Debridement

Question 1

Removal of necrotic and/or infected tissues that interfere with wound healing; Decreases risk of infection; Enhances wound healing

Answer 1

debridement

Question 2

What are the purposes for debridement?

Answer 2

1. decreases bacterial concentration within the wound bed and the risk of infection
2. Increase the effectiveness of topical antimicrobials
3. improve the bactericidal activity of leukocytes
4. shorten the inflammatory phase of wound healing
5. decrease the energy required by the body for wound healing
6. eliminate the physical barrier to wound healing
7. decrease wound odor

Question 3

What are indications to debridement?

Answer 3

1. Necrotic tissue, foreign material, debris
2. Possibly blisters and calluses

• Red–yellow–black system

Question 4

system to describe wound bed
- pale pink to beefy red, granulation tissue
tx goals:
- protect wound
- maintain warm, moist environment
- protect periwound

Answer 4

red

Question 5

system to describe wound bed
- moist, yellow slough; may vary in adherence
tx goals:
- debride necrotic tissue
- absorb drainage
- protect periwound

Answer 5

yellow

Question 6

system to describe wound bed
- thick, black, adherent eschar
tx goals:
- debride necrotic tissue

Answer 6

black

Question 7

should you pop or not pop blisters?

Answer 7

Newest research suggests that all blisters open and closed be debrided
- blister fluid increases inflammatory response and provides ideal environment for bacterial proliferation

Question 8

What are the contraindications to debridement?

Answer 8

1. Red, granular tissue
2. Stable intact heel pressure ulcer
3. Urgent need for surgical debridement - Gangrene, Osteomyelitis
4. Electrical burns
5. Deeper tissue

Question 9

What are the types of selective debridement?

Answer 9

1. Sharp
2. Autolytic
3. Chemical/Enzymatic
4. Biological
5. Surgical

Question 10

What are the types of nonselective debridement?

Answer 10

Mechanical

Question 11

Endogenous enzymes digest necrotic tissue with moisture-retentive dressing

Answer 11

Autolytic debridement

- hydrocolloid; transparent

Question 12

What are the advantages of autolytic debridement?

Answer 12

1. Least invasive, least painful method
2. Doesn’t disrupt healthy tissue
3. May be used in conjunction with other methods
4. Easy to perform
5. Selective
6. Requires minimal professional expertise/monitoring

Question 13

What are the indications of autolytic debridement?

Answer 13

1. All wounds with necrotic tissue
2. Patients who cannot tolerate other forms of debridement
3. Commonly used in home or long-term care settings

Question 14

What are the contraindications of autolytic debridement

Answer 14

1. Infected or deep cavity wounds

2. Wounds that require sharp or surgical debridement

Question 15

What are the disadvantages of autolytic debridement?

Answer 15

1. Time for debridement to occur
2. Maceration possible
3. Potential for bacterial growth
4. Sensitivity to adhesives
5. Does not allow for frequent wound visualization

Question 16

Use of exogenous enzymes to remove devitalized tissue; Form of selective debridement; Requires physician’s prescription

Answer 16

Enzymatic debridement

• Collagenase - only enzyme currently FDA approved
• Santyl

Question 17

What are the advantages of enzymatic debridement?

Answer 17

1. Less skill required

2. Less painful

Question 18

What are the disadvantages of enzymatic debridement?

Answer 18

1. Maceration
2. Skin sensitivity
3. Pain, erythema, dermatitis, burning/stinging
4. Expensive

Question 19

What are the indications of enzymatic debridement?

Answer 19

1. Infected and uninfected wounds with necrotic tissue

2. Pt. unable to tolerate sharp debridement

Question 20

What are the contraindications of enzymatic debridement?

Answer 20

1. Wounds with exposed deep tissues
2. Facial burns
3. Over calluses
4. Wounds free of necrotic tissue
5. Should not be applied to wounds being autolytically debrided

Question 21

Use of force to remove devitalized tissue, foreign material, and debris; Nonselective

Answer 21

mechanical debridement

• Wet-to-dry dressings
• Pulsatile lavage
• Scrubbing
• Whirlpool
• Wound cleansing
• Wound irrigation

Question 22

Use of scalpels, scissors, or lasers in a sterile environment to remove necrotic tissue, foreign material, and debris; Performed by physician or podiatrist

Answer 22

surgical debridement

Question 23

Who can perform sharp debridement?

Answer 23

PTs, Nurses, PAs

• Standard of care for open wounds
• need order from physician
• most PTAs cannot perform

Question 24

Use of scissors or scalpel to cut and remove necrotic tissue; Fastest, most aggressive form of debridement

Answer 24

Sharp debridement

- Hemostatic agents and topical pain medications may be needed

Question 25

What are indications for sharp debridement?

Answer 25

Large amount of necrotic tissue, callus, advancing cellulitis, sepsis; May be used on wounds with any amount of necrotic tissue; Chronic wounds

Question 26

What are contraindications for sharp debridement?

Answer 26

1. Clotting disorders 2. Systemic infection 3. Ischemic leg/foot ulcers 4. Medically unstable patient 5. When area cannot be adequately visualized 6. Material to be debrided is unidentified 7. Lack of clinician competency – needs more training to feel confident - Caution: anticoagulants

Question 27

When should you terminate sharp debridement?

Answer 27

1. Clinician fatigues 2. Pain is not adequately controlled for patient 3. Decline in patient status or tolerance to technique 4. Extensive bleeding 5. Nothing remaining to debride

Question 28

How do you stop bleeding?

Answer 28

``` Pressure with gauze for 5 min Do not check wound Add gauze if blood soaks through Elevate body part above heart Use silver nitrate if needed ```