Wound Care

Published on 22/05/2015 by admin

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Last modified 22/05/2015

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Chapter 38 Wound Care

OVERVIEW.

Wound care may incorporate debridement techniques. Debridement is the procedure of removing devitalized tissue (and foreign matter) from a wound. Moist devitalized tissue supports the growth of pathological organisms, initiates an inflammatory response, and retards wound healing. The removal of devitalized tissue is considered necessary for wounds to heal.1

In this section, debridement concerns for autolytic, enzymatic, mechanical (wet-to-dry gauze dressings, wound irrigation, whirlpool, dextromoners), and sharp techniques are reviewed. The sources included one governmental/agency, three physical therapy, and one nursing. Wound cleaning solvents and dressing issues are also briefly addressed.

CONTRAINDICATIONS AND PRECAUTIONS

DEBRIDEMENT

Autolytic Debridement (AD)

Autolytic debridement uses moisture-retentive synthetic dressing, permitting devitalized tissue to self-digest from enzymes normally in the wound. AD is indicated when the patient may not tolerate other forms of debridement and would not become infected if the wound was not debrided using faster methods. AD takes longer than other methods.1

General note: Stable heel ulcers. The AHCPR1 panel’s opinion is that stable heel ulcers with a dry eschar do not need to be debrided if they do not have drainage, fluctuance, erythema, or edema because they provide a natural protective cover. These stable heel ulcers with dry eschar should be monitored daily and must be debrided if signs of pressure ulcer complications appear.

S00-T98 INJURY, POISONING, AND CERTAIN OTHER CONSEQUENCES OF EXTERNAL CAUSES

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PROCEDURAL CONCERN

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Enzymatic Debridement

Topical debriding enzymatic agents are applied to the wound surface of devitalized tissue and are considered if ulcer is not infected, individuals are in LTC facilities or at home or if surgery cannot be tolerated.1

S00-T98 INJURY, POISONING, AND CERTAIN OTHER CONSEQUENCES OF EXTERNAL CAUSES

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PROCEDURAL CONCERNS

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Mechanical Debridement

Mechanical debridement uses some outside force to remove dead tissue such as (1) wet-to-dry dressings, (2) hydrotherapy, (3) wound irrigation, and (4) dextranomers.

Wet-to-Dry Gauze Dressings

Wet-to-dry gauze dressings removes necrotic tissue nonselectively that has dried and adhered to gauze.4

D50-D89 DISEASES OF BLOOD AND BLOOD-FORMING ORGANS AND CERTAIN DISORDERS

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S00-T98 INJURY, POISONING, AND CERTAIN OTHER CONSEQUENCES OF EXTERNAL CAUSES

image

PROCEDURAL CONCERNS

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