- Edema from dependent LE positioning
- Hypotension
What is negative pressure wound therapy (NPWT)?
Non-invasive modality that involves placing a sterile foam dressing over the wound and sealing it with an airtight secondary dressing which is attached to a vacuum pump.
When is negative pressure wound therapy indicated?
Indicated for wounds that cannot be closed by primary intention
What are 5 contraindications to using negative pressure wound therapy? (NPWT)
- Malignancy within the wound
- Insufficient vascularity for wound healing
- Large amounts of necrotic tissue
- Uncontrolled pain
- Untreated osteomyelitis
What is hyperbaric oxygen?
Refers to the inhalation of 100% oxygen at a pressure greater than 1 atmosphere to reduce edema and hyper oxygenating tissue
When is hyperbaric oxygen indicated? (5)
Osteomyelitis Diabetic wounds Crush injuries Thermal wounds Radiation necrosis
What are growth factors?
Derived from naturally occurring protein factors. Promote healing by stimulating the activity of specific cell types
When is the use of growth factors indicated?
To treat neuropathic ulcers extending into or through subcutaneous tissue
When is the use of growth factors contraindicated?
Contraindicated for wounds closed by primary intention
What is the difference between primary and secondary dressings?
Primary = dressings that come in direct contact with the wound
Secondary = dressings that are placed directly over the primary dressing for protection/absorption etc.
What are 6 types of wound dressings?
Alginates Foam Dressings Gauze Hydrocolloids Hydrogels Transparent films
What are alginates?
Dressings derived from seaweed extraction that create a hydrophilic gel and are highly absorptive but highly permeable
What type of wound dressings typically require secondary dressings? (3)
Alginates
Non-adhesive foam dressings
Hydrogels
When are alginates typically used?
On partial or full-thickness wounds (typically infected)
What are foam dressings?
Dressing made of a polyurethane base that contacts the wound surface and a hydrophobic outer layer
When are foam dressings typically used?
To provide protection and absorption over partial and full-thickness wounds with varying levels of exudate.
What is the most readily available dressing in an inpatient environment?
Gauze
What are hydrocolloids?
Gel forming polymers backed by a strong film or foam adhesive that do not attach to the wound itself but to the intact surrounding skin.
What is a contraindication to hydrocolloids?
It cannot be used on infected wounds
What are hydrogels?
Water and gel forming materials used on superficial and partial thickness wounds
What is one disadvantage of hydrogels?
Cannot be used on wounds with significant drainage
What are transparent films?
Thin membranes made from transparent polyurethane that are permeable to vapor/oxygen and nonpermeable to water/bacteria
What do hydrocolloids, hydrogels and transparent film dressing have in common?
They cannot be used on infected wounds
What type of dressing can be used as a coupling agent for ultrasound?
Hydrogels
What types of wound dressing CANNOT be used on infected wounds?
Hydrocolloids
Hydrogels
Transparent film
What does occlusion mean in terms of wound dressings?
Refers to the ability of a dressing to transmit moisture, vapor or gases between the wound bed and the atmosphere.
List the wound dressings in order of most occlusive to non-occlusive. (7)
- Hydrocolloids
- Hydrogels
- Semipermeable foam
- Semipermeable film
- Impregnated gauze
- Alginates
- Traditional gauze
List the wound dressings from most to least moisture retentive.
Alginates Semipermeable foams Hydrocolloids Hydrogels Semipermeable films
What is dehiscence?
The separation, rupture or splitting of a wound closed by primary intention
