Irrigation and Physical Agents in Wound Management – Vocabulary Review

Vocabulary flashcards covering key terms, modalities, parameters, indications, contraindications, and documentation concepts from the lecture on wound irrigation and physical agents.

Wound Irrigation

The use of fluids (commonly saline or tap water) to remove dressing residue, loose devitalized tissue, topical-agent remnants, and surface bacteria without traumatizing the wound bed.

Standard of Care (Irrigation)

Every wound should be irrigated after dressing removal regardless of other interventions.

Pounds per Square Inch (PSI)

Unit measuring irrigation pressure; >15 PSI can damage tissue, 4–15 PSI is considered safe for wound irrigation.

Bulb Syringe Rinsing

Low-pressure (≈4 PSI) watering of a wound that is NOT considered true irrigation.

Angiocatheter Method

35 mL syringe with 19-gauge catheter delivering 4–15 PSI for irrigation; inexpensive but messy and unsuitable for heavy bleeding.

Pressurized Saline Canister

Pre-pressurized container that delivers irrigation fluid under controlled pressure; can be used alone or with devices like Waterpik.

Pulsed Lavage

Hand-held system that delivers irrigation (4–15 PSI) with simultaneous suction, enhancing removal of pathogens and exudate.

Waterpik (Low Setting)

Dental device adapted for wound care at ≈6 PSI; must be set on low and used with saline.

Personal Protective Equipment (PPE)

Required gear (face shield, mask, fluid-proof gown, shoe covers, gloves, hair cover) to prevent splash contamination during irrigation.

Whirlpool (Hydrotherapy)

Non-selective mechanical debridement using agitated water (92–102 °F) for 10–20 min; macerates periwound skin and is contraindicated for VI, DVT, acute cellulitis, etc.

High-Volt Pulsed Current (HVPC)

Electrical stimulation modality delivering twin-peaked monophasic pulses for wound healing via galvanotaxis.

Galvanotaxis

Migration of cells in response to an electrical field, used therapeutically to attract reparative cells to a wound site.

Negative Polarity (Cathode)

HVPC setting used in the inflammatory phase to increase blood flow and reduce edema (100–128 pps, 100–150 V, 60 min, 5–7×/wk).

Positive Polarity (Anode)

HVPC setting that promotes granulation and epithelialization during proliferation/remodeling phases.

Medicare ES Guidelines

Electrical stimulation is reimbursed after 30 days of conservative care for Stage III/IV pressure ulcers with documented progress.

Electrical Stimulation Contraindications

Malignancy, untreated osteomyelitis, thrombophlebitis/DVT, pacemaker, carotid sinus, pregnancy uterus, dressings containing metal ions (e.g., silver).

Negative Pressure Wound Therapy (NPWT)

Vacuum-assisted closure using foam, transparent film, and suction (50–175 mmHg; optimal blood flow at 125 mmHg) to promote wound contraction and granulation.

Macrostrain

Tissue-level effect of NPWT that pulls wound edges together, removes exudate, and evenly distributes negative pressure.

Microstrain

Cell-level deformation from NPWT that decreases edema and stimulates cell migration, perfusion, and granulation.

NPWT Indication

Chronic/acute wounds (pressure, venous, diabetic, grafts, flaps, traumatic) with ≥80 % clean wound bed.

NPWT Contraindication

Foam contact with exposed vessels/organs, malignancy, untreated osteomyelitis, unexplored fistulas, necrotic tissue with eschar.

Low-Frequency Ultrasound (LFUS)

25–40 kHz ultrasound using saline mist for debridement and bioburden reduction; 20–60 s/cm², minimum 4 min, 2–3×/wk.

Therapeutic Ultrasound (1 MHz / 3 MHz)

Sound waves to enhance collagen deposition, granulation, angiogenesis; 1 MHz for deep, 3 MHz for superficial wounds.

Ultrasound Zone

Treatment area equal to 1.5× the transducer head; 2–3 min per zone, 2×/day to 3×/wk.

Hyperbaric Oxygen Therapy (HBO)

Administration of 100 % O₂ at 1.5–2.5 ATM for 90–120 min, 2×/day–3×/wk, up to 60 sessions for complicated wounds.

TCOM (Transcutaneous Oxygen Monitoring)

Measurement of skin oxygen; >40 mmHg supports healing, <30 mmHg suggests poor prognosis even with HBO.

HBO Contraindication

CHF, DVT, claustrophobia, pregnancy, severe arterial insufficiency, COPD, and uncomplicated wounds.

Ultraviolet C (UVC)

200–290 nm germicidal light that increases vascular permeability and may reduce bioburden in critically colonized Stage III/IV pressure ulcers.

Monochromatic Infrared Energy (MIRE)

890 nm near-infrared delivered via diode pads, purported to boost circulation up to 400 %; evidence is limited.

Low-Level Laser Therapy (LLLT)

Light therapy with mixed evidence aiming to stimulate cellular activity and improve scar tensile strength.

Clinical Decision Matrix

Guide matching wound presentation (granular, necrotic, draining/non-draining) to modalities such as pulsed lavage, whirlpool, e-stim, LFUS, HBO.

Plan of Care (POC) Documentation

Section outlining frequency, duration, interventions, and anticipated progression; must avoid vague phrases like “continue POC.”

Daily Note Components

SOAP format capturing patient status, interventions, response, future plan, and discharge considerations for each visit.

Sample Size (Research)

Number of subjects in a study—often small in wound-care research, limiting statistical power and generalizability.

Statistical vs. Clinical Significance

Difference between mathematically significant results and changes that are meaningful in patient outcomes—critical in interpreting wound-care studies.