زائر
The tines:
1-the intdtin.
2-definitin.
3-assifiatin f wnds.
4-pess f wnd heaing.
5- Fats Affeting Wnd Heaing.
6-mpiatins f wnd heaing.
7- Wnd Assessment hat Gideines .
8-diagnsti pedes.
9-gidane f management f wnd infetin.
10-speia nsideatin eated t fd nditins.
11-physia theapy mdaities in wnd ae
12-types f wnd debidement.
13-dessing and es f wnd ae.
a-the five es f wnd ae.
b-dessing assifiatin.
14- Advese effets f dessings.
15-wnd eanses.
16-ste emving gideines.
17-efeenes.
the intdtin:
the skin is the bdy agest gan. It mpses ne sixth f the tta bdy weight. the integment is a ptetive baie against disease asing ganism .
Injy t the integment pses isk t safety and tigges a mpex heaing espnse.
Definitin:
— A wnd is a disptin f nma anatmia stte and fntin that ests fm pathgia pess beginning intenay extenay t the invved gan.
: Wnd assifiatin
Desiptive qaities
eaniness
Seveity f injy
ase
Stats f skin integity
1-aeatin.
2-abasin.
3-ntsin.
1-ean.
2-ean ntaminated
3-ntaminated
4-infeted.
5-nized.
1-spe faia.
2-penteating.
3-pefating.
1-intentina.
2-ninentina.
1-pen.
2- sed.
3-ate.
4-hni.
Exampes:
— 1-pen wnd ike (sgia inisin,
gnsht).
— 2-sed wnd ike(tea f visea gan).
— 3-ate wnd (tama by shap bjet).
4-hni wnd(pesse ses).
— 5-intentina(sgia inisin).
— 6-nintentina(bn).
— 7-spefaia(abasin ,fist degee bn).
— 8-pentating(gnsht ,stab wnd).
— 9-pefating wnd is penetating wnd in whih feign bjet entes and exist an intena gan.
— 10-ean wnd is wnd ntaining n pathgi ganism.(sed sgia wnd nt enteing GIT , T, genitaia , ninfeted T ,
— phayngea avity)
— 11-ean ntaminated is wnd made nde asepti tehniqe bt invving bdyavity that habs miganisms ike sgia wnd enteing gastintestina nde nted nditins.
12-ntaminated(pen tamati aidenta wnd)
13-aeatin wnd is teaing f tisses with iega wnd edges.
14-abasin wnd ike wnd esting fm fa(skinned knee ebw).
15-ntsin wnd is wnd ased by bw t bdy by bnt bjet.
Pess f wnd heaing:
The entie wnd heaing pess is a mpex seies f events that begins at the mment f injy and an ntine f mnths t yeas. This veview wi hep in identifying the vais stages f wnd heaing.
I. Infammaty Phase
A) Immediate t 2-5 days
B) Hemstasis
* Vasnstitin
* Pateet aggegatin
* Thmbpastin makes t
) Infammatin
* Vasdiatin
* Phagytsis
II. Pifeative Phase
A) 2 days t 3 weeks
B) Ganatin
* Fibbasts ay bed f agen
* Fis defet and pdes new apiaies
) ntatin
* Wnd edges p tgethe t ede defet
D) Epitheiaizatin
* sses mist sfae
* e tave abt 3 m fm pint f igin in a dietins
III. emdeing Phase
A) 3 weeks t 2 yeas
B) New agen fms whih ineases tensie stength t wnds
) Sa tisse is ny 80 peent as stng as igina tisse .
Fats Affeting Wnd Heaing
Age
The physigia hanges that with ageing pae the de patient at highe isk f p wnd heaing. eded skin eastiity and agen epaement infene heaing. The immne system as deines with age making de patients me sseptibe t infetin. de pepe an as pesent with the hni diseases, whih affet thei iatin and xygenatin t the wnd bed.
Dehydatin
This eads t an eetyte imbaane and impaied ea fntin. It is a patia pbem in patients with bns and fistae.
Hand Washing
Effetive hand washing geaty edes the isk f tansfeing pathgeni ganisms fm ne patient t anthe by diet ntat by ntaminatin f inanimate bjets that ae shaed.
Infetin
Infetin has been defined as the depsitin and mtipiatin f ganisms in tisse with an assiated hst eatin. If the hst eatin is sma negigibe then the ganism is desibed as nising the wnd athe than infeting it. It is imptant t distingish between nisatin and infetin sine nised wnds wi hea witht the need f antibitis (tting 1994).
ntaminatin is the depsitin and sviva, bt nt the mtipiatin, f the ganism Aytn 1985).
Wnd infetin is a pbem bease, at the mst fndamenta eve, infetin stps a wnd fm heaing by:
* Pnging the infammaty phase
* Dispting the nma tting mehanisms
* Pmting disdeed ekyte fntin and timatey peventing the devepment f new bd vesses and fmatin f ganatin tisse.
Assessment f a wnd in de t identify wnd infetin shd nt be imited t swabbing the wnd f bateigia anaysis.
Infetin s when viene fats expessed by ne me mi-ganisms in a wnd t-mpete the pesn's immne system. Sbseqent invasins and spead f miganisms in gd tisse pvkes a seies f a and systemi espnses sh as:
i) Sgia (ate wnds)
* a pain tendeness
* a sweing edema
* ineased exdate eithe ses pent haemses
* sepaatin f wnd edges wnd beakdwn
* pyexia
* deayed heaing
ii) hni wnds
* deayed heaing
* ineased fagiity hange in appeaane f ganatin tisse
* nexpeted pain tendeness
* pketing bidging f epitheia tisse
* an abnma sme
* pesene f exdate eithe ses pent haemses
* a sweing edema
* extending magin eythema
* pyexia
* wnd beakdwn
Mediatin
Anti-infammaty, yttxi, immnsppessive and antiagant dgs a ede heaing ates by intepting e divisin the tting pess.
xygenatin and tisse pefsin
* Gd wnd xygenatin is essentia f wnd heaing. xygen infenes angigenesis, epitheiaisatin and esistane t infetin
* Disage smking
Pesna and a hygiene
* The need f gd pesna and a hygiene shd be disssed with the patient.
Ntitin
* Ptein is eqied f a the phases f wnd heaing, patiay imptant f agen synthesis.
* Gse baane is essentia f wnd heaing.
* In, eqied t tanspt xygen.
* Mineas, zin, ppe, ae imptant f enzyme systems and immne systems. Zin defiieny ntibtes t disptin in ganatin tisse fmatin.
* Vitamins A, B mpex and , ae espnsibe f sppting epitheiaisatin and agen fmatin. It is as imptant f the infammaty phase f wnd heaing.
* abhydates and fats. These pvide the enegy eqied f e fntin. When the patient des nt have engh, the bdy beaks dwn ptein t meet the enegy needs. Fatty aids and essentia f wnd heaing.
* efe t Dietiian if patient is manished
PATIENT EDATIN - sggest t patient that:
* Fd is thee t be enjyed
* Vaiety in what we eat is heathy
* They shd eat the ight amnt t be a heathy weight. This wi vay f age, sex and eve f ativity.
* They shd ty nt t eat t mh fat, sga sat.
* The diet shd pvide penty f vitamins and mineas
* Keep eves f ah within emmended imits
mpiatins f wnd heaing:
1-hemhage.
Hemhage ing afte hmestasis indiates a sipped ste, a disdged t, infetin , esin f bd vesse by feign bjet (eg.dain)
Hemhage may extenay intenay.
The nse an detet intena beeding by king f distentin sweing f the affeted bdy pat.
A hange in the type and amnt f dainage fm a sgia dain .
2-infetin.
Wnd infetin is the send mst mmn nsmia infetin ading t the D.
A wnd is infeted if pent mateia dains fm it. even if the te is nt taken has a –ve est .why?
Bease many wnds nies f nn infetis esident bateia.
A hni dema wnd ae nsideed ntaminated with bateia.
a.What is the diffeene between infetin and ntaminatin nizatin?
Wnds with me than 100,000 ganism pe miiite .ae infeted the ny exeptin is when the ganism is beta –hemyti stepts the pesene f this ganism f ess than 100,000 ganism pe miiite.
The hane f wnd infetin is geate when the wnd ntains dead tamati tisse.
A ntaminated tamati wnd may shw sign f infetin within 2-3 days.
A sgia wnd infetin des nt devep nti the 4th 5th pstpeative day.
b. Hw d I knw if the wnd I'm teating is infeted?
Thee ae many ts that y have at y dispsa t detemine if an infetin is pesent. T begin with, y shd assess the inia pite f this patient and his he wnd. Is the patient febie? Ae the vita signs nma abnma ? Des the wnd appea ed and swen ? Is thee pent dainage a f d ? Is the aea and the wnd wam t the th as mpaed t neaby skin skin n the ppsite extemity? Is bne expsed (this d indiate stemyeitis)?
In additin, thee ae many abaty tests t detemine whethe an infetis pess is ing. These inde: white bd e nt (WB), eythyte sedimentatin ate (ES), -eative ptein, x-ay examinatin, deep tisse te (nt swab), nea mediine testing (gaim, tehnetim and indim sans) and bd tes.
Thee entie pite mst be evaated aefy. An abnmay high WB witht the inia appeaane f infetin d indiate a fase test, an infetin ing smepae ese (sh as a inay tat infetin) anthe disease pess atgethe.
. Ae a wnds infeted?
N, bt y shd nside a wnds as being ntaminated with miganisms. A ntaminated wnd wi hea, an infeted wnd wi nt. Wnd exdate ntains bateia kiing enzymes that wi hep pevent an infetin. Ppe eansing, debidement and maintaining f a mist wnd envinment wi a eate an nditin that essens the hane f infetin.
d. Ae swab tes imptant?
As stated in the AHP gideines, swab tes d nt effetivey evea the infeting ganism. Swab tes ny et the sfae ntaminating ganisms. Tisse bipsy and te, fid aspiatin tes and pssibe bne bipsy ae bette atenatives f ting the infeting ganism. Nte: the AHP gideines state that stemyeitis is deteted in 69 peent f the ases whee the WB, ES and pain x-ays wee a psitive, theefe, the need f an invasive bne bipsy may be eded.
e. Hw ae infetins teated?
The fist item t be disssed is infetin nt. We mst a stive t avid any type f ss ntaminatin between patients mtipe wnds n the same patient. Hand washing, ean dessing sppies, new gves and steie instments ae a eqied t pefm basi wnd ae. Ppe dispsa f ntaminated waste is gvened by the patina Safety and Heath Administatin (SHA). As, ptet the wnd fm ine fea ntaminatin.
If a wnd infetin is sspeted, ntify the ppe heath ae pvide n the ase immediatey. ne an infetin is diagnsed, the patitine may de tpia antibiti fshes, tpia antibiti appiatins, a systemi antibitis. An inisin and dainage (I and D) may be neessay t dempess an absess emve devitaized tisse. These pts wi be detemined by the extent f infetin, infeting ganism, media histy f the patient and any media aegies. Ading t the AHP, ne shd nt se tpia antibitis sh as pvidne idine, idph, sdim hyphite [Dakin's Stin], hydgen pexide aeti aid t ede bateia in wnd tisse. These pdts have been shwn t be yttxi and inhibit ganatin tisse.
3-dehisene.
