Question

process of cleansing a wound

Answer 1

The wound is defined as an injury to living tissue caused by a cut, blow, or other impacts, typically one in which the skin is cut or broken. We have to treat the wound is sterile manner to avoid or prevent infection as well as promote the healing.

We can discuss the step by step process in wound cleaning :

*Step 1:

• position patient based on their comfort and our comfort for the procedure of cleaning the wound
• pre-medicate if needed
• clear distractions - judge whether family or friends should stay

*Step II:

• separate dressing from the tissue by "Soaking" it off using adhesive remover (non-glycerol)

*Step III :

• cleanse the wound with...

1. sterile saline (throw out every 24 hours) using gauze or
2. wound cleanser (1-month use for a single patient)

*Avoid Hydrogen peroxide, Dakin's solution, and Betadine unless for management of active infection.

*Avoid scrubbing wound with abrasive material
*Can use surgical scrub brushes if wound really sloughy

*Step IV :

-Cleanse with pulsatile lavage with suction, irrigation kit or IV bag, or shower

• shower - ensure no vital structures exposed

*Step V:

-Debride

• do not do if the wound is dry, intact eschars
• eschars wet or wound sloughy --> Debride loose slough

# Sharp/Selective Debridement

*Most efficient way to remove necrotic tissue and slough
*Remove only what is non-viable..." selective or conservative"

#Autolytic Debridement

*uses cells and enzymes normally present in the wound to remove debris from the wound
*facilitated by moist wound environment
*use hydrating agents or film dressings
*slow process
*not good for actively infected wounds
*concern for periwound maceration
*use if selective debridement is too painful, small wound area, minimal depth and palliative

#Enzymatic Debridement:

*apply outside chemical enzymes such as...
1. collagenase
2. Papain-urea
*often combined with selective and autolytic debridement
*daily application recommended to all deeper penetration to eschar
*keep it moist!

#Mechanical Debridement

use of physical forces to remove foreign material, dead or damaged tissue by...
1. irrigation/PLWS
2. hydrotherapy/whirlpool
3. wet to dry dressing - no longer standard of care

#Biologic Debridement

sterile maggots produce enzymes that degrade necrotic tissue and are antimicrobial
*can use loose or in the pouch
*requires MOISTURE, exudative wound
* pain-free!

-Decision-making factors in choosing a dressing for a wound:

• wound size and shape
• wound location
• ease of application/removal
• patient comfort (i.e. bulk, cosmetic appearance)
• who can apply it?
• cost (per treatment, total course of care)
• availability

*Inflammatory phase of wound healing expects a more frequent change of any dressing:

-dry gauze good for:
*cleaning
*packing/filling wound
*absorption/wicking/protection/thermal
(use in a pinch)
-vaseline gauze:
*moisture balance!!!

Hydrogel, transparent films dressings are used for dry to little fluid wounds

*Transparent films:

-Indicated for fluid conservation or light fluid wounds
-partial thickness wounds (blisters, tears, skin abrasions)
-minimal drainage or lead to maceration (venous)
-used after autolytic debridement

*Hydrocolloids, Calcium alginate, Hydrofiber, foam dressings are used for moderate to high fluid wounds

*Hydrocolloids:

-Indicated for light to medium fluid wounds
-partial thickness wounds/Full thickness wounds
-shallow wound (sacral wounds/pressure wounds)
-good to increase moisture or maintain (maintains moist environment/temp control)
-doesn't allow bacteria to pass through
-autolytic debridement/light moderate exudate
*NOT for highly exuding, infected, or undermining ulcer

*Calcium Alginate:

-indicated for moderate to heavy fluid wounds
-Fillstunnellingg and undermining

*Hydrofiber :

-Same as alginate except for 30% more absorption!!!
-Fills tunnelling and undermining

*Hydrogel:

-indicated for dry wounds or light fluid
-autolytic debridement (eschar, slough)
-protects peri-wound
-no treatment required

*Foam:

-Indicated for most medium and high fluid wounds
-absorption
-space filling
*NEVER PUT ON INTACT SKIN