Archive for the ‘Debridement’ Category

Disappointed by Debridement

Friday, March 3rd, 2017

Nancy Collins, PhD, RDN, LD, FAPWCA, FAND

Plaintiffs often express shock and disbelief after eschar is removed, which often leaves a wound larger than the original size of the eschar.

Disappointed by Debridement

Wound photo: “Stage 4 decubitus displaying the Gluteus medius muscle attached to the crest of the ilium” by Bobjgalindo is licensed under CC BY 2.0

 

“We were in shock and couldn’t believe our eyes. It was like half her foot was gone.”

“My husband and I were horrified when we saw what they did.”

“My sister and I looked at each other, and I just kept asking why?”

“I had to leave the room and go the bathroom to cry when I saw what they did to my mother.”

You might think these quotes are from people who have witnessed a shocking crime or some sort of violence, but they are not. These are quotes from family members, now plaintiffs, who are suing for poor medical care related to a chronic wound. Their shock all had one thing in common—it came after seeing a wound that was surgically debrided.

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Wet-to-Dry Dressings: Why Not?

Friday, February 10th, 2017

What should wound care professionals do when a physician orders wet-to-dry dressings? Be prepared and know the facts.

Wet-to-Dry Dressings: Why Not?

 

Those of us in wound care know that wet-to-dry dressing are considered substandard care. Some physicians, however, commonly order wet-to-dry dressings for patients, often leaving clinicians in a tricky situation. Do you feel conflicted as to how you should respond? It can be intimidating, but with a little preparation, it doesn’t have to be. By knowing the facts about wet-to-dry dressings, as well as effective and cost-efficient alternatives, you can handle such situations with confidence. Not sure where to start? We’re here to help.

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Wound Care Myths: 5 More Debunked

Friday, November 25th, 2016

Whether it involves heel protectors, anti-embolism stockings, or letting wounds “breathe,” there are still plenty of wound-care myths circulating out there. Ready for the truth? You can handle it.

Wound Care Myths: 5 More Debunked

 

Do you use wet-to-dry dressings in order to save money? Have you administered oral antibiotics to treat infected wounds? And do you follow physicians’ orders for wound treatments even though you know they’re inappropriate?

If you answered yes to any of these questions, then you are not alone. You are among a host of other professionals who have believed or participated in some of the most common wound care myths. In an earlier post, we revealed why these and other wound care myths simply need to go away. But we’re not finished. Here are five more myths that run counter to the evidence and wound care standards that guide our clinical practice.

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Wound Care and Debridement: Know the BEAMS

Friday, August 26th, 2016

These five major debridement methods for wound clinicians are easy to remember (hint: BEAMS), and key to the wound healing process.

Wound Care and Debridement: Know the BEAMS

When it comes to healing chronic wounds, clinicians are all about Wound Bed Preparation, which is the process of removing local barriers to wound healing. A key to this process is debridement – the removal of necrotic, dead tissues from the wound bed.

In order to provide the best care possible for your patients, it’s important to know the differences between the two main categories and five major methods of debridement.

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Maggots and Wound Care: The Not-So-Odd Couple

Monday, May 23rd, 2016

The use of maggots in wound care is making a comeback – in the form of maggot debridement therapy – and wound clinicians can’t wait to talk about it.

Maggots and Wound Care

 

Most people don’t get too excited about maggots. In fact, the mere mention of legless larvae surely triggers gag responses and/or skin crawling in millions of non-healthcare citizens everywhere. But that’s definitely not the case for those of us in wound care.

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Pressure Injury (Ulcer) Staging: More Real-World Answers

Friday, April 15th, 2016

More real-world wound care questions and answers relating to pressure injury staging, including slough, debridement and skin breakdown.

More Real-World Pressure Injuries

 

Can’t get enough of pressure injury staging? Neither can we. That’s why we’re excited to present even more questions and answers about this topic, based on what wound clinicians experience out in the field (versus what we might learn from textbooks or in a classroom).

In our first such post – packed with some awesome pressure injury staging questions from the field – we discussed slough, levels of destruction and debridement. Here, you’ll find out more about pressure injury staging as it relates to abrasions, surgical flaps, skin breakdown due to clothing, and more. So here they are – five more tips for staging pressure injuries, based on real questions from clinicians.

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Wet-to-Dry Dressings: Here We Go Again

Thursday, October 15th, 2015

 

Wet-to-Dry dressingsIn the modern world of wound care, we’ve seen drastic improvements in treatment options over the years. So it’s always a surprise when we hear that there are still orders being submitted these days for outdated practices. In this case, we’re talking about those dreaded wet-to-dry dressings.

Why is this still happening – even though the disadvantages to this approach are well-documented? Could it simply be due to a lack of education? Or maybe it’s due to the unavailability of other wound care products that have been shown to yield much better (and safer) outcomes. Whatever the reason, we’re here to double-down on this: no more wet-to-dry dressings.

What is Wet-to-Dry?

Wet-to-dry is a form of mechanical debridement, and is substandard for wound care.  Here’s how it works:

  • A moist saline gauze is placed onto the wound bed.
  • The dressing is allowed to dry and adhere to the tissue in the wound bed.
  • Once the gauze is dry, the clinician forcefully removes the gauze.
  • Any dead tissue that has adhered to the dry gauze will then be removed from wound bed.
  • These steps are to be repeated every 4 to 6 hours.