Is patia tta sepaatin f the wnd ayes.
isk fats f dehisene:
a-p ntitina stats .
b-infetin.
-besity.,
dehisene ften invves abdmina sgia wnds and afte a sdden stain sh as ghing, vmiting sitting p in bed.
ients ften epts feeing as thgh smething has given away.
4-eviseatin.
Ptsin f visea gan thgh a wnd pening .
The nditin is a media emegeny that eqie a sgia epai.
The nse a steie twes saked in a steie saine t ede hane f bateia invasin and dying.
If the gan ptded thgh the wnd ,bd sppy t the tisse is mpmised.
The ient shd be kept NP .
bseve signs and symptms f shk and pepae f E sgey.
5-fista.
Is an abnma passage between tw gans between an gan and the tside f the bdy.
Mst fista ,hweve fm as a est f p wnd heaing as a mpiatin f a disease sh as hns disease.
Tama, infetin , adiatin expse and disease sh as ane pevent tisse ayes fm sing ppey and aw the fista tat t fm.
6- deayed wnd heaing.
Sme times efeed as 3d –intentin wnd heaing .
deayed wnd heaing is a deibeate by the sgen t aw effetive eansing f the ean ntaminated wnd ntaminated wnd.
The wnd is nt sed nti a evidene f edema and wnd debis has been emved.
7- Wnd Assessment hat Gideines Assessment
Eiit a aef histy f injy i.e.:
* mehanism f injy; assiated bd ss; isk f ntaminatin; deepe stte damage;
* tetans stats;
* nside Nn aidenta Iinjy;
* ndeying hni iness disabiity.
Fy examine the injed pat in patia heking f
* ndeying neve, vesse and tendn damage. This eqies assessment f mvement whie exping the wnd (espeiay in pama hand wnds).
* Assess tisse damage ss
Afte assessing a wnd, ppe dmentatin is neessay f media, ega and eimbsement easns. A phtgaph f the wnd is the mst eiabe dmentatin. Y hating shd inde the fwing infmatin n eah wnd ae visit:
* Patient's name and date f visit
* Vita signs - temp., pse, espiatin, bd pesse
* Ae the dessings intat? - (wet, dy, se, ean, dity)
* Stikethgh - Is thee dainage n the tside f the dessing mateia?
* atin f wnd - ft, eg, thigh, sam, ebw, shde, ight, eft, dsa, panta, media, atea, antei, pstei, et.
* Size - ength, width and depth meased in entimetes. (se a steie ttn tip appiat t mease depth). D NT SS NTAMINATE WNDS by sing the same gves, instments, measing devies, et. if the patient has mtipe wnds. Based n pevis measements, is the wnd impving, deteiating emaining stagnant.
* Taking - defined as skin vehanging a dead spae
* ndemining - k f skin that vehangs the wnd's edges
* Dainage - Is thee dainage n the ntat ayes f the dessing? What des it k ike (ses, pent, bdy, geen, yew, ea, thik, et.) Is the dainage a beakdwn f the wnd dessing (ike a hydid) ata dainage fm the wnd? Yew pent dainage d indiate staphys invvement. Geen dainage d indiate psedmnas invvement. Estimate the amnt f dainage pesent.
* d - Is thee any d fm the wnd? This an ffe a geat dea f infmatin n whih ganism may be ntaminating infeting a wnd. Fity sme pints twad staphys ganisms. F d (fea ike) pints twad gam negative bateia.
* Neti tisse - What peentage f the wnd appeas t be neti tisse. Neti tisse shd be nsideed as any tisse that is nt beefy ed and gana. Whee is the neti tisse? Daw a sma diagam.
* Infetin - Is the wnd ed ( steaking edness), ht and swen? Is thee seness t f pptin t what shd be pesent given the patient's media histy and the pgessin and etigy f the wnd? Infetin shd be assessed bth iniay and with the hep f ab data sh as vitas and WB nt.
* Stage pesse es - efe t the setin n staging pesse es f a mpete eview. In sht, an e with an intat esha shd be nted as nstageabe de t esha fmatin. I stngy emmend that y D NT evese stage a heaing e. F exampe, an e initiay dmented as a stage 4 shd nt be dmented as a stage 2 a stage 1 as it heas. The easn is simpe. Skin ve a heaed e is ny 70 - 80 peent as stng as ndamaged skin. A new heath ae pfessina n the ase may k at the atest ntes and ny see a stage 2 in the assessment and nt eaize that this patient is at high isk. I ike t dment that the wnd is a heaing stage 4 e.
* assify nn pesse es - se Wagne assifiatin f ft es. se "f thikness" "patia thikness" phasing t dment the types f es. Wagne assifiatin is as fws:
* Gade 0 - Pe-eative esin, heaed es, pesene f bny defmity
* Gade 1 - Spefiia e witht sbtanes tisse invvement
* Gade 2 - Penetatin thgh the sbtanes tisse (may expse bne, tendn, igament, jint apse)
* Gade 3 - steitis, absess, stemyeitis
* Gade 4 - Gangene f the feft
* Gade 5 - Gangene f the entie ft
* Past teatment - Nte the past teatments and any hanges in pdts. This wi hep new heath ae pfessinas n the ase. Pdts that may nt have pded the desied ests wn't be aidentay dpiated.
* ent teatment - Dment the type f iigatin, pdts and senday dessings sed ding the dessing hange.
* Signate - Sign the bttm f the nte.
* Fw p - ntat the apppiate dt, nse, theapist the heath ae pfessina t disss y findings, espeiay if thee is deteiatin.
abaty Data and diagnsti pedes:
* Baseine B
* ine anaysis
* Sem eetytes
* Ateia bd gas
* abxyhemgbin eves
* hest x-ay the x-ay
* xay f adipaqe feign bdy ndeying fate
* tasnd is sef f pnte wnds with a adient feign bdy sh as thn spinte.
Gidane f Management f Wnd Infetins:
Mst wnd infetins ae de t staphyi and stepti. This wd ikey hd te even in the pst-hiane setting.
* F initia antimibia teatment f infeted wnds, beta-atam antibitis with anti-staphya ativity (ephaexin, dixaiin, ampiiinsbatam et.) and indamyin ae emmended ptins.
* f nte, eenty an ineasing nmbe f mmnity assiated skin and sft tisse infetins appea t be ased by methiiin-esistant Staphys aes (MSA). Infetins ased by this ganism wi nt espnd t teatment with beta-atam antibitis and shd be nsideed in patients wh fai t espnd t this theapy. Teatment ptins f these mmnity MSA infetins inde timethpim-sfamethxaze (a) vanmyin (intavens). indamyin is as a ptentia ptin, bt nt a isates ae sseptibe.
* Inisin and dainage f any sbtanes etins f ps (absesses) is as an imptant mpnent f teating wnd infetins.
Speia nsideatins eated t Fd nditins:
ntaminatin f wnds with wate (fesh sea wate) an ead t infetins ased by watebne ganisms. Thgh infetins with these ganisms ae nmmn, even afte fds, this pssibiity shd be nsideed in patients wh fai t espnd t initia theapies desibed abve. Wate-bne ganisms ften impiated in these infetins inde: Aemnas spp., nn-hea Vibi spp. and smetimes Psedmnas the Gam-negative ds.
Timethpimsfamethxaze, amxiiinavanate and newe fqinnes (evfxain, mxifxain, gatifxain) wi teat Aemnas and the fqinnes wi as teat Psedmnas and many the Gam-negative pathgens.
iniians shd nside Vibi as a pssibe asative ganism f wnd infetins ined in asta wates fm ntat with shefish maine widife. Vibi vnifis wnd infetins may eqie extensive debidement and mtaity an be high. These infetins ften manifest with bs esins that may be hemhagi. Pesns with ndeying hepati disease the immnmpmising iness ae at highest isk f Vibi vnifis infetin. When this infetin is sspeted, the emmendatin is that patients be teated with a mbinatin f eftazidime and dxyyine.
Physia Theapy Mdaities in Wnd ae:
Eetia Stimatin
tasnd
Whip
Hypebai xygen
Eetia Stimatin:
Eetia stimatin is defined as the se f an eetia ent t tansfe enegy t a wnd. The type f eetiity that is tansfeed is nted by the eetia se. ( AHP 94). apaitativey ped eetia stimatin invves the tansfe f eeti ent thgh an appied sfae eetde pad that is in wet (eetyti) ntat ( apaitativey ped) with the extena skin sfae and wnd bed. When apaitativey ped eetia stimatin is sed, tw eetdes ae eqied t mpete the eeti iit. Eetdes ae say paed ve wet ndtive medim, in the wnd bed and n the skin a distane away fm the wnd.
tasnd
tasnd is a mehania vibatin deiveed at a feqeny abve the ange f hman heaing. inia tasnd nits enty being manfated typiay deive tasnd at feqenies f 1 and 3 MHz with dty yes anging fm 20 t 100 peent. Dty yes ess than 100% ae say temed psed tasnd whie a 100% dty ye is efeed t as ntins tasnd.
Hw des tasnd benefit wnd heaing?
Infammaty Phase - tasnd ases a deganatin f mast es esting in the eease f histamine. Histamine and the hemia mediats eeased fm the mast e ae fet t pay a e in attating netphis and mnytes t the injed site. These and the events appea t aeeate the ate infammaty phase and pmte heaing.
Pifeative Phase - tasnd has been nted t effet fibbasts and stimate them t seete agen 1. This an aeeate the pess f wnd ntatin and inease tensie stength f the heaing tisse 2. nnetive tisse wi engate bette if bth heat and steth ae mbined. ntins tasnd at highe theapeti intensities pvides and effetive means f heating deepe tisse pi t steth.
Feqeny
As the feqeny f tasnd is ineased, the penetatin f the signa deeases. F mst dema wnds, it is pefeabe theefe, t tiize a feqeny f 3 MHz. 1 MHz wnd be me effetive n deepe sttes peiwnd skin.
nsideatins in the se f tasnd
As with the media devies, inapppiate se an est in seis mpiatins. The basi peatins shd be taken:
Teat at the west intensity that wi pde the desied est.
Asse that the appiat is kept in nstant mtin thght teatment and that the ppe asti ping medim is sed.
ede the intensity teminate teatment if the patient mpains f any inease in pain.
Appiatin f tasnd t wnds
Pi t tasnd teatment, emve dessings and ean wnd f feign debis dessing eside.
A hydge sheet shd be paed in diet ntat with te wnd bed and wnd magins, paying speia attentin t emving any ai bbbes that might be pesent beneath the dessing. emve any ptetive pasti veing n the hydge sheet.
In ases whee a avity type f wnd exists that pevents mpete ntat between the hydge sheet and the wnd base, as steie aqes hydge fie shd be sed. The avity is fied with the aqes ge and then veed wit the hydge sheet. emve a ndeying ai bbbes between the aqes hydge and hydge sheet.
ne the hydge sheet is in pae, appy an tasni ping ge n tp f the sheet. Seet the apppiate sized appiat. (the aea teated shd be n age than 1.5 t 2 times the size f the appiat. If a eativey age wnd is being teated, it wd need t be divided int setins.
Set the tasnd mahine t a 20 % dty ye at a feqeny f 3 MHz.
Appying ight pesse, the snd head is paed in ntat with the ping medim n tp f the hydge sheet and mved in a sw and deibeate manne sing eithe a inea ia tehniqe.
