Diana Ramirez-Ripp, Author at WCEI WCEI

Author Archive

Wound Debridement Basics: The 5 Major Methods Explained

Friday, June 24th, 2022

What is Debridement?

Wound debridement is the removal of necrotic, dead tissue from the wound bed. It also plays a vital role in the tissue management concept of wound bed preparation. Wound bed preparation is the comprehensive approach we use to get our chronic wounds to heal. There are two main categories of debridement: selective and non- selective. Selective methods are when only necrotic, non-viable tissue is removed from the wound bed. Non-selective methods remove both necrotic tissue and viable living tissue.

The 5 Major Debridement Methods

These five major debridement methods for wound clinicians are easy to remember (BEAMS), and key to the wound healing process. Debridement methods can be categorized under two main types.

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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.

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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Ouch! Let’s Talk About Skin Tears

Wednesday, December 2nd, 2015

This WCEI free webinar will help wound care professionals understand more about skin tears, including how to treat and prevent them (and help patients heal).

If you’ve ever suffered a significant skin tear, then you know how painful they can be. The inevitable bleeding (and sometimes even disfigurement) during the healing process can take a toll, both physically and emotionally. So you can imagine how awful it would be to experience this same cycle of pain, over and over again.

Unfortunately, skin tears are a common occurrence with institutionalized patients (particularly in older adults), and often lead to further complications. In fact, a reported 1.5 million skin tears occur in this population each year, and that doesn’t even include unreported incidents occurring at home.

But we’re here to help, thanks to our own WCEI Clinical Instructor Gail Hebert, and her presentation at the 2015 Wild on Wounds National Conference in Las Vegas, “How To: Skin Tears – Prevention and Management.” In this free webinar (see access code below), you can listen to her recorded session and arm yourself with the latest information about skin tear treatment, prevention and management. You can also help to bring the number of annual skin tears down while protecting patients and helping support the facilities in which you work.

Gail Hebert, RN, BS, MS, CWCN, WCC, DWC, OMS, WCEI Clinical Instructor

Ready to learn?

So what exactly is a skin tear? As Hebert explains in the webinar, it’s a traumatic wound caused by shear, friction and/or blunt force trauma that results in either a partial or full thickness injury. And while skin tears certainly occur, to think they are inevitable is short-sighted.

“Our role is to make sure we’ve done everything we can to minimize their occurrences,” says Hebert. “Not just by accepting that skin tears happen and move on, but to work hard at all the variables that can be controlled, so skin tears can be the exception rather than the rule.”

Through Hebert’s webinar, you will learn so much more about skin tears, including:

How to identify risks for skin tears and skin tear category classifications.
Current evidence-based recommendations for accurate skin tear assessment, prediction, treatment and prevention strategies.
Forms and tools you can put to use immediately.

“Skin tears are considered to be negative patient outcomes,” adds Hebert. “So in terms of your facility’s reputation, you don’t want to be known as a place where an excessive number of skin tears take place.” In other words, if people wonder if your facility is doing everything it can to prevent them, you want to be able to respond with a resounding, “Yes!”

What people have to say

Those who were able to attend Hebert’s session in person last summer at the WOW Conference had plenty of feedback to share. Here’s a sample:

“Who knew there was enough on this subject matter to actually speak on it for one whole hour? It was great!”

“Excellent speaker, and was happy to hear that I was caring for skin tears in the right manner! Now I can go back to my facilities and students, and pass this information on! Thank you so much! Very engaging speaker!”

“This was a great review for me. I used last year’s skin tear outline to help build our skin tear policy, so I truly appreciate the updated outlines provided with this lecture.”

Go ahead, take the skin tear plunge!

Are you ready to learn more about skin tears and put into practice your newfound knowledge? Click here and use the code SKINTEARS to access this 60-minute recording, which qualifies for an education credit.

Tell us your stories

Have you made improvements in your own facility when it comes to skin-tear prevention? What were they, and what results have you noticed? Do you have any other suggestions for skin-tear treatment, prevention or assessment? Leave your comments below.

Wound Care Education Institute® provides online and onsite courses in the fields of Skin, Wound, Diabetic and Ostomy Management. Health care professionals who meet the eligibility requirements may sit for the prestigious WCC®, DWC® and OMS national board certification examinations through the National Alliance of Wound Care and Ostomy® (NAWCO®). For more information see wcei.net.

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What is Charcot Foot?

Thursday, January 1st, 2015

What is Charcot Arthropathy? Charcot foot, as it is commonly referred to, is a chronic progressive disease of the bone and joints found in the feet and ankles of our diabetic patients with peripheral neuropathy.

