Role of Physical Therapy and Wound Care

Wound care certified

Licensed healthcare professionals include PT, PTA, OT, MD, DO, RN, LPN, and NP
2 hour exam of 110 questions; lasts 5 years

Certified wound specialist

Any licensed healthcare professional with a Bachelor's, Master's or Doctoral degree with 3 or more years of clinical wound care experience
Must pass a 4 hour exam, certification lasts for 10 years
Must take 6 qualifying CEUs/year

Fellow of the American College of Certified Wound Specialists

One must already be a CWS or other recognized wound care specialist

Wounds to refer to a PT

Necrotic
Wounds with purulent exudate
Chronic
Pasty/salmon pink (chronic proliferation)
Without good epithelial margin
Extremity wounds with edema
Nonhealing oncology

Wounds not to refer to a PT

Acute stage one or stage two pressure ulcers
Wounds that are 100% granulating with a good epithelial margin
Wounds responding well to conservative nursing treatment
Cancer lesions

Maceration

Softening or dissolution of tissue after lengthy exposure to fluid

What does TIME stand for

Tissue non viable
Infection/Inflammation
Moisture imbalance
Edge of wound

What does TIME deal with

Wound bed prep care cycle

Whirlpool: advantages

Cleansing of necrotic and odorous wounds
Softening of eschar or necrotic tissue
Debriding by turbulence
Increases blood flow and circulation

Whirlpool: contraindications

Moderate to severe edema
Incontinence
Acute phlebitis or cellulitis
DVT
Dry gangrene

Pulsed lavage

Irrigates and cleanses wounds via pulsatile lavage jets
Reduce bacteria and infection
Promotes granulation and epithelialization
Only get local vasodilation

What is the irrigation pressure range (PSI) for pulse lavage?

4-15

What is the most effective irrigation pressure for pulse lavage?

8

Irrigation pressure

Normal saline IV bag used as irrigant
Debrides and cleans through pressure to necrotic tissue
Reduces bacteria and inflammation of tissue

Negative pressure

Provides concurrent suction (60-100 mm Hg)
Removed debris, bacteria, and irrigant
Dilates arterioles to increase blood flow

Pulsed lavage: advantages

Include cost efficiency
Faster outcomes
Decreased length of stay
Better control of suction and pressure
Decreased need for OR
Limb salvage

Pulsed lavage: disadvantages

Acute bleeding
Exposed arteries, nerves, tendons and bone
Grafts/flaps
Cavity lining (ex: open fascia)
Patients on anticoagulation medications
Aerosolization

Aerosolization

Treatment only 1 pt/room or in separate air-lock treatment rooms
Must terminally clean room in between patients

If swelling is visible, what % increase is there in the diffusion distance?

100%

Compression therapy: indications

LE edema due to impaired venous return or lymphedema
Manage edema until fitted for custom fit stockings
Decrease frequency of dressing changes for venous ulcers
Clean venous ulcers with minimal drainage

Compression therapy: contraindications

ABI < 0.8
Poor personal hygiene
Infected necrotic ulcers
Mixed arterial/venous disease
DVT
Non-dopplerable pulses
Osteomyelitis (non-treated)

Unnna boot compression

Venous stasis ulcers and edema
Light to moderate drainage
More active patients
Gauze has mixture of zinc oxide, glycerin, and calamine
Apply ace wrap over gauze to secure

The ulna boot compression provides __-__ mm Hg of compression.

20-30

WCL: abbreviation

Wound contact layer

What is four-layer compression

Bandage placed over primary dressing (WCL)

What is the 1st layer of compression

Absorbent padding

What is the 2nd layer of compression

Crepe bandage holds layer 1 in place

What is the 3rd layer of compression

Classic 3a elastic compression bandage

What is the 4th layer of compression

Class 3b cohesive bandage

Four-layer compression achieves __-__ mm Hg of compression.

30-40

How many days can a four-layer compression dressing stay on?

7

Electric stimulation: theory

Use of bioelectric current to attract cells to increase wound healing
Use of positive and negative polarity current in wound bed with electrodes or aluminum foil
Increases blood flow, collagen synthesis, and decreases edema

T/F: Both PTs and PTAs are qualified to apply topical agents and dressings to wounds, as well as performing sharp wound debridement.

False

Sharp debridement

Attempt to remove any devitalized tissue
Used pre-medication
Recommend performing ABI first if indicated
May require several sessions
Minimize overall bleeding (know INR)
Work on cleaner areas first then necrotic

How many minutes is generally set to perform sharp debridement?

15-20

List the five elements of proper documentation for sharp debridement.

Description of procedure as excisional
Instruments used
Tissue removed
Appearance and size of wound
Depth of debridement