Set the intensity t ess than 0.5 watts pe sqae entimete (say 0.3 wattsm 2). ede the intensity if the patient expeienes pain heat.
Teatment datin is sggested t be abt 1 t 2 mintes pe zne.
Ate wnds ae teated 1 t 2 times pe day nti ate symptms (infammatin) sbside. Teatments an then deease t 2 t 3 times pe week
Appiatin f tasnd t peiwnd tisse
When it is desied t pvide mid heating t the peiwnd tisse in de t stimate iatin, highe intensity tasnd an be given. Exteme ae shd be sed, hweve, t asse the tisse is apabe f handing the thema eves deiveed.
T teat peiwnd tisse, 1 MHz, ntins tasnd is say empyed. Again, an tasnd appiat 1.5 t 2 times the size f the teatment aea shd be sed. With an aqes ping medim in pae, the snd head is paed ighty against the skin sfae and mved in a sw and deibeate manne. The intensity is typiay set t between 1 and 1.5 watts pe sqae entimete. This paamete is extemey vaiabe and depends n the patient's iaty, sensy and menta stats. Thema tasnd shd neve be sed in sitatins whee impaied peeptin pevents the patient fm sensing heat pain. If at anytime ding the teatment the patient shd expeiene an inease in pain, the intensity shd be tned dwn the teatment disntined.
Teatment datin is sighty nge than that f psed tasnd sine a mid thema effet is desied. Initia teatment is abt 2-3 mintes pe zne and an be ineased by 30 send inements t a maximm f 5 mintes pe zne and deiveed 3 times pe week
Whip
Whip is the physia agent mst sey identified with physia theapy wnd ae.
1. Whip may be sed at diffeent tempeate settings t mdify its effet n iatin. Athgh it is the mst mmny sed mdaity, it's effet n wnd heaing has nt been eseahed.
Whip tanks may be eithe pemanent ptabe, f bdy extemity. The agitatin fe and dietin f the tbene may be adjsted t ptet ganatin tisse fm tama.
2. Hw des this mdaity benefit a wnd patient:
bjetives f whip teatment inde:
vasdiitatin
ineased bd fw
sftening and sening f neti tisse
mehania debidement
wnd eansing: debis and tpia agents
exdate emva --- > eded infetin
pain management
3. They behind mdaity's effetiveness:
Whip effets the Infammatin Phase f heaing
Wam wate ineases vasdiitatin f the spefiia vesses
Ineased bd fw bings xygen and ntients t the tisses and emves metabites
Ineased bd fw bings antibdies, ekytes and systemi antibitis
Fid shifts int the intestitia spaes eading t edema
Sftening and sening f neti tisse aides phagytsis
eansing and emva f wnd exdate nts infetin
Mehania effets f whip stimate ganatin tisse fmatin
Sedatin and anagesia ae inded by the wam wate
4. Hw shd a physia theapist se this mdaity n a wnd?
This teatment mdaity is ften administeed twie daiy f 20 mintes, hweve, ne daiy teatment shd be nsideed as an apppiate ptin. Fwing whip, the wnd and snding tisses shd be insed vigsy with ean wate t emve eside fm the wnd and snding tisses. The best types f wnds f whip ae thse that fa int the ategies f:
Neti
Mdeate t heavy exdative wnds
Wnds with debis
Tisse whih an teate mdeate t heavy ineased iaty pefsin
Ishemi wnds whee vigs pefsin t wnd and snding tisses is desied
Pt:
Whip tempeate Gide
Wate tempeate ange fm 33.5 ° t 35.5 0 = 92 °F t 96 °F
Wate tempeate shd nt exeed 1 ° abve skin tempeate in pesene f PVD.
Wate tempeate shd nt exeed 38 ° in pesene f adipmnay disease
Wate tempeate f 32 ° bd fw f 2.3100 f imb vme. Highe tempeate gives geate bd fw vme.
When sing we tempeates, avid hiing by maintaining wam m tempeate and se ny f singe imb, nt whe bdy.
5. Ae thee any isks mpiatin with this mdaity?
Whip may be ntaindiated f the fwing wnd sitatins:
ean ganating wnds - ean ganating wnds ae easiy tamatized by the fe f even a mid agitatin
epitheiaizing wnds
migating epidema es may be damaged by even minima fe
new skin gafts - skin gafts wi nt teate the high sheaing fes and tbene
new tisse faps - tisse faps ae vey sensitive t sheaing fes and vasnstitin whih may if the wate ai tempeate ase hiing
vens es - it is ndesiabe t inease bd vme t an aea whee bd vme is aeady a pbem - wi mpiate the pbem; in additin, a dependent psitin wi pde me dependent edema and stasis; the had neti fibin fnd in a vens e ae nt effetivey debided by hydtheapy.
nn-neti diabeti es - as wi be sftened eading t maeatin, maeated tisse wi nt teate pesse and wnd wi be enaged
6. Shd antiseptis be sed in the whip?
Thee emains ntvesy abt the se f antisepti agents in the whip. Mh eseah indiates that the mst mmny sed antisepti agents ae hamf t the es f tisse epai. In additin, they may nt be abe t ede the nmbe f bateia when the bateia ae vey nmes. A stdy by Bhannan fnd that f times as many bateia wee emved fm a vens e when insed vigsy with ean tap wate than when the wnd was ny teated in a pvdine idine whip. Patients with hni wnds may devep aegi espnses t the hemia agents.
If antiseptis ae t be sed, they shd be sed f neti, heaviy exdating wnds. Then mnit aefy and ntine ny nti wnd is ean. D NT VESE.
mmny sed antiseptis in the whip ae:
pvidine idine
sdim hyphite
HiBiens ®
hazene ® (hamine)
7. Ae any patientspathgies phibited fm sing this mdaity?
edema f the extemity
ethagy
nespnsiveness
maeatin
ppe extemity infetin
febie nditins
mpmised adivasa pmnay fntin
ate phebitis
ena faie
dy gangene - evaate f ishemia
inntinene f ine fees, if in f bdy whip
8. Infetin nt in hydtheapy
Ppe eaning f whip eqipment and the se f disinfeting stins seeted t ki infetis ganisms shd be a piy and pede f a heath ae faiities.
Ppe se f nivesa peatins is imptant in nting infetin. ting f whip eqipment is nt emmended ness thee is an episde f nexpained nsmia infetins that an be taed bak t se f the whip eqipment. A piy t pevent inhaatin ntat dematitis by the hydtheapy pesnne shd be deveped f eah heath ae faiity when sing antiseptis and disinfeting agents.
Hypebai xygen
atinae:
In an hypxi envinment, wnd heaing is hated by deeased fibbast pifeatin agen pdtin, and apiay angigenesis (1). Hypxia as aws gwth f anaebi ganisms, fthe mpiating wnd heaing. Hypebai xygen theapy pvides a signifiant inease in tisse xygenatin in the hyppefsed, infeted wnd. It infenes the ate f agen depsitin, angigenesis, and bateia eaane in wnds. The geatest benefits ae ahieved in tisses with mpmised bd fw and xygen sppy.
Diabeti Wnds:
The ineased wnd xygen tensin ahieved with HB pmtes wnd heaing, ineases the hst antimibia defenses and has a diet bateistati effet n anaebi miganisms.
Vens Stasis es:
HB theapy has a vey imited e. It is ny indiated in highy seeted patients in the pepaatin f a ganating bed ve debided vens e f eventa skin gafting. (2)
Pesse es:
HB theapy may be sef when ndeying stemyeitis is pesent t impve the sft tisse envepe f ensttin.
Ateia Insffiieny es:
HB theapy may be f benefit in seeted ases, espeiay when a wnd fais t hea despite maximm evasaizatin.
Teatments:
HB teatments ae pefmed at 2.0 t 25 ATA f 90 t 120 mintes f xygen beathing. The initia teatment shede is ditated by the seveity f the disease pess. In the pesene f imb-theatening infetin afte debidement mpmised sgia faps fwing amptatin the patient shd be teated twie daiy. When the infetin is nde nt and the sft tisse envepe impves, ne daiy teatments ae adeqate.
Types f Wnd Debidement
Atyti Debidement:
Desiptin:
Atysis ses the bdy's wn enzymes and miste t e-hydate, sften and finay iqefy had esha and sgh. Atyti debidement is seetive; ny neti tisse is iqefied. It is as vitay painess f the patient. Atyti debidement an be ahieved with the se f sive semi-sive dessings whih maintain wnd fid in ntat with the neti tisse. Atyti debidement an be ahieved with hydids, hydges and tanspaent fims.
Best ses:
In stage III IV wnds with ight t mdeate exdate
Advantages:
Vey seetive, with n damage t snding skin.
The pess is safe, sing the bdy's wn defense mehanisms t ean the wnd f neti debis.
Effetive, vesatie and easy t pefm
itte t n pain f the patient
Disadvantages:
Nt as apid as sgia debidement
Wnd mst be mnited sey f signs f infetin
May pmte anaebi gwth if an sive hydid is sed
Enzymati Debidement:
Desiptin:
hemia enzymes ae fast ating pdts that pde sgh f neti tisse. Sme enzymati debides ae seetive, whie sme ae nt.
Best ses:
n any wnd with a age amnt f neti debis.
Esha fmatin
Advantages:
Fast ating
Minima n damage t heathy tisse with ppe appiatin.
Disadvantages:
Expensive
eqies a pesiptin
Appiatin mst be pefmed aefy ny t the neti tisse.
May eqie a speifi senday dessing
Infammatin dismft may
Mehania Debidement:
Desiptin:
This tehniqe has been sed f deades in wnd ae. Awing a dessing t peed fm mist t wet, then manay emving the dessing ases a fm f nn-seetive debidement.
Hydtheapy is as a type f mehania debidement. It's benefits vs. isks ae f isse.
Best ses:
Wnds with mdeate amnts f neti debis
Advantages:
st f the ata mateia (ie. gaze) is w
Disadvantages:
Nn-seetive and may tamatize heathy heaing tisse
Time nsming
an be painf t patient
Hydtheapy an ase tisse maeatin. As, watebne pathgens may ase ntaminatin infetin. Disinfeting additives may be yttxi.
Sgia Debidement:
Desiptin:
Shap sgia debidement and ase debidement nde anesthesia ae the fastest methds f debidement.
They ae vey seetive, meaning that the pesn pefming the debidement has mpete nt ve whih tisse is emved and whih is eft behind
Sgia debidement an be pefmed in the peating m at bedside, depending n the extent f the neti mateia.
Best ses:
Wnds with a age amnt f neti tisse.
In njntin with infeted tisse.
Advantages:
Fast and Seetive
an be extemey effetive
Disadvantages:
Painf t patient
sty, espeiay if an peating m is eqied
eqies tanspt f patient if peating m is eqied
Dessing and the 5 es f wnd ae:
Even with the ineased aviabity f dessings.
An apppiate seetin an be made if etain pinipes ae maintained efeed t as the 5 es f wnd ae:
1:ATEGIZATIN:
ean abt dessing by genei ategy and mpae new pdts with thse that aeady make p the ategy.
The nse shd beme famiia with indiatins , ntaindiatin ,and side effets.
The best dessing may be by mbining pdts fm diffeent ategies .t ahieve sevea gas at the same time.