What leads to this Charcot foot? Having long standing diabetes for greater than 10 years is one contributing factor. Having autonomic neuropathy leads to abnormal bone formation and having sensory neuropathy causes the insensate foot, or foot without sensation and thus susceptible to trauma, this is another contributing factor. These bones in the affected foot collapse and fracture becoming malformed without any major trauma. One common malformation you see related to Charcot foot is the “rocker bottom” where there is a “bulge” on the bottom of the foot where the bones have collapsed.

Your patient with Charcot foot will present with a painless, warm, reddened and swollen foot. You may see dependent rubor, bounding pedal pulses, and feel or hear crackling of the bones when moving the foot. If a patient were to continue to bear weight on the Charcot foot there is a high chance for ulceration that could potentially lead to infection and/or amputation.

Continued, on-going weight-bearing can result in a permanently deformed foot that is more prone to ulceration and breakdown. Prompt treatment is necessary using total contact casting, where no weight bearing will occur on the affected foot for 8-12 weeks. Our job as wound care clinicians is good foot assessment with prompt identification and treatment of this acute Charcot foot to prevent foot deformity and further complications in the diabetic patient.

Posted in Diabetes, Diabetic Wound Management | Comments Off on What is Charcot Foot?

Venous, Arterial or Mixed Ulcer…How Do I Know For Sure?

Monday, December 15th, 2014

Proper assessment is essential for differentiating between venous and arterial ulcers.

Your patient has a lower extremity wound. You aren’t sure what exactly you are dealing with. You know you need to measure the ankle-brachial index (ABI), but as you wait for results, some of your wound assessment findings offer clues.

Characteristics of Venous Ulcers

Let’s start with the venous ulcer, typically found on the medial lower leg, medial malleolus and superior to the medial malleolus. Seldom will you see them on the foot or above the knee. They tend to be irregular in shape, are superficial, have a red wound bed, have moderate to heavy amount of exudate and the patient may have no pain or a moderate level of pain. Surrounding skin can be warm to the touch, edematous, scaly, weepy and you may see hemosiderin staining present. An ABI provides a definitive answer and will come back at 0.9.
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How Do I Stage a Wound If Cartilage Is Present?

Monday, November 17th, 2014

In the human body the cartilage is found in joints, rib cage, ear, nose, bronchial tubes and between the inter-vertebral discs.

As wound clinicians we most often see it just below the bridge of the nose or on the ear in our patients with pressure injuries.

Many clinicians continually question themselves how to stage a wound with visible or palpable cartilage present.

After all, cartilage does serve the same function as bone, but the word itself is not found in the stage IV definition from the National Pressure Ulcer Advisory Panel, or NPUAP.

So how do you stage the pressure injury where it is visible or palpable?

Here is your answer: In August 2012, the NPUAP released a statement that stated: “Although the presence of visible or palpable cartilage at the base of a pressure injury was not included in the stage IV terminology; it is the opinion of the NPUAP that cartilage serves the same anatomical function as bone. Therefore, pressure injuries that have exposed cartilage should be classified as a stage IV.”

What that means is any pressure injury where you can see or feel cartilage will be classified as a stage IV pressure injury.

Simply put: if you have cartilage present in the wound, you stage it as a stage IV pressure injury.

Take our webinar, Staging and Identifying Pressure Injuries, or browse through all our webinars. Use Coupon Code: BLOG.

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A Stinky Situation: When Wound Odor is a Problem

Monday, November 10th, 2014

You may have become desensitized to it, but if your patient has odor in the wound bed, consider it a problem that you need to fix.

As healthcare clinicians, in a way, we are lucky. We become desensitized to things we encounter over and over again, they just don’t bother us like the first time we were exposed. This stands true for those wounds with odor. We almost become immune, yes we are aware the odor is there; but to our noses it is not an issue. The real issue is for our patients and their friends and family. Odor is subjective. Depending on the patient and family members ability, they may be very much aware of the odor. It can be very bothersome to the patient and their loved ones. The patient maybe embarrassed by it, and may try to self-isolate. They may not want to have people around them because of the way their wound smells. This is something as wound care clinicians we need to fix.

The first thing we need to look at is, what is causing the odor? Is it from necrotic tissue that supports the growth of anaerobic bacteria? Is it from a high level of wound exudate? Is there an actual wound infection? Do we have the wrong wound dressing on the patient?

