chapter 5- wound debridement

purpose of wound irrigation

removes loosely adhered debris, bacteria, exudate residual topical agents

wound irrigation indications

standard component of treatment for all wound types

contraindiction of wound irrigation

wounds with active, profuse bleeding

advantages of wound irrigation

simple, quick, inexpensive, effective, can use for wound in any location and in any setting

disadvantage of wound irrigation

messy

methods of wound irrigation

saline or tap water

4-15 psi

pressurized saline canister

35 mL syringe and 19 gauge angiocatheter

waterpik to gravity

1 inch away, top to bottom

purpose of debridement

decrease bacterial concentration within the wound bed and the risk of infection, increase effectiveness of topical antimicrobials, improve bactericidal activity of leukocytes, shorten inflammatory phase, decrease energy required by body, eliminate physical barrier to wound healing, decrease odor

general indications for debridement

red- pale to pink beefy red granulation tissue, protect wound, maintain warm, moist and protect periwound

DEBRIDE if yellow - moist yellow slough, debride nectoric tissue, absorb drainage, protect periwound

if black- thick black adherent eschar- then debride necrotic tissue

eschar usually indicates

full thickness wound,

adhered soft: soggy tissue, strongly attached to base of center of wound

adhered hard: firm, crusty, strongly attached to wound base and edges like scab

fibrin

tough, yellow tissue typically tightly adhered in wound, common in venous ulcers, sometimes referred to as fibrinous slough

hyperkeratosis

callus at wound edge, common in neuropathic ulcers due to lack of sensation

general considerations for debridement

characteristics of wound

status of patient: general health and nutrition, concomitant medical conditions, immunosuppression, thrombocytopenia, or anticogulants

existing state practice acts

clinicians knowlegde and skill level

sharp debridement

use of forceps, scissors, scalpel to selectively remove devitalized tissue, foreign material, and debris (selective sharp debridement, and serial instrument debridement)

autolytic debridement

maintaining warm, moist wound enviroment to allow endogenous enzymes to digest necrotic tissue

enzymatic

use of exogeneous enzymes to remove devitalized tissue, have to change dressing everyday (Ex collagenase)

considerations: wound with exposed deep tissues, facial burns, calluses, wounds free of necrotic tissue,

do not do if autolytically debridement, with dressing, topical agents, or solutions containing silver iodine, acetic acid, or hydrogen peroxide

mechanical debridement

use of force to remove devitalized tissur, foreign material, and debris

nonselective

EX: wet to dry dressing, scrubbing (road rash), wound cleansing (dont do, cytotoxic, delays wound healing), wound irrigation, pulsatile lavage, whirlpool, hydrogen peroxide (bc of bubbles)

surgicial debridement

use of scaplels, scissors, or lasers in. a sterile enviroment by physician or podiatrist to remove necrotic tissue, foreign material, and debris (nonselective)

indications: ascending cellulitis, osteomyelitis, extensive necrotic wounds, extensive undermining, necrotic tissues near vital organs and structures, sepsis

indications of sharp debridement

large amount of necrosis, callus, advancing cellulitis, sepsis, eschar

may be used on wounds with any amount of necrotic tissue

chronic wounds may require repeats

contraindications of sharp debridement

area cant be visualized properly, material to be debrided is unidentified, infected ischemic ulcers with low ABI, patients who are immunosuppressed, thrombocytopenic, or on anticoagulants, patients with life threatening disease or condition

what is scoring

parallel cuts through eschar

cross hatching

perpendicular cuts to scored cuts, creates squares to facilitate removal

ways to stop bleeding

pressure, silver nitrate, gelatin sponge

what blisters to debride

large fluid filled, filled over joints, burn blister (has fluid that prevents new tissues from being built)

if it is open or could potentially open

why debride callus

to eliminate localized areas of increased pressure, to reduce infection (debride callus forming crack or fissure where bacteria can enter into body)

more about autolytic debridement

moisture retentive dressing on for several days, endogenous enzymes digest nectroic tissue with moisture retentive dressing

most conservative of debridement

least invasive and least painful

easy to teach

debride or cross hatch before if needed

dont do if infected or gangrene

example of biologic debridment

maggot therapy

pulsed lavage (with suction)

with negative pressure also called closed pulsed irrigation