2:SEETIN:
Seet safe and mst effetive, se fiendy and st effetive dessing pssibe.
3:HANGE:
hange dessing based n patient ,wnd, and dessing assessment, nt n standadized tines.
Nata wnd heaing shd be distbed as itte as pssibe, ness the wnd is infeted with heavy dishage.
It is mmn t eave hni wnd veed f 48-72h and ate wnd f 24h.
4:EVTIN:
As the wnd pgesses thgh the phases f wnd heaing the dessing pt is ateed t ptimize wnd heaing .it is ae in hni wnds ,that sme dessing mateia is apppiate thght the wnd heaing pess.
5
ATIE :
Patie with dessing mateia is eqied f the nse t ean the pefmane paametes f the patia dessings.
efining skis f appying apppiate dessing ety and eaning abt new dessing pdts ae essentia espnsibiities .
Idea wnd dessing
N singe dessing is sitabe f a types f wnds. ften a nmbe f diffeent types f dessings wi be sed ding the heaing pess f a singe wnd. Dessings shd pefm ne me f the fwing fntins:
* Maintain a mist envinment at the wnddessing intefae
* Absb exess exdate witht eakage t the sfae f the dessing
* Pvide thema insatin and mehania ptetin
* Pvide bateia ptetin
* Aw gases and fid exhange
* Absb wnd d
* Be nn-adheent t the wnd and easiy emved witht tama
* Pvide sme debidement atin (emve dead tisse and feign paties)
* Be nn-txi, nn-aegeni and nn-sensitising (t bth patient and media staff)
* Steie .
assifiatin f wnd dessings
Syntheti wnd dessings an be bady ategized int the fwing types.
Type
Ppeties
Passive pdts
Taditina dessings that pvide ve ve the wnd, e.g. gaze and te dessings
Inteative pdts
Pymei fims and fms whih ae msty tanspaent, pemeabe t wate vap and xygen, nn-pemeabe t bateia, e.g. hyani aid, hydges, fam dessings
Biative pdts
Dessings whih deive sbstanes ative in wnd heaing, e.g. hydids, aginates, agens, hitsan
dessings types and thei ppeties:
The fwing tabe desibes sme f the many diffeent types f wnd dessings and thei main ppeties.
Dessing type
Ppeties
Gaze
* Dessings an stik t the wnd sfae and dispt the wnd bed when emved
* ny se n min wnds as senday dessings
Te
* Dessing des nt stik t wnd sfae
* Sitabe f fat, shaw wnd
* sef in patient with sensitive skin
* E.g. Jenet®, Paanet®
Semipemeabe fim
* Steie sheet f pyethane ated with ayi adhesive
* Tanspaent awing wnd heks
* Sitabe f shaw wnd with w exdate
* E.g. pSite®, Tegadem®
Hydids
* mpsed f abxymethyese, geatin, petin, eastmes and adhesives that tn int a ge when exdate is absbed. This eates a wam, mist envinment that pmtes debidement
* and heaing
* Depending n the hydid dessing hsen an be sed in wnds with ight t heavy exdate, sghing ganating wnds
* Avaiabe in many fms (adhesive nn-adhesive pad, paste, pwde) bt mst mmny as sef-adhesive pads
* E.g. DDEM®, Tegasb®
Hydges
* mpsed mainy f wate in a mpex netwk fibes that keep the pyme ge intat. Wate is eeased t keep the wnd mist
* sed f neti sghy wnd beds t ehydate and emve dead tisse. D nt se f mdeate t heaviy exdating wnds
* E.g. Tegage®, Intasite®
Aginates
* mpsed f aim aginate (a seaweed mpnent). When in ntat with wnd, aim in the dessing is exhanged with sdim fm wnd fid and this tns dessing int a ge that maintains a mist wnd envinment
* Gd f exdating wnds and heps in debidement f sghing wnds
* D nt se n w exdating wnds as this wi ase dyness and sabbing
* Dessing shd be hanged daiy
* E.g. Katstat®, Sbsan®
Pyethane siine fams
* Designed t absb age amnts f exdates
* Maintain a mist wnd envinment bt ae nt as sef as aginates hydids f debidement
* D nt se n w exdating wnds as this wi ase dyness and sabbing
* E.g. Aevyn®, yfam®
Hydfibe
* Sft nn-wven pad ibbn dessing made fm sdim abxymethyese fibes
* Inteat with wnd dainage t fm a sft ge
* Absb exdate and pvide a mist envinment in a deep wnd that needs paking
agens
* Dessings me in pads, ges paties
* Pmte the depsit f newy fmed agen in the wnd bed
* Absb exdate and pvide a mist envinment
Diffeent types f wnds and the diffeent stages f a heaing wnd eqie diffeent dessings mbinatins f dessings. The fwing tabe shws sitabe dessings f patia wnd types.
wnd type
ean, medim-t-high exdate (epitheiaising)
* Paaffin gaze
* Knitted visse pimay dessing
ean, dy, w exdate (epitheiaising)
* Absbent pefated pasti fim-faed dessing
* Vap-pemeabe adhesive fim dessing
ean, exdating (ganating)
* Hydids
* Fams
* Aginates
Sgh-veed
* Hydids
* Hydges
Dy, neti
* Hydids
* Hydges
The dessings may eqie senday dessings sh as absbent pad and bandages.
DME tiizatin Gide
The fwing is the ffiia DME tiizatin gideine f 1995. I beieve that they ny seve as gideines and that diffeing pts ae apppiate, bt need t be sbstantiated with dmentatin media neessity.
Aginate wnd ve......................Dessing hange ne daiy
Aginate wnd fie......................Dessing hange ne daiy, p t 2 six inh stips awed pe dessing hange
mpsite dessing ........................3 times pe week, ne dessing pe dessing hange
ntat aye ...................................ne pe week
Fam dessing..................................p t 3 times pe week
Fam wnd fie...........................ne daiy
Gaze................................................3 times pe day, n me than 2 pads n a wnd
(nn-impegnated)
Gaze ...............................................ne daiy
(impegnated - the than wate saine)
Gaze................................................Nn-veed, eded t ega nn-impegnated gaze eve
(impegnated with wate saine)
Hydid ve and fie .........3 times pe week
Hydge wnd ve.....................ne daiy ( 3 times pe week if sing adhesive bde)
Hydge wnd fie.....................ne daiy, n me than 3 nes pe wnd in a 30 day peid
Speiaty absptive dessing.........ne pe day ( evey the day if sing adhesive bde)
Tanspaent fim..............................p t 3 times pe week
Wnd fie nt assified..............ne pe day
Wnd ph....................................p t 3 times pe week
Tape...................................................detemined by feqeny f dessing hange
Easti bandage.................................ne pe week
Gaze, easti...................................detemined by the feqeny f dessing hange f the pimay dessing
Gaze, nn-easti............................detemined by the feqeny f dessing hange f the pimay dessing.
Advese effets f dessings
Wnd dessings an ase pbems, inding:
* Maeatin (sgginess) f snding skin (hange dessing feqenty and se a me absbent dessing)
* Iitant ntat dematitis (ptet skin with emient baie fim)
* Aegi ntat dematitis (nmmn: hange dessing type, appy tpia steids)
Wnd eanses — ean the sfae f the wnd by emving bateia and dainage. Pdts sed might ntain a detegent. Nma saine as an be sed t ean wnds witht haming new tisse.
Sme band name wnd eanses inde: Pi-ens (fm past), Shens (fm nvaTe), taKenz (fm aingtn), Biex Wnd eanse (fm Bad)
Insttins f making saine stin:
* se 1 gan f distied wate bi 1 gan f tap wate f five mintes. D nt se we wate sea wate.
* Add 8 teaspns f tabe sat t the distied bied wate.
* Mix the stin we nti the sat is mpetey dissved. Be se stage ntaine and mixing tensi ae ean (bied).
Nte: t m tempeate befe sing. This stin an be sted at m tempeate in a tighty veed gass pasti btte f p t ne week
What abt sing pvidne idine, hydgen pexide, Dakin's, aeti aid and the agents?
Pease efe t the AHP inia Patie Gideine f a detaied disssin f these and the eanses.
In sht, it has been detemined that these pdts may atay sw wnd heaing. Sme f these pdts ae yttxi t hman fibbasts, ede white bd e viabiity and deease phagyti effiieny. Stdies shw that mst f these pdts mst be dited t avid these txi effets and a ditin gide is avaiabe thgh the AHP gideine.
n a me patia eve, many f these pdts ae dying agents as we as antimibia. We have aeady identified that exdate is neessay t eate an evinment whih stimates me apid wnd heaing. By dying the wnd bed, the exdate and a its benefiia es ae emved fm the aea. Dy tisse tends t nese and seve as a bateia medim.
In additin, we knw that mst wnds shd be nsideed as ntaminated and ntaminated wnds wi hea. The nstant appiatin f an anti-mibia agent is nt neessay t pde apid wnd heaing avid infetin. In fat, thee ae inia stdies whih have shwn that a wnd maintained in a mist envinment (with exdate) has a we infetin ate than a wnd whih is dy.
Is thee a e f pvidne idine, hydgen pexide, Dakin's, aeti aid and the agents?
etainy! When disssing wnd ae, emembe that thee ae hni wnds and ate wnds. An ate wnd, ike a aeatin, wi mst ikey hea in an individa wh has n media pbem that wd deay wnd se. Aviding infetin is imptant in these ases, and maybe the heathae pvide fees mftabe sing sme f these pdts. As, in a hni wnd that has an infetin, it may be apppiate t se these pdts nti the infetin has esved.
Fm pesna expeiene, I nw appy a tanspaent fim t a my min ts and abasins, as I have fnd that my ate wnds hea vey qiky with this pt. I may as eans the wnd with ne f the abve pdts pi t the fim's appiatin.
Ste emva Gideines
emve stes eay engh t avid ste maks bt ate engh t pevent the wnd fm epening.
With eay ste emva einfe the wnd edges with Stei-Stips.
Aways hek t be se the wnd is eady f ste emva. If nt ehek in 2 days. nside emving evey the ste.
Site
Adt
hiden
Fae
4-5 days
3-4 days
Sap
6-7 days
5-6 days
Tnk
7-10 days
6-8 days
Am (nt jint)
7-10 days
5-9 days
eg (nt jint)
8-10 days
6-8 days
Jint extens sfae
8-14 days
7-12 days
Jint fex sfae
8-10 days
6-8 days
Dsm f hand
7-9 days
5-7 days
Pam
7-12 days
7-10 days
Se f ft
7-12 days
7-10 days
efeenes:
1-ya ege f sgens f Edinbgh.sgiaknwedge and skis website,wnd management,www.ed.sed.a.kwnd 20%managmentntent.htm.25t,2007.
2-Emegeny wnd management f heath ae pfessinas,D,page ast eviewed Jne 9,2006 ,.
3-wnd ae infmatin netwk ,n.d, .
4- Wnd Management e Infmatin: Sting and Bipsies , ast pdated: tbe 23, 2002,3dNv,07.
5-Szannne.Smetze.Benda G.Bae .Text bk f Media sgia nsing,Bnne &Sddaths,ippentt,9th ed,p1454-1455.
6-Patiia A.Ptte , Anne G Pey .Fndamentas f nsing ,Ptte.Pey,5th ed,SA,P1551-1552-1553-1554-1556.