Once we figure out the cause then we need to remove it, whether its debridement of necrotic tissue, managing the high level of exudate with dressings or using Negative Pressure Wound Therapy; we need to find what works. With an actual wound infection, treating with antimicrobial dressings or antiseptic’s/antibiotic’s are a must to remove the organism causing the infection and the odor. Sometimes just changing the dressing more frequently will help. Using dressings like those with activated charcoal, or those dressings with medical grade honey in them may help the wound odor. Another option is topical Metronidazole Gel to the wound bed, this may help eliminate wound odor as well.

Just because the odor in the wound bed isn’t offensive to us as wound care clinicians, doesn’t mean it isn’t offensive to others. As a rule, if your patient has odor in the wound bed, consider it a problem that you need to fix.

Wound Care Education Institute® provides online and onsite courses in the fields of Skin, Wound, Diabetic and OstomyManagement. Health care professionals who meet the eligibility requirements may sit for the prestigious WCC®, DWC® and OMS national board certification examinations through the National Alliance of Wound Care and Ostomy® (NAWCO®). For more information see wcei.net.

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Why ABI?

Monday, October 20th, 2014

What exactly is an ABI? ABI stands for Ankle Brachial Index. This is a non-invasive bedside tool that compares the systolic blood pressure of the ankle to that of the arm. It is done to rule out Peripheral Arterial Disease in the lower extremities. The ABI is considered the “bedside” gold standard diagnostic test and can be done by any trained clinician in a clinic, hospital, nursing home and/or even the home care setting. All you need is a blood pressure cuff and a hand held Doppler.

Why do we do the Ankle Brachial Index or ABI? Well, there are several reasons why we include the ABI as part of our assessment for the patient with lower extremity wounds. First of all, in order to heal a wound we have to be sure that our patient has adequate blood flow. The ABI will tell us if the patient has impaired arterial blood flow, and how significant that impairment is. We also need to know the amount of compression that we can safely apply to the venous patient, in general the lower the patients ABI reading, the lower the amount of compression that can be safely applied.

When do I need to do the ABI? Standards of care and Guidelines dictate when we should be doing the Ankle Brachial Index. Our current standard of practice states to do the ABI: Anytime a patient has a lower extremity ulcer, when foot pulses are not clearly palpable, prior to applying compression wraps / garments or when the lower extremity ulcer is no longer healing.

What does the ABI “number” mean? First we need to be aware that not everyone’s ABI is reliable, in fact patients with diabetes or end-stage renal disease may have incompressible vessels rendering a falsely high ABI score. For these patients we use another diagnostic test called the Toe Brachial Pressure Index (TBPI) instead of the ABI. For those with ABI readings, in general as the patients ABI score decreases, this signifies that the patient has arterial disease of the lower extremity, and poor blood flow. Any patient with an abnormal reading needs a referral to a vascular specialist. Bedside interpretations of the ABI that we use as wound clinicians are: 1.0 considered a normal reading, an ABI of 0.9 indicate more venous, 0.6-0.8 indicate a mixed etiology (venous and arterial) and less than or equal to 0.5 is indicative of arterial disease of the lower extremity.

We as wound care clinicians are held to certain standards of care and must follow those guidelines established by the experts. Performing the ABI on patients before applying compression and on patients with lower extremity ulcers is one of them. As wound clinicians we use the ABI and our clinical assessment to help guide us into determining what type of ulcer we are dealing with so we can make appropriate referrals and develop the best treatment plan for our patients. It’s a step we can’t afford to leave out; our patient’s limb may depend on it.

Posted in Diabetic Wound Management, Wound Assessment & Documentation | Comments Off on Why ABI?

Why I Became a Wound Care Certified Nurse

Monday, December 13th, 2010

Wound Care Certified

An interesting question has been posed of me recently, and when I reflected upon it, I realize now that I’ve been asked this question thousands of times. The question was “Why did you become a Wound Care Certified Nurse?” Wow, its a good question. The answer has many components to it and many levels of reasoning. I’ll explain…

Many people have become nurses for various reason; they want to change the world, they like the challenge, they like the pay (compared to other jobs they had), their guidance counselor told them the job outlook was good, they knew someone who was a nurse and they thought they looked good in scrubs…Who knows? But for those of us that got into nursing for a deeper reason or interest, you know what I mean.

My journey began way back in high school when I worked in between my sports as a student athletic trainer. I would work with the other student athletes when they were injured. I thought I would eventually become a Certified Athletic Trainer or Physical Therapist. I did the same in College in off season. I remember working a Cross Country meet and a participant sustained a head injury that caused extensive bleeding and subsequent loss of consciousness. Assisting in the stabilization of this patient and accompanying him to the Emergency Room in a Philadelphia City Hospital, I was exposed to a new world of health care. It just so happened that there were a few male nurses there who I erroneously thought were doctors. It turned out they were nurses. As the dust settled and the opportunity to converse with these nurses played out, I realized that there was something I may be interested in pursuing.