 A Reality Check

Although this is technically the way wet-to-dry dressings are applied, most often clinicians will modify it by moistening the gauze prior to removal. This is so that it won’t stick to the wound bed and cause bleeding and trauma, or remove healthy tissue along with it.  The problem is that, while well-intentioned, the moistening of the gauze before removal, which spares the patient pain, defeats the original purpose (mechanical debridement). In addition, the prescribing clinician’s orders are not being followed.

To further complicate matters, some professionals with prescriptive authority write for this dressing but do not understand it is for debridement.  For example, a Physician’s Assistant once explained that he thought this type of dressing meant that the wound bed would be kept moist and covered with a dry secondary dressing.  So in many cases, we have wet-to-dry orders being written by someone who doesn’t understand what they’re ordering, and we have clinicians implementing these orders incorrectly.

The 2014 International Pressure Ulcer Guidelines clearly state that wet-to-dry dressings can be painful and may remove healthy tissue.  It also states that they are being used less frequently. In fact, research shows that this procedure is associated with slower healing rates and are costly in professional time due to the need for frequent wound dressing changes.

We Have Solutions

So, what is the answer to this ongoing problem for wound care practitioners?  It’s all about education, and everyone can help by:

  1. Sharing information. Proper educational resources and information regarding this issue need to be shared with not only nursing staff, but also with those who write the orders.
  2. Making a plan. Talk to your medical director and plan a short educational program to present alternatives for those with prescriptive authority.
  3. Asking for change. Ask for a facility policy change from your medical director that states wet-to-dry dressing orders are no longer acceptable.
  4. Talking about it. Keep the discussion going and enlist help from all levels of the organization.
  5. Learning from others. There are plenty of success stories out there from facilities that have planned for and implemented change involving key stake holders. Know that changes can be made, and don’t get discouraged if it doesn’t happen quickly. Remember, your patients are counting on you.

What do you think?

Do you work in a facility that has eliminated wet-to-dry dressings?  How did this change in policy take place, and do you have tips for others who are dealing with this problem? We would love to hear about your experiences having to do with this topic. Please leave your comments below.

 

Wound Care Treatment Outside The Bottle!

Friday, July 17th, 2015

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Learn WHY Maggot Debridement Therapy is highly effective in treating non-healing wounds. DIVE into the technical aspects of maggot debridement therapy and how to apply live maggot dressings to mock wounds.

Taught in two sessions, you will get the didactic and the practical hands on. Learn about the history, current status, mechanisms of action, as well as indications and contraindications for maggot and leech therapy.

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Sharp Debridement Hands-On Session at WOW!

Friday, July 3rd, 2015

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Among our most popular hands-on sessions is Sharp Debridement. This session offers a comprehensive presentation of wound bed preparation utilizing conservative sharp debridement. It will also include anatomy and physiology, implications and contraindications, techniques, tools, documentation, legal issues and policy development.
The hands-on lab practicum starts with all debridement instruments and supplies provided and ends with skills performance check-off. Participants will receive documentation of competency in performing conservative sharp debridement upon completion of the session.  Bill_TJ

INSTRUCTORS:
Bill Richlen PT, CWS, WCC, DWC, WCEI Instructor
Teresa Ferrante PTA, WCC

Session 305 HOW TO: Hands-On: Sharp Debridement Saturday September 5, 2015 8:30am – 12:00pm
$150 (lab fee)

This session will sell out. Reserve your seat today!

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Wild On Wounds Conference Early Registration Savings

Friday, April 17th, 2015

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When you register early, you save $100 and you will have first choice in selecting all conference sessions. The early discount rate expires May 1, 2015.  Register today!

Industry and clinical experts will provide training, product demonstrations and will help answer your “hard to heal” wound questions.

Join us in Las Vegas, September 2-5, 2015 and network with hundreds of passionate wound care clinicians with the same goal in mind, to advance their wound care knowledge.

About WOW

Wild On Wounds is a national conference dedicated to clinicians who want to enhance their knowledge and learn current standards of care in skin and wound care. Attend lecture sessions, participate in hands-on workshops and learn all the new products and technologies from industry experts.

Full Conference Registration Includes:

  • Access to educational sessions over 3.5 days
  • Access to product experts during the exhibitor showcase
  • Lunch on each registered day
  • Poolside get-together with a robust buffet
  • FREE cyber cafe to check emails, complete onsite evaluations, etc
  • Complimentary collectible event T-shirt
  • And more!

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WOUND CARE CERTIFICATION – This Wound Care Certified (WCC®) course offers an evidence-based approach to wound management and current standards of practice to keep clinicians legally defensible at bedside.

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DIABETIC WOUND CERTIFICATION – This Diabetic Wound Certified (DWC®) course takes you through the science of the disease process, focuses on limb salvage and prevention, and covers the unique needs of a diabetic patient.

WCEI2015_OMS_BUTTON_revOSTOMY CERTIFICATION – This Ostomy Management Specialist (OMS) course will take you through the anatomy and physiology of the systems involved in fecal/urinary diversions. The course includes hands-on workshops and online pre-course modules.

 

CLICK HERE FOR COURSE DETAILS