1-the intdtin.
2-definitin.
3-assifiatin f wnds.
4-pess f wnd heaing.
5- Fats Affeting Wnd Heaing.
6-mpiatins f wnd heaing.
7- Wnd Assessment hat Gideines .
8-diagnsti pedes.
9-gidane f management f wnd infetin.
10-speia nsideatin eated t fd nditins.
11-physia theapy mdaities in wnd ae
12-types f wnd debidement.
13-dessing and es f wnd ae.
a-the five es f wnd ae.
b-dessing assifiatin.
14- Advese effets f dessings.
15-wnd eanses.
16-ste emving gideines.
17-efeenes.
the intdtin:
the skin is the bdy agest gan. It mpses ne sixth f the tta bdy weight. the integment is a ptetive baie against disease asing ganism .
Injy t the integment pses isk t safety and tigges a mpex heaing espnse.
Definitin:
— A wnd is a disptin f nma anatmia stte and fntin that ests fm pathgia pess beginning intenay extenay t the invved gan.
: Wnd assifiatin
Desiptive qaities
eaniness
Seveity f injy
ase
Stats f skin integity
1-aeatin.
2-abasin.
3-ntsin.
1-ean.
2-ean ntaminated
3-ntaminated
4-infeted.
5-nized.
1-spe faia.
2-penteating.
3-pefating.
1-intentina.
2-ninentina.
1-pen.
2- sed.
3-ate.
4-hni.
Exampes:
— 1-pen wnd ike (sgia inisin,
gnsht).
— 2-sed wnd ike(tea f visea gan).
— 3-ate wnd (tama by shap bjet).
4-hni wnd(pesse ses).
— 5-intentina(sgia inisin).
— 6-nintentina(bn).
— 7-spefaia(abasin ,fist degee bn).
— 8-pentating(gnsht ,stab wnd).
— 9-pefating wnd is penetating wnd in whih feign bjet entes and exist an intena gan.
— 10-ean wnd is wnd ntaining n pathgi ganism.(sed sgia wnd nt enteing GIT , T, genitaia , ninfeted T ,
— phayngea avity)
— 11-ean ntaminated is wnd made nde asepti tehniqe bt invving bdyavity that habs miganisms ike sgia wnd enteing gastintestina nde nted nditins.
12-ntaminated(pen tamati aidenta wnd)
13-aeatin wnd is teaing f tisses with iega wnd edges.
14-abasin wnd ike wnd esting fm fa(skinned knee ebw).
15-ntsin wnd is wnd ased by bw t bdy by bnt bjet.
Pess f wnd heaing:
The entie wnd heaing pess is a mpex seies f events that begins at the mment f injy and an ntine f mnths t yeas. This veview wi hep in identifying the vais stages f wnd heaing.
I. Infammaty Phase
A) Immediate t 2-5 days
B) Hemstasis
* Vasnstitin
* Pateet aggegatin
* Thmbpastin makes t
) Infammatin
* Vasdiatin
* Phagytsis
II. Pifeative Phase
A) 2 days t 3 weeks
B) Ganatin
* Fibbasts ay bed f agen
* Fis defet and pdes new apiaies
) ntatin
* Wnd edges p tgethe t ede defet
D) Epitheiaizatin
* sses mist sfae
* e tave abt 3 m fm pint f igin in a dietins
III. emdeing Phase
A) 3 weeks t 2 yeas
B) New agen fms whih ineases tensie stength t wnds
) Sa tisse is ny 80 peent as stng as igina tisse .
Fats Affeting Wnd Heaing
Age
The physigia hanges that with ageing pae the de patient at highe isk f p wnd heaing. eded skin eastiity and agen epaement infene heaing. The immne system as deines with age making de patients me sseptibe t infetin. de pepe an as pesent with the hni diseases, whih affet thei iatin and xygenatin t the wnd bed.
Dehydatin
This eads t an eetyte imbaane and impaied ea fntin. It is a patia pbem in patients with bns and fistae.
Hand Washing
Effetive hand washing geaty edes the isk f tansfeing pathgeni ganisms fm ne patient t anthe by diet ntat by ntaminatin f inanimate bjets that ae shaed.
Infetin
Infetin has been defined as the depsitin and mtipiatin f ganisms in tisse with an assiated hst eatin. If the hst eatin is sma negigibe then the ganism is desibed as nising the wnd athe than infeting it. It is imptant t distingish between nisatin and infetin sine nised wnds wi hea witht the need f antibitis (tting 1994).
ntaminatin is the depsitin and sviva, bt nt the mtipiatin, f the ganism Aytn 1985).
Wnd infetin is a pbem bease, at the mst fndamenta eve, infetin stps a wnd fm heaing by:
* Pnging the infammaty phase
* Dispting the nma tting mehanisms
* Pmting disdeed ekyte fntin and timatey peventing the devepment f new bd vesses and fmatin f ganatin tisse.
Assessment f a wnd in de t identify wnd infetin shd nt be imited t swabbing the wnd f bateigia anaysis.
Infetin s when viene fats expessed by ne me mi-ganisms in a wnd t-mpete the pesn's immne system. Sbseqent invasins and spead f miganisms in gd tisse pvkes a seies f a and systemi espnses sh as:
i) Sgia (ate wnds)
* a pain tendeness
* a sweing edema
* ineased exdate eithe ses pent haemses
* sepaatin f wnd edges wnd beakdwn
* pyexia
* deayed heaing
ii) hni wnds
* deayed heaing
* ineased fagiity hange in appeaane f ganatin tisse
* nexpeted pain tendeness
* pketing bidging f epitheia tisse
* an abnma sme
* pesene f exdate eithe ses pent haemses
* a sweing edema
* extending magin eythema
* pyexia
* wnd beakdwn
Mediatin
Anti-infammaty, yttxi, immnsppessive and antiagant dgs a ede heaing ates by intepting e divisin the tting pess.
xygenatin and tisse pefsin
* Gd wnd xygenatin is essentia f wnd heaing. xygen infenes angigenesis, epitheiaisatin and esistane t infetin
* Disage smking
Pesna and a hygiene
* The need f gd pesna and a hygiene shd be disssed with the patient.
Ntitin
* Ptein is eqied f a the phases f wnd heaing, patiay imptant f agen synthesis.
* Gse baane is essentia f wnd heaing.
* In, eqied t tanspt xygen.
* Mineas, zin, ppe, ae imptant f enzyme systems and immne systems. Zin defiieny ntibtes t disptin in ganatin tisse fmatin.
* Vitamins A, B mpex and , ae espnsibe f sppting epitheiaisatin and agen fmatin. It is as imptant f the infammaty phase f wnd heaing.
* abhydates and fats. These pvide the enegy eqied f e fntin. When the patient des nt have engh, the bdy beaks dwn ptein t meet the enegy needs. Fatty aids and essentia f wnd heaing.
* efe t Dietiian if patient is manished
PATIENT EDATIN - sggest t patient that:
* Fd is thee t be enjyed
* Vaiety in what we eat is heathy
* They shd eat the ight amnt t be a heathy weight. This wi vay f age, sex and eve f ativity.
* They shd ty nt t eat t mh fat, sga sat.
* The diet shd pvide penty f vitamins and mineas
* Keep eves f ah within emmended imits
mpiatins f wnd heaing:
1-hemhage.
Hemhage ing afte hmestasis indiates a sipped ste, a disdged t, infetin , esin f bd vesse by feign bjet (eg.dain)
Hemhage may extenay intenay.
The nse an detet intena beeding by king f distentin sweing f the affeted bdy pat.
A hange in the type and amnt f dainage fm a sgia dain .
2-infetin.
Wnd infetin is the send mst mmn nsmia infetin ading t the D.
A wnd is infeted if pent mateia dains fm it. even if the te is nt taken has a –ve est .why?
Bease many wnds nies f nn infetis esident bateia.
A hni dema wnd ae nsideed ntaminated with bateia.
a.What is the diffeene between infetin and ntaminatin nizatin?
Wnds with me than 100,000 ganism pe miiite .ae infeted the ny exeptin is when the ganism is beta –hemyti stepts the pesene f this ganism f ess than 100,000 ganism pe miiite.
The hane f wnd infetin is geate when the wnd ntains dead tamati tisse.
A ntaminated tamati wnd may shw sign f infetin within 2-3 days.
A sgia wnd infetin des nt devep nti the 4th 5th pstpeative day.
b. Hw d I knw if the wnd I'm teating is infeted?
Thee ae many ts that y have at y dispsa t detemine if an infetin is pesent. T begin with, y shd assess the inia pite f this patient and his he wnd. Is the patient febie? Ae the vita signs nma abnma ? Des the wnd appea ed and swen ? Is thee pent dainage a f d ? Is the aea and the wnd wam t the th as mpaed t neaby skin skin n the ppsite extemity? Is bne expsed (this d indiate stemyeitis)?
In additin, thee ae many abaty tests t detemine whethe an infetis pess is ing. These inde: white bd e nt (WB), eythyte sedimentatin ate (ES), -eative ptein, x-ay examinatin, deep tisse te (nt swab), nea mediine testing (gaim, tehnetim and indim sans) and bd tes.
Thee entie pite mst be evaated aefy. An abnmay high WB witht the inia appeaane f infetin d indiate a fase test, an infetin ing smepae ese (sh as a inay tat infetin) anthe disease pess atgethe.
. Ae a wnds infeted?
N, bt y shd nside a wnds as being ntaminated with miganisms. A ntaminated wnd wi hea, an infeted wnd wi nt. Wnd exdate ntains bateia kiing enzymes that wi hep pevent an infetin. Ppe eansing, debidement and maintaining f a mist wnd envinment wi a eate an nditin that essens the hane f infetin.
d. Ae swab tes imptant?
As stated in the AHP gideines, swab tes d nt effetivey evea the infeting ganism. Swab tes ny et the sfae ntaminating ganisms. Tisse bipsy and te, fid aspiatin tes and pssibe bne bipsy ae bette atenatives f ting the infeting ganism. Nte: the AHP gideines state that stemyeitis is deteted in 69 peent f the ases whee the WB, ES and pain x-ays wee a psitive, theefe, the need f an invasive bne bipsy may be eded.
e. Hw ae infetins teated?
The fist item t be disssed is infetin nt. We mst a stive t avid any type f ss ntaminatin between patients mtipe wnds n the same patient. Hand washing, ean dessing sppies, new gves and steie instments ae a eqied t pefm basi wnd ae. Ppe dispsa f ntaminated waste is gvened by the patina Safety and Heath Administatin (SHA). As, ptet the wnd fm ine fea ntaminatin.
If a wnd infetin is sspeted, ntify the ppe heath ae pvide n the ase immediatey. ne an infetin is diagnsed, the patitine may de tpia antibiti fshes, tpia antibiti appiatins, a systemi antibitis. An inisin and dainage (I and D) may be neessay t dempess an absess emve devitaized tisse. These pts wi be detemined by the extent f infetin, infeting ganism, media histy f the patient and any media aegies. Ading t the AHP, ne shd nt se tpia antibitis sh as pvidne idine, idph, sdim hyphite [Dakin's Stin], hydgen pexide aeti aid t ede bateia in wnd tisse. These pdts have been shwn t be yttxi and inhibit ganatin tisse.
3-dehisene.