A few years later, my father became ill with lung cancer. His hospitalization was short as we brought him home on Hospice. The hospital staff nurses were awesome to my father. They made him comfortable when we knew there wasn’t much time. They did some cool things and taught me some things that at the time I didn’t know. They helped me understand better what was happening.

Fast forward a few years into my nursing career. For some reason, I was always pulled into helping with changing the bandages of some of the most involved wounds. Back then it seemed there was no method to the madness (treatment orders). I saw it all. Packing dressings with BARD, Milk of Magnesia dressings, Heat Lamps…..the list goes on. I came to have a reputation for ‘enjoying’ doing the dressing changes and had an interest in doing this type of work. I took pride in seeing the various traumatic and surgical wounds heal as the days, weeks and months passed.

As the career path became work clear and evident, I sought out becoming official and getting specialized training. I attended any and all types of inservices and meetings concerning wound care. Then it hit me. I learned about the Wound Care Education Institute’s Wound and Skin Management Course. Behold, you can become Wound Care Certified in One Week! I said to myself “I’m totally doing this!”

I remember my class like it was yesterday. I had two instructors. Cindy Broadus RN and Scott Batie PT. I sat in the front row to the right and it was awesome! These instructors rocked! They had a plethora of knowledge that they transferred to me that is invaluable. All of these individuals have so many initials behind their names that would amaze you as to their experience and clout. They are truly amazing people. To date, there are over 9000+ WCCs (Wound Care Certified) Professionals. The number is more close to 10,000. The people at the Wound Care Education Institute are responsible for teaching the teachers and clinical experts out there that are touching the lives of countless names and faces of patients that are cared for in the United States and beyond. Yes Beyond!!! Many of the WCCs are treating patients Internationally in places like Haiti and Ethiopia. I’m certain there are more places but you get the idea.

Intrinsically, there is something that is of value to be able to physically see and measure improvement of a healing wound. To know that you have something to do with the resulting healing wound gives extreme satisfaction. On a superficially level, its like winning a game or knowing the directions to a destination of which you are the one that has that knowledge. When you transfer that knowledge (like WCEI has done for me), and you see the results before your eyes, the reward is priceless. It helps to see the smiles on the faces of the patients we care for, wouldn’t you say?

For me, I am taking it in a bit of a different direction. Although I still see and treat patients in a Hyperbaric Oxygen Wound Clinic setting, I think there is an amazing opportunity to share the knowledge I’ve gained online. Some of you may have attended the Wild On Wounds National Conference the past few years and had the opportunity to catch one of my presentations on Social media and Wound Care. One of the things we do as Wound Care Nurses (and Professionals) is educate our patients, their family members and colleagues about the wound healing process. The internet provides a medium for a digital version. Through Blog posts such as this one, Audio and Video Podcasts (YouTube and iTunes), Micoblogs (Twitter), Social Networking (Facebook and LinkedIn) and more, we can converse and add value to our communities by teaching and consuming content that enriches our knowledge and the education of others. Its another way that we can help and extend our wound care education for ourselves and that of the communities we serve.

What about you? Why did you become wound care certified? If you are not certified yet, why would you like to be?

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Wound Measurement and Documentation

Monday, January 18th, 2010

Wound Measurement

Wound Measurement and Documentation is a daily task the wound care professionals utilize in their practice. There are various tools like flow sheets, tracing materials, measuring tapes, skin markers, labels, and other products specifically designed for wound assessment, measurement and documentation.

There are varying types of documentation methods from print to electronic, digital photography to tracing. For example, tracings are used to measure the surface of a wound and provide a clear, visual picture of how a wound appears without the use of a camera. Some institutions prefer not to photography and tracing or measurement based documentation is preferred. Some Departments of Health require film based photography only and others are more accepting of Digital Photography.

DSLR

Wound measurement tools are used to determine length, width, and depth. They are available in a wide variety of materials, including plastics, paper, or soft film and as single-patient use or reusable.

The use of wound measuring tools help documentation to be consistent and more exact in measuring the status of a wound as to whether it is progressing or regressing or remaining static. There is no question that documentation is a necessity. The more accurately we document, the better we can convey the understanding of what we are trying to relay to other health care professionals and readers of the patient’s chart.

So what kinds of measuring and documentation tools do you use in your wound care setting?

The Wound Care Education Institute will teach you how to accurately measure wounds in their Skin and Wound Management Course. Check out our list of dates and locations for more information about becoming Wound Care Certified

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