Archive for the ‘Debridement’ Category

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 wait! Here are five more myths that run counter to the evidence and wound care standards that guide our clinical practice.

(more…)

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.

(more…)

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.

(more…)

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.

pressure injury staging

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.

(more…)

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 are Wet-to-Dry Dressings?

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.

Debridement Basics. How Many Methods Are There?

Monday, December 1st, 2014

debridementDebridement 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 where only necrotic, non-viable tissue is removed from the wound bed. Non-selective methods remove both necrotic tissue and viable living tissue.

There are 5 major debridement methods. They are known by the acronym BEAMS. The Selective methods include: Biological, Enzymatic and Autolytic. The non-selective methods are Mechanical and Sharp .

Biological debridement is also known as maggot debridement using sterile medical maggots to remove necrotic tissue. These sterile maggots debride necrotic tissue by liquefying and digesting it, they also kill and ingest bacteria while stimulating wound healing.

Enzymatic debridement is the use of collagenase ointment (Santyl) once daily to the wound bed. The ointment works from the bottom up to loosen the collagen that holds the necrotic material to the wound bed. It is a faster method than autolytic debridement, but slower than sharp debridement.

Autolytic Debridement is the slowest type. It uses the body’s own enzymes to assist in breaking down the necrotic tissue. This is achieved by using products that maintain a moist wound environment. This type of debridement is not appropriate for large amounts of necrotic tissue or infected wounds.

Mechanical debridement is a method that uses an external force to separate the necrotic tissue from the wound bed. This may be painful and removes non-viable as well as viable tissue. Methods include wet to dry dressings, scrubbing, whirlpool and irrigation. Contraindications for mechanical debridement would be epithelializing and granulating wounds.

The fastest method of debridement is the Sharp method. There are 2 types, Sharp surgical (done by a surgeon, physician or podiatrist) or sharp conservative (done at bedside by a trained clinician). It involves the use of scalpels, scissors, curettes or forceps. Sharp surgical is a major procedure that sacrifices some viable tissue where sharp conservative is a minor procedure done at the bedside that removes non-viable tissue.

The debridement method used will be chosen on a variety of factors including the wound characteristics, amount of necrotic tissue in wound, efficiency and selectivity of the debridement method itself, pain management for your patient, the cost of the procedure, exudate levels of the wound, presence of or risk of infection, the patients care setting, and the patients overall medical condition all need to be taken into account.

It is also important to remember not every patient with necrotic tissue will always be a candidate for debridement. Be sure that you understand indications and contraindications for each method when you are selecting the one for your patient.

Click Here for FREE WEBINAR