Is patia tta sepaatin f the wnd ayes.
isk fats f dehisene:
a-p ntitina stats .
b-infetin.
-besity.,
dehisene ften invves abdmina sgia wnds and afte a sdden stain sh as ghing, vmiting sitting p in bed.
ients ften epts feeing as thgh smething has given away.
4-eviseatin.
Ptsin f visea gan thgh a wnd pening .
The nditin is a media emegeny that eqie a sgia epai.
The nse a steie twes saked in a steie saine t ede hane f bateia invasin and dying.
If the gan ptded thgh the wnd ,bd sppy t the tisse is mpmised.
The ient shd be kept NP .
bseve signs and symptms f shk and pepae f E sgey.
5-fista.
Is an abnma passage between tw gans between an gan and the tside f the bdy.
Mst fista ,hweve fm as a est f p wnd heaing as a mpiatin f a disease sh as hns disease.
Tama, infetin , adiatin expse and disease sh as ane pevent tisse ayes fm sing ppey and aw the fista tat t fm.
6- deayed wnd heaing.
Sme times efeed as 3d –intentin wnd heaing .
deayed wnd heaing is a deibeate by the sgen t aw effetive eansing f the ean ntaminated wnd ntaminated wnd.
The wnd is nt sed nti a evidene f edema and wnd debis has been emved.
7- Wnd Assessment hat Gideines Assessment
Eiit a aef histy f injy i.e.:
* mehanism f injy; assiated bd ss; isk f ntaminatin; deepe stte damage;
* tetans stats;
* nside Nn aidenta Iinjy;
* ndeying hni iness disabiity.
Fy examine the injed pat in patia heking f
* ndeying neve, vesse and tendn damage. This eqies assessment f mvement whie exping the wnd (espeiay in pama hand wnds).
* Assess tisse damage ss
Afte assessing a wnd, ppe dmentatin is neessay f media, ega and eimbsement easns. A phtgaph f the wnd is the mst eiabe dmentatin. Y hating shd inde the fwing infmatin n eah wnd ae visit:
* Patient's name and date f visit
* Vita signs - temp., pse, espiatin, bd pesse
* Ae the dessings intat? - (wet, dy, se, ean, dity)
* Stikethgh - Is thee dainage n the tside f the dessing mateia?
* atin f wnd - ft, eg, thigh, sam, ebw, shde, ight, eft, dsa, panta, media, atea, antei, pstei, et.
* Size - ength, width and depth meased in entimetes. (se a steie ttn tip appiat t mease depth). D NT SS NTAMINATE WNDS by sing the same gves, instments, measing devies, et. if the patient has mtipe wnds. Based n pevis measements, is the wnd impving, deteiating emaining stagnant.
* Taking - defined as skin vehanging a dead spae
* ndemining - k f skin that vehangs the wnd's edges
* Dainage - Is thee dainage n the ntat ayes f the dessing? What des it k ike (ses, pent, bdy, geen, yew, ea, thik, et.) Is the dainage a beakdwn f the wnd dessing (ike a hydid) ata dainage fm the wnd? Yew pent dainage d indiate staphys invvement. Geen dainage d indiate psedmnas invvement. Estimate the amnt f dainage pesent.
* d - Is thee any d fm the wnd? This an ffe a geat dea f infmatin n whih ganism may be ntaminating infeting a wnd. Fity sme pints twad staphys ganisms. F d (fea ike) pints twad gam negative bateia.
* Neti tisse - What peentage f the wnd appeas t be neti tisse. Neti tisse shd be nsideed as any tisse that is nt beefy ed and gana. Whee is the neti tisse? Daw a sma diagam.
* Infetin - Is the wnd ed ( steaking edness), ht and swen? Is thee seness t f pptin t what shd be pesent given the patient's media histy and the pgessin and etigy f the wnd? Infetin shd be assessed bth iniay and with the hep f ab data sh as vitas and WB nt.
* Stage pesse es - efe t the setin n staging pesse es f a mpete eview. In sht, an e with an intat esha shd be nted as nstageabe de t esha fmatin. I stngy emmend that y D NT evese stage a heaing e. F exampe, an e initiay dmented as a stage 4 shd nt be dmented as a stage 2 a stage 1 as it heas. The easn is simpe. Skin ve a heaed e is ny 70 - 80 peent as stng as ndamaged skin. A new heath ae pfessina n the ase may k at the atest ntes and ny see a stage 2 in the assessment and nt eaize that this patient is at high isk. I ike t dment that the wnd is a heaing stage 4 e.
* assify nn pesse es - se Wagne assifiatin f ft es. se "f thikness" "patia thikness" phasing t dment the types f es. Wagne assifiatin is as fws:
* Gade 0 - Pe-eative esin, heaed es, pesene f bny defmity
* Gade 1 - Spefiia e witht sbtanes tisse invvement
* Gade 2 - Penetatin thgh the sbtanes tisse (may expse bne, tendn, igament, jint apse)
* Gade 3 - steitis, absess, stemyeitis
* Gade 4 - Gangene f the feft
* Gade 5 - Gangene f the entie ft
* Past teatment - Nte the past teatments and any hanges in pdts. This wi hep new heath ae pfessinas n the ase. Pdts that may nt have pded the desied ests wn't be aidentay dpiated.
* ent teatment - Dment the type f iigatin, pdts and senday dessings sed ding the dessing hange.
* Signate - Sign the bttm f the nte.
* Fw p - ntat the apppiate dt, nse, theapist the heath ae pfessina t disss y findings, espeiay if thee is deteiatin.
abaty Data and diagnsti pedes:
* Baseine B
* ine anaysis
* Sem eetytes
* Ateia bd gas
* abxyhemgbin eves
* hest x-ay the x-ay
* xay f adipaqe feign bdy ndeying fate
* tasnd is sef f pnte wnds with a adient feign bdy sh as thn spinte.
Gidane f Management f Wnd Infetins:
Mst wnd infetins ae de t staphyi and stepti. This wd ikey hd te even in the pst-hiane setting.
* F initia antimibia teatment f infeted wnds, beta-atam antibitis with anti-staphya ativity (ephaexin, dixaiin, ampiiinsbatam et.) and indamyin ae emmended ptins.
* f nte, eenty an ineasing nmbe f mmnity assiated skin and sft tisse infetins appea t be ased by methiiin-esistant Staphys aes (MSA). Infetins ased by this ganism wi nt espnd t teatment with beta-atam antibitis and shd be nsideed in patients wh fai t espnd t this theapy. Teatment ptins f these mmnity MSA infetins inde timethpim-sfamethxaze (a) vanmyin (intavens). indamyin is as a ptentia ptin, bt nt a isates ae sseptibe.
* Inisin and dainage f any sbtanes etins f ps (absesses) is as an imptant mpnent f teating wnd infetins.
Speia nsideatins eated t Fd nditins:
ntaminatin f wnds with wate (fesh sea wate) an ead t infetins ased by watebne ganisms. Thgh infetins with these ganisms ae nmmn, even afte fds, this pssibiity shd be nsideed in patients wh fai t espnd t initia theapies desibed abve. Wate-bne ganisms ften impiated in these infetins inde: Aemnas spp., nn-hea Vibi spp. and smetimes Psedmnas the Gam-negative ds.
Timethpimsfamethxaze, amxiiinavanate and newe fqinnes (evfxain, mxifxain, gatifxain) wi teat Aemnas and the fqinnes wi as teat Psedmnas and many the Gam-negative pathgens.
iniians shd nside Vibi as a pssibe asative ganism f wnd infetins ined in asta wates fm ntat with shefish maine widife. Vibi vnifis wnd infetins may eqie extensive debidement and mtaity an be high. These infetins ften manifest with bs esins that may be hemhagi. Pesns with ndeying hepati disease the immnmpmising iness ae at highest isk f Vibi vnifis infetin. When this infetin is sspeted, the emmendatin is that patients be teated with a mbinatin f eftazidime and dxyyine.
Physia Theapy Mdaities in Wnd ae:
Eetia Stimatin
tasnd
Whip
Hypebai xygen
Eetia Stimatin:
Eetia stimatin is defined as the se f an eetia ent t tansfe enegy t a wnd. The type f eetiity that is tansfeed is nted by the eetia se. ( AHP 94). apaitativey ped eetia stimatin invves the tansfe f eeti ent thgh an appied sfae eetde pad that is in wet (eetyti) ntat ( apaitativey ped) with the extena skin sfae and wnd bed. When apaitativey ped eetia stimatin is sed, tw eetdes ae eqied t mpete the eeti iit. Eetdes ae say paed ve wet ndtive medim, in the wnd bed and n the skin a distane away fm the wnd.
tasnd
tasnd is a mehania vibatin deiveed at a feqeny abve the ange f hman heaing. inia tasnd nits enty being manfated typiay deive tasnd at feqenies f 1 and 3 MHz with dty yes anging fm 20 t 100 peent. Dty yes ess than 100% ae say temed psed tasnd whie a 100% dty ye is efeed t as ntins tasnd.
Hw des tasnd benefit wnd heaing?
Infammaty Phase - tasnd ases a deganatin f mast es esting in the eease f histamine. Histamine and the hemia mediats eeased fm the mast e ae fet t pay a e in attating netphis and mnytes t the injed site. These and the events appea t aeeate the ate infammaty phase and pmte heaing.
Pifeative Phase - tasnd has been nted t effet fibbasts and stimate them t seete agen 1. This an aeeate the pess f wnd ntatin and inease tensie stength f the heaing tisse 2. nnetive tisse wi engate bette if bth heat and steth ae mbined. ntins tasnd at highe theapeti intensities pvides and effetive means f heating deepe tisse pi t steth.
Feqeny
As the feqeny f tasnd is ineased, the penetatin f the signa deeases. F mst dema wnds, it is pefeabe theefe, t tiize a feqeny f 3 MHz. 1 MHz wnd be me effetive n deepe sttes peiwnd skin.
nsideatins in the se f tasnd
As with the media devies, inapppiate se an est in seis mpiatins. The basi peatins shd be taken:
Teat at the west intensity that wi pde the desied est.
Asse that the appiat is kept in nstant mtin thght teatment and that the ppe asti ping medim is sed.
ede the intensity teminate teatment if the patient mpains f any inease in pain.
Appiatin f tasnd t wnds
Pi t tasnd teatment, emve dessings and ean wnd f feign debis dessing eside.
A hydge sheet shd be paed in diet ntat with te wnd bed and wnd magins, paying speia attentin t emving any ai bbbes that might be pesent beneath the dessing. emve any ptetive pasti veing n the hydge sheet.
In ases whee a avity type f wnd exists that pevents mpete ntat between the hydge sheet and the wnd base, as steie aqes hydge fie shd be sed. The avity is fied with the aqes ge and then veed wit the hydge sheet. emve a ndeying ai bbbes between the aqes hydge and hydge sheet.
ne the hydge sheet is in pae, appy an tasni ping ge n tp f the sheet. Seet the apppiate sized appiat. (the aea teated shd be n age than 1.5 t 2 times the size f the appiat. If a eativey age wnd is being teated, it wd need t be divided int setins.
Set the tasnd mahine t a 20 % dty ye at a feqeny f 3 MHz.
Appying ight pesse, the snd head is paed in ntat with the ping medim n tp f the hydge sheet and mved in a sw and deibeate manne sing eithe a inea ia tehniqe.
