my wound care modalities

What are the advantages to using Pulsatile Lavage vs. Whirlpool

PLWS cleans and debrides with irrigation and suction from a handheld device

Indications for pulsatile lavage

For any open wound, with no known contraindications, For tunneling and undermining

What are the contraindications for pulsatile lavage

Some systems have a latex component (latex allergies)

What pressure (psi) would you want to use to initiate treatment with pulsatile lavage

4 to 15

What pressure (psi) would you want to use for Tunnelling with pulsatile lavage

2 to 6 psi

Most wounds will decrease bacterial count at 12 to 15 psi so when would we increase and decrease psi

Decrease if pain or bleeding occurs and Increase if excessive exudation or necrotic tissue

How long is a typical treatment with pulsatile lavage

Each treatment is 15 to 30 minutes, Once or twice daily depending on the amount of necrotic tissue debrided, D/C after 1 week if no improvement

Purposes of using NPWT with a patient

to draw wound edges together, removing infectious materials, and promote granulation at the cellular level (Watch for pain when turning on and off)

What type of E stim is widely used for wound healing

High voltage, pulse current (HVPC) is most widely used

When using E stim for wound healing, what is the appropriate treatment time and frequency

60 minute/day, 7 days/week

Voltage for E stim for wound healing

75 to 150V

Pulse Frequency for E stim for wound healing

100 pps

Positive polarity for E stim

Epithelization, Autolysis or reactivate inflammation

Negative polarity for E stim

Granulation, Infection

Monopolar set up for E stim

one directly over the wound and a ground pad 15

Bipolar set up for E stim

two electrodes placed periwound and a ground pad 15

Contraindications for E stim

Skin CA in the area, Untreated osteomyelitis, On the neck, Over a pacemaker, Metal implants in the area

Appropriate MHz for Ultrasound for wound healing

3 for directly over wounds stage 2 or 3, 1 for periwound skin of deep wounds

Appropriate duty Cyle for ultrasound

20%

Wattage for ultrasound wound healing

0.3 for acute/inflammation phase, 0.5 for reparative phase, 0.5 to 1.0 for remodeling

Full thickness wound

Treat periwound with US gel, Don’t get the US gel in the wound

Partial thickness wound

Treat wound and 6cm periwound, Use hydrogel sheet or gel

Contraindications for Ultrasound

CA near, Pregnancy, Near pacemaker, Over metal implants or reproductive organs or eyes, Thrombophlebitis, Osteomyelitis, Fracture site, Infected wounds

What is Ultrasound mist

Painless, noncontact, low frequency US delivered in a saline mist, Uses gentle sound waves to stimulate cells in the wound bed

UVB and UVC are absorbed by the

superficial epidermis

UVB

causes an inflammatory reaction that stimulates granulation tissue and breakdown of necrotic tissue

UVC is used

for infection

What type of UV requires a MED

UVB requires minimal erythemal dose, Expose 4 one cm areas, about 2 cm apart, to 15, 30, 45, 60 seconds

The MED will be the shortest exposure that

causes reddening of skin in 1 to 6 hours and disappears after 24

How long should you apply UV to kill any bacteria or virus within the wound bed

2 minutes, most if not all surface bacteria will be killed

Precautions for UV light

Recent x ray, Photosensitivity or photosensitive meds, Exposure to eyes, Fragile skin

Contraindications of UV

TB, or other systemic conditions, CA in area, Fever, Acute skin conditions, Hyperthyroidism, Severe DM

How does hyperbaric oxygen work to heal wounds

Patient breathes in 100% oxygen in a sealed chamber (2.0

What type of evidence does diabetic ulcers respond to hyperbaric oxygen

B evidence

What type of evidence does venous insufficiency respond to hyperbaric oxygen

C evidence

Treatment of hyperbaric oxygen and time/intensity

Debride, irrigate, and redress before session, 90 to 120 mins/day in chamber with 20 to 40 total sessions at 2.0 to 2.5 x atmospheric pressure

Contraindications of hyperbaric oxygen

Antineoplastic drugs, Doxorubicin, disulfiram, cisplatin, mafenide acetate, Untreated pneumothorax

Precautions of hyperbaric oxygen

Upper respiratory infection, Emphysema, Seizure disorder, High fever, History of thoracic surgery, Viral infection, Optic neuriti