Set the intensity t ess than 0.5 watts pe sqae entimete (say 0.3 wattsm 2). ede the intensity if the patient expeienes pain heat.
Teatment datin is sggested t be abt 1 t 2 mintes pe zne.
Ate wnds ae teated 1 t 2 times pe day nti ate symptms (infammatin) sbside. Teatments an then deease t 2 t 3 times pe week
Appiatin f tasnd t peiwnd tisse
When it is desied t pvide mid heating t the peiwnd tisse in de t stimate iatin, highe intensity tasnd an be given. Exteme ae shd be sed, hweve, t asse the tisse is apabe f handing the thema eves deiveed.
T teat peiwnd tisse, 1 MHz, ntins tasnd is say empyed. Again, an tasnd appiat 1.5 t 2 times the size f the teatment aea shd be sed. With an aqes ping medim in pae, the snd head is paed ighty against the skin sfae and mved in a sw and deibeate manne. The intensity is typiay set t between 1 and 1.5 watts pe sqae entimete. This paamete is extemey vaiabe and depends n the patient's iaty, sensy and menta stats. Thema tasnd shd neve be sed in sitatins whee impaied peeptin pevents the patient fm sensing heat pain. If at anytime ding the teatment the patient shd expeiene an inease in pain, the intensity shd be tned dwn the teatment disntined.
Teatment datin is sighty nge than that f psed tasnd sine a mid thema effet is desied. Initia teatment is abt 2-3 mintes pe zne and an be ineased by 30 send inements t a maximm f 5 mintes pe zne and deiveed 3 times pe week
Whip
Whip is the physia agent mst sey identified with physia theapy wnd ae.
1. Whip may be sed at diffeent tempeate settings t mdify its effet n iatin. Athgh it is the mst mmny sed mdaity, it's effet n wnd heaing has nt been eseahed.
Whip tanks may be eithe pemanent ptabe, f bdy extemity. The agitatin fe and dietin f the tbene may be adjsted t ptet ganatin tisse fm tama.
2. Hw des this mdaity benefit a wnd patient:
bjetives f whip teatment inde:
vasdiitatin
ineased bd fw
sftening and sening f neti tisse
mehania debidement
wnd eansing: debis and tpia agents
exdate emva --- > eded infetin
pain management
3. They behind mdaity's effetiveness:
Whip effets the Infammatin Phase f heaing
Wam wate ineases vasdiitatin f the spefiia vesses
Ineased bd fw bings xygen and ntients t the tisses and emves metabites
Ineased bd fw bings antibdies, ekytes and systemi antibitis
Fid shifts int the intestitia spaes eading t edema
Sftening and sening f neti tisse aides phagytsis
eansing and emva f wnd exdate nts infetin
Mehania effets f whip stimate ganatin tisse fmatin
Sedatin and anagesia ae inded by the wam wate
4. Hw shd a physia theapist se this mdaity n a wnd?
This teatment mdaity is ften administeed twie daiy f 20 mintes, hweve, ne daiy teatment shd be nsideed as an apppiate ptin. Fwing whip, the wnd and snding tisses shd be insed vigsy with ean wate t emve eside fm the wnd and snding tisses. The best types f wnds f whip ae thse that fa int the ategies f:
Neti
Mdeate t heavy exdative wnds
Wnds with debis
Tisse whih an teate mdeate t heavy ineased iaty pefsin
Ishemi wnds whee vigs pefsin t wnd and snding tisses is desied
Pt:
Whip tempeate Gide
Wate tempeate ange fm 33.5 ° t 35.5 0 = 92 °F t 96 °F
Wate tempeate shd nt exeed 1 ° abve skin tempeate in pesene f PVD.
Wate tempeate shd nt exeed 38 ° in pesene f adipmnay disease
Wate tempeate f 32 ° bd fw f 2.3100 f imb vme. Highe tempeate gives geate bd fw vme.
When sing we tempeates, avid hiing by maintaining wam m tempeate and se ny f singe imb, nt whe bdy.
5. Ae thee any isks mpiatin with this mdaity?
Whip may be ntaindiated f the fwing wnd sitatins:
ean ganating wnds - ean ganating wnds ae easiy tamatized by the fe f even a mid agitatin
epitheiaizing wnds
migating epidema es may be damaged by even minima fe
new skin gafts - skin gafts wi nt teate the high sheaing fes and tbene
new tisse faps - tisse faps ae vey sensitive t sheaing fes and vasnstitin whih may if the wate ai tempeate ase hiing
vens es - it is ndesiabe t inease bd vme t an aea whee bd vme is aeady a pbem - wi mpiate the pbem; in additin, a dependent psitin wi pde me dependent edema and stasis; the had neti fibin fnd in a vens e ae nt effetivey debided by hydtheapy.
nn-neti diabeti es - as wi be sftened eading t maeatin, maeated tisse wi nt teate pesse and wnd wi be enaged
6. Shd antiseptis be sed in the whip?
Thee emains ntvesy abt the se f antisepti agents in the whip. Mh eseah indiates that the mst mmny sed antisepti agents ae hamf t the es f tisse epai. In additin, they may nt be abe t ede the nmbe f bateia when the bateia ae vey nmes. A stdy by Bhannan fnd that f times as many bateia wee emved fm a vens e when insed vigsy with ean tap wate than when the wnd was ny teated in a pvdine idine whip. Patients with hni wnds may devep aegi espnses t the hemia agents.
If antiseptis ae t be sed, they shd be sed f neti, heaviy exdating wnds. Then mnit aefy and ntine ny nti wnd is ean. D NT VESE.
mmny sed antiseptis in the whip ae:
pvidine idine
sdim hyphite
HiBiens ®
hazene ® (hamine)
7. Ae any patientspathgies phibited fm sing this mdaity?
edema f the extemity
ethagy
nespnsiveness
maeatin
ppe extemity infetin
febie nditins
mpmised adivasa pmnay fntin
ate phebitis
ena faie
dy gangene - evaate f ishemia
inntinene f ine fees, if in f bdy whip
8. Infetin nt in hydtheapy
Ppe eaning f whip eqipment and the se f disinfeting stins seeted t ki infetis ganisms shd be a piy and pede f a heath ae faiities.
Ppe se f nivesa peatins is imptant in nting infetin. ting f whip eqipment is nt emmended ness thee is an episde f nexpained nsmia infetins that an be taed bak t se f the whip eqipment. A piy t pevent inhaatin ntat dematitis by the hydtheapy pesnne shd be deveped f eah heath ae faiity when sing antiseptis and disinfeting agents.
Hypebai xygen
atinae:
In an hypxi envinment, wnd heaing is hated by deeased fibbast pifeatin agen pdtin, and apiay angigenesis (1). Hypxia as aws gwth f anaebi ganisms, fthe mpiating wnd heaing. Hypebai xygen theapy pvides a signifiant inease in tisse xygenatin in the hyppefsed, infeted wnd. It infenes the ate f agen depsitin, angigenesis, and bateia eaane in wnds. The geatest benefits ae ahieved in tisses with mpmised bd fw and xygen sppy.
Diabeti Wnds:
The ineased wnd xygen tensin ahieved with HB pmtes wnd heaing, ineases the hst antimibia defenses and has a diet bateistati effet n anaebi miganisms.
Vens Stasis es:
HB theapy has a vey imited e. It is ny indiated in highy seeted patients in the pepaatin f a ganating bed ve debided vens e f eventa skin gafting. (2)
Pesse es:
HB theapy may be sef when ndeying stemyeitis is pesent t impve the sft tisse envepe f ensttin.
Ateia Insffiieny es:
HB theapy may be f benefit in seeted ases, espeiay when a wnd fais t hea despite maximm evasaizatin.
Teatments:
HB teatments ae pefmed at 2.0 t 25 ATA f 90 t 120 mintes f xygen beathing. The initia teatment shede is ditated by the seveity f the disease pess. In the pesene f imb-theatening infetin afte debidement mpmised sgia faps fwing amptatin the patient shd be teated twie daiy. When the infetin is nde nt and the sft tisse envepe impves, ne daiy teatments ae adeqate.
Types f Wnd Debidement
Atyti Debidement:
Desiptin:
Atysis ses the bdy's wn enzymes and miste t e-hydate, sften and finay iqefy had esha and sgh. Atyti debidement is seetive; ny neti tisse is iqefied. It is as vitay painess f the patient. Atyti debidement an be ahieved with the se f sive semi-sive dessings whih maintain wnd fid in ntat with the neti tisse. Atyti debidement an be ahieved with hydids, hydges and tanspaent fims.
Best ses:
In stage III IV wnds with ight t mdeate exdate
Advantages:
Vey seetive, with n damage t snding skin.
The pess is safe, sing the bdy's wn defense mehanisms t ean the wnd f neti debis.
Effetive, vesatie and easy t pefm
itte t n pain f the patient
Disadvantages:
Nt as apid as sgia debidement
Wnd mst be mnited sey f signs f infetin
May pmte anaebi gwth if an sive hydid is sed
Enzymati Debidement:
Desiptin:
hemia enzymes ae fast ating pdts that pde sgh f neti tisse. Sme enzymati debides ae seetive, whie sme ae nt.
Best ses:
n any wnd with a age amnt f neti debis.
Esha fmatin
Advantages:
Fast ating
Minima n damage t heathy tisse with ppe appiatin.
Disadvantages:
Expensive
eqies a pesiptin
Appiatin mst be pefmed aefy ny t the neti tisse.
May eqie a speifi senday dessing
Infammatin dismft may
Mehania Debidement:
Desiptin:
This tehniqe has been sed f deades in wnd ae. Awing a dessing t peed fm mist t wet, then manay emving the dessing ases a fm f nn-seetive debidement.
Hydtheapy is as a type f mehania debidement. It's benefits vs. isks ae f isse.
Best ses:
Wnds with mdeate amnts f neti debis
Advantages:
st f the ata mateia (ie. gaze) is w
Disadvantages:
Nn-seetive and may tamatize heathy heaing tisse
Time nsming
an be painf t patient
Hydtheapy an ase tisse maeatin. As, watebne pathgens may ase ntaminatin infetin. Disinfeting additives may be yttxi.
Sgia Debidement:
Desiptin:
Shap sgia debidement and ase debidement nde anesthesia ae the fastest methds f debidement.
They ae vey seetive, meaning that the pesn pefming the debidement has mpete nt ve whih tisse is emved and whih is eft behind
Sgia debidement an be pefmed in the peating m at bedside, depending n the extent f the neti mateia.
Best ses:
Wnds with a age amnt f neti tisse.
In njntin with infeted tisse.
Advantages:
Fast and Seetive
an be extemey effetive
Disadvantages:
Painf t patient
sty, espeiay if an peating m is eqied
eqies tanspt f patient if peating m is eqied
Dessing and the 5 es f wnd ae:
Even with the ineased aviabity f dessings.
An apppiate seetin an be made if etain pinipes ae maintained efeed t as the 5 es f wnd ae:
1:ATEGIZATIN:
ean abt dessing by genei ategy and mpae new pdts with thse that aeady make p the ategy.
The nse shd beme famiia with indiatins , ntaindiatin ,and side effets.
The best dessing may be by mbining pdts fm diffeent ategies .t ahieve sevea gas at the same time.
2:SEETIN:
Seet safe and mst effetive, se fiendy and st effetive dessing pssibe.
3:HANGE:
hange dessing based n patient ,wnd, and dessing assessment, nt n standadized tines.
Nata wnd heaing shd be distbed as itte as pssibe, ness the wnd is infeted with heavy dishage.
It is mmn t eave hni wnd veed f 48-72h and ate wnd f 24h.
4:EVTIN:
As the wnd pgesses thgh the phases f wnd heaing the dessing pt is ateed t ptimize wnd heaing .it is ae in hni wnds ,that sme dessing mateia is apppiate thght the wnd heaing pess.
5
ATIE :Patie with dessing mateia is eqied f the nse t ean the pefmane paametes f the patia dessings.
efining skis f appying apppiate dessing ety and eaning abt new dessing pdts ae essentia espnsibiities .
Idea wnd dessing
N singe dessing is sitabe f a types f wnds. ften a nmbe f diffeent types f dessings wi be sed ding the heaing pess f a singe wnd. Dessings shd pefm ne me f the fwing fntins:
* Maintain a mist envinment at the wnddessing intefae
* Absb exess exdate witht eakage t the sfae f the dessing
* Pvide thema insatin and mehania ptetin
* Pvide bateia ptetin
* Aw gases and fid exhange
* Absb wnd d
* Be nn-adheent t the wnd and easiy emved witht tama
* Pvide sme debidement atin (emve dead tisse and feign paties)
* Be nn-txi, nn-aegeni and nn-sensitising (t bth patient and media staff)
* Steie .
assifiatin f wnd dessings
Syntheti wnd dessings an be bady ategized int the fwing types.
Type
Ppeties
Passive pdts
Taditina dessings that pvide ve ve the wnd, e.g. gaze and te dessings
Inteative pdts
Pymei fims and fms whih ae msty tanspaent, pemeabe t wate vap and xygen, nn-pemeabe t bateia, e.g. hyani aid, hydges, fam dessings
Biative pdts
Dessings whih deive sbstanes ative in wnd heaing, e.g. hydids, aginates, agens, hitsan
dessings types and thei ppeties:
The fwing tabe desibes sme f the many diffeent types f wnd dessings and thei main ppeties.
Dessing type
Ppeties
Gaze
* Dessings an stik t the wnd sfae and dispt the wnd bed when emved
* ny se n min wnds as senday dessings
Te
* Dessing des nt stik t wnd sfae
* Sitabe f fat, shaw wnd
* sef in patient with sensitive skin
* E.g. Jenet®, Paanet®
Semipemeabe fim
* Steie sheet f pyethane ated with ayi adhesive
* Tanspaent awing wnd heks
* Sitabe f shaw wnd with w exdate
* E.g. pSite®, Tegadem®
Hydids
* mpsed f abxymethyese, geatin, petin, eastmes and adhesives that tn int a ge when exdate is absbed. This eates a wam, mist envinment that pmtes debidement
* and heaing
* Depending n the hydid dessing hsen an be sed in wnds with ight t heavy exdate, sghing ganating wnds
* Avaiabe in many fms (adhesive nn-adhesive pad, paste, pwde) bt mst mmny as sef-adhesive pads
* E.g. DDEM®, Tegasb®
Hydges
* mpsed mainy f wate in a mpex netwk fibes that keep the pyme ge intat. Wate is eeased t keep the wnd mist
* sed f neti sghy wnd beds t ehydate and emve dead tisse. D nt se f mdeate t heaviy exdating wnds
* E.g. Tegage®, Intasite®
Aginates
* mpsed f aim aginate (a seaweed mpnent). When in ntat with wnd, aim in the dessing is exhanged with sdim fm wnd fid and this tns dessing int a ge that maintains a mist wnd envinment
* Gd f exdating wnds and heps in debidement f sghing wnds
* D nt se n w exdating wnds as this wi ase dyness and sabbing
* Dessing shd be hanged daiy
* E.g. Katstat®, Sbsan®
Pyethane siine fams
* Designed t absb age amnts f exdates
* Maintain a mist wnd envinment bt ae nt as sef as aginates hydids f debidement
* D nt se n w exdating wnds as this wi ase dyness and sabbing
* E.g. Aevyn®, yfam®
Hydfibe
* Sft nn-wven pad ibbn dessing made fm sdim abxymethyese fibes
* Inteat with wnd dainage t fm a sft ge
* Absb exdate and pvide a mist envinment in a deep wnd that needs paking
agens
* Dessings me in pads, ges paties
* Pmte the depsit f newy fmed agen in the wnd bed
* Absb exdate and pvide a mist envinment
Diffeent types f wnds and the diffeent stages f a heaing wnd eqie diffeent dessings mbinatins f dessings. The fwing tabe shws sitabe dessings f patia wnd types.
wnd type
ean, medim-t-high exdate (epitheiaising)
* Paaffin gaze
* Knitted visse pimay dessing
ean, dy, w exdate (epitheiaising)
* Absbent pefated pasti fim-faed dessing
* Vap-pemeabe adhesive fim dessing
ean, exdating (ganating)
* Hydids
* Fams
* Aginates
Sgh-veed
* Hydids
* Hydges
Dy, neti
* Hydids
* Hydges
The dessings may eqie senday dessings sh as absbent pad and bandages.
DME tiizatin Gide
The fwing is the ffiia DME tiizatin gideine f 1995. I beieve that they ny seve as gideines and that diffeing pts ae apppiate, bt need t be sbstantiated with dmentatin media neessity.
Aginate wnd ve......................Dessing hange ne daiy
Aginate wnd fie......................Dessing hange ne daiy, p t 2 six inh stips awed pe dessing hange
mpsite dessing ........................3 times pe week, ne dessing pe dessing hange
ntat aye ...................................ne pe week
Fam dessing..................................p t 3 times pe week
Fam wnd fie...........................ne daiy
Gaze................................................3 times pe day, n me than 2 pads n a wnd
(nn-impegnated)
Gaze ...............................................ne daiy
(impegnated - the than wate saine)
Gaze................................................Nn-veed, eded t ega nn-impegnated gaze eve
(impegnated with wate saine)
Hydid ve and fie .........3 times pe week
Hydge wnd ve.....................ne daiy ( 3 times pe week if sing adhesive bde)
Hydge wnd fie.....................ne daiy, n me than 3 nes pe wnd in a 30 day peid
Speiaty absptive dessing.........ne pe day ( evey the day if sing adhesive bde)
Tanspaent fim..............................p t 3 times pe week
Wnd fie nt assified..............ne pe day
Wnd ph....................................p t 3 times pe week
Tape...................................................detemined by feqeny f dessing hange
Easti bandage.................................ne pe week
Gaze, easti...................................detemined by the feqeny f dessing hange f the pimay dessing
Gaze, nn-easti............................detemined by the feqeny f dessing hange f the pimay dessing.
Advese effets f dessings
Wnd dessings an ase pbems, inding:
* Maeatin (sgginess) f snding skin (hange dessing feqenty and se a me absbent dessing)
* Iitant ntat dematitis (ptet skin with emient baie fim)
* Aegi ntat dematitis (nmmn: hange dessing type, appy tpia steids)
Wnd eanses — ean the sfae f the wnd by emving bateia and dainage. Pdts sed might ntain a detegent. Nma saine as an be sed t ean wnds witht haming new tisse.
Sme band name wnd eanses inde: Pi-ens (fm past), Shens (fm nvaTe), taKenz (fm aingtn), Biex Wnd eanse (fm Bad)
Insttins f making saine stin:
* se 1 gan f distied wate bi 1 gan f tap wate f five mintes. D nt se we wate sea wate.
* Add 8 teaspns f tabe sat t the distied bied wate.
* Mix the stin we nti the sat is mpetey dissved. Be se stage ntaine and mixing tensi ae ean (bied).
Nte: t m tempeate befe sing. This stin an be sted at m tempeate in a tighty veed gass pasti btte f p t ne week
What abt sing pvidne idine, hydgen pexide, Dakin's, aeti aid and the agents?
Pease efe t the AHP inia Patie Gideine f a detaied disssin f these and the eanses.
In sht, it has been detemined that these pdts may atay sw wnd heaing. Sme f these pdts ae yttxi t hman fibbasts, ede white bd e viabiity and deease phagyti effiieny. Stdies shw that mst f these pdts mst be dited t avid these txi effets and a ditin gide is avaiabe thgh the AHP gideine.
n a me patia eve, many f these pdts ae dying agents as we as antimibia. We have aeady identified that exdate is neessay t eate an evinment whih stimates me apid wnd heaing. By dying the wnd bed, the exdate and a its benefiia es ae emved fm the aea. Dy tisse tends t nese and seve as a bateia medim.
In additin, we knw that mst wnds shd be nsideed as ntaminated and ntaminated wnds wi hea. The nstant appiatin f an anti-mibia agent is nt neessay t pde apid wnd heaing avid infetin. In fat, thee ae inia stdies whih have shwn that a wnd maintained in a mist envinment (with exdate) has a we infetin ate than a wnd whih is dy.
Is thee a e f pvidne idine, hydgen pexide, Dakin's, aeti aid and the agents?
etainy! When disssing wnd ae, emembe that thee ae hni wnds and ate wnds. An ate wnd, ike a aeatin, wi mst ikey hea in an individa wh has n media pbem that wd deay wnd se. Aviding infetin is imptant in these ases, and maybe the heathae pvide fees mftabe sing sme f these pdts. As, in a hni wnd that has an infetin, it may be apppiate t se these pdts nti the infetin has esved.
Fm pesna expeiene, I nw appy a tanspaent fim t a my min ts and abasins, as I have fnd that my ate wnds hea vey qiky with this pt. I may as eans the wnd with ne f the abve pdts pi t the fim's appiatin.
Ste emva Gideines
emve stes eay engh t avid ste maks bt ate engh t pevent the wnd fm epening.
With eay ste emva einfe the wnd edges with Stei-Stips.
Aways hek t be se the wnd is eady f ste emva. If nt ehek in 2 days. nside emving evey the ste.
Site
Adt
hiden
Fae
4-5 days
3-4 days
Sap
6-7 days
5-6 days
Tnk
7-10 days
6-8 days
Am (nt jint)
7-10 days
5-9 days
eg (nt jint)
8-10 days
6-8 days
Jint extens sfae
8-14 days
7-12 days
Jint fex sfae
8-10 days
6-8 days
Dsm f hand
7-9 days
5-7 days
Pam
7-12 days
7-10 days
Se f ft
7-12 days
7-10 days
efeenes:
1-ya ege f sgens f Edinbgh.sgiaknwedge and skis website,wnd management,www.ed.sed.a.kwnd 20%managmentntent.htm.25t,2007.
2-Emegeny wnd management f heath ae pfessinas,D,page ast eviewed Jne 9,2006 ,.
3-wnd ae infmatin netwk ,n.d, .
4- Wnd Management e Infmatin: Sting and Bipsies , ast pdated: tbe 23, 2002,3dNv,07.
5-Szannne.Smetze.Benda G.Bae .Text bk f Media sgia nsing,Bnne &Sddaths,ippentt,9th ed,p1454-1455.
6-Patiia A.Ptte , Anne G Pey .Fndamentas f nsing ,Ptte.Pey,5th ed,SA,P1551-1552-1553-1554-1556.