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78 Cards in this Set
- Front
- Back
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When to use modalities to facilitate healing |
Chronic Wounds Wounds that fail to respond to standard care |
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Modalities for wound healing |
Wound Irrigation Whirlpool Pulse Lavage EStim Ultra sound Hyperbaric Oxygen Chamber Negative Pressure Wound therapy Ultra voilet - low intensity laser - monochromatic infrared |
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Purpose of irrigation |
Removes loosely adhered debris, bacteria, exudate Faciliates debridement Promotes moist wound healing Irrigation after whirlpool removes 4x more bacteria than whirpool alone |
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Indications and Contraindications/precautions of irrigation |
I: Standard component of treatment for all wound types C/P: Wounds with active, profuse bleeding |
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Method of wound irrigation |
Irrigation pressure of 4-15 PSI *** 35mL syringe and 19g angiocatheter Waterpik at lowest setting Irrigant: saline or tap water Alone or in combo with other modalities |
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Advantages of Wound Irrigation |
Simple Quick Inexpensive Effectuve Wound on any location Any setting |
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Disadvantages of Wound Irrigation |
Messy May not use adequate amount of irrigant |
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Anternative interventions for wound irrigation |
Soak wound with saline moistened gauze Whirlpool Pulsed Lavage |
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What is whirpool |
Hydrotherapy is one of the oldest available in many shapes and sizes Form of nonselective mechanical debridement |
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Purpose of Whirlpool |
Removes loosely adhered debris, bacteria, exudate Facilitates debridement Promotes moist wound healing Promotes circulation Dec Pain Makes ROM exercises easier Helps remove adhered dressings |
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Indications and Contraindications/Precautions for Whirlpool |
I: Infected wounds, woulds with thick eschar or exudate, loosely adherent necrotic tissue, "big larger LE wounds" C/P: Clean, granulating wounds, edematous or draining, Tunneling and undermining, active bleeding, AI ulcers, |
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Method for Whirpool |
Immersion Showering over whirpool or hubbard tank Temp 92-98deg , no more than 102 Treatment time 10-20 Chemical additives use only in isolated cases Rinse with saline or tap water after Wear PPE |
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Advantages of Whirpool |
Comfortable Promotes moist wound healing Available in most clinical settings Simple/Effective |
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Disadvantages for whirlpool |
Cant calibrates pressure Potential for maceration edema, cross contamination Time intensive for setup and clean up Expensive |
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Rationale and indications for pulsed lavage |
Flushes out debris and bacteria. Softens necrosis Wounds with cavities, tracts, or infection |
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Contraindications/Precautions for pulsed lavage |
Newly granulating wounds Exposed deep tissue Facial wounds Recent surgery Latex allergy P: anticoagulants P: Deep tunnel |
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Parameters for Pulsed Lavage |
Saline irrigation, 5-10 min 4-5psi QD-BID? |
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Describe Pulsed lavage and concurrent suction |
Delivery of irrigant under controlled pressure with handheld device Applies negative pressure to wound bed -Removes irrigant/pathogens -Enhances granulation tissue formation epithelization, and local tissue perfusion |
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Purpose of pulsed lavage |
Irrigates wound bed with precise calibrated pressure Assisted in moist environment Facilitates debridement Enhance granulation |
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Method of Pulsed Lavage |
Pressure 4-15 psi warm 1-3 liters of irrigant to 102-106 15-30 minutes PPE Prevent cross contamination |
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Advantages of pulsed lavage |
Encourages through irrigation Can use in any setting and on wound in any location Wuick Low risk of cross contamination Dec pain Ergonomical |
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Disadvantages of pulsed lavage |
Messy More expensive than simple irrigation Not appropriate for large wounds Tips and some tubing designed for one time use |
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Research supporting EStim |
Meta Analysis: 144% dec in wound size compared to standard care Majority use high volt pulsed current Significant variation in parameters |
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Uses for Estim |
Adjunct to healing for chronic or recalcitrant wounds that are clean or infected CMMS: Category 3/4 that fail to respond after 30 days of standard care |
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Rational for Estim |
R: Skin battery, galvanotaxic, bactericidal effects, edema reduction |
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Purpose of E Stim |
-Restore current of injury -Causes Galvanotaxis -Stimulates cells -Increases blood flow -Increases bactericidal and bacteriostatic effects – polarity depends on micro-organism -Reduces edema -Facilitates debridement – autolysis of necrotic tissue -Pain control – (TENS) -Scar formation – mast cell degradation will lead to decreased scar thickness |
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Indications for Estim |
Chronic Wounds Pressure Injuries Diabetic ulcers Surgical Wounds |
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Contraindications/Precautions of E Stim |
General precautions of Estim Untreated Osteomyelitis Metal ions P: Sensory Neuropathy P: Venous Insufficiency P: DVT P: Neoplastic cells |
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Parameters of ESTIM |
–100-105pps, pulsed amplitude, Tingling parasthesia, 5x week, polarity – or + |
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Method for EStim
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Direct, Immersion, Periwound Fq 80-115Hz Int: 75-200 V sub motor Interpulse interval: 550-100 ms Active cathod - infected to reduce bioburden Active anode: promote granulation and epi Time 45-60min Fq 3-7day/wk for 30min/day |
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Advantages for Estim |
Research supports efficacy Can use in any setting Does not cause pain Less setup and clean up |
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Disadvantages to Estim |
Time consuming Risk of contamination Not appropriate for large wounds |
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Alternatives to Estim |
Ultrawound Hyperberic Oxygen |
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Research for Ultrasound |
Most studies on animals, acute, traumatic wounds Facilitating healing in recalcitrant wounds Enhances all three phases of wound healing |
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Ultrasound and saline |
Low fq: 25-40Hz Assists with debridement of fibrin Reduce wound bioburden |
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Purpose of ultrasound |
Enhances all 3 phases of wound healing Inc: Collagen, granulation, angiogensis Enhances wound contraction Improves scar pliability Noncontact Low fq US: debridement and dec wound bioburden |
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Contraindications/Precautions |
Untreated osteomyelitis Wounds with active profuse bleeding Severe arterial insufficiency DVT |
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Methods for US |
Direct, immersion, periwound Fq: Superficial 3.0 Deep 1.0 Hz Intesnity: Pulsed 0.5-1.0, continuous <1.5 Time 2-3 minutes/zone Fq: 2x/day for 3day/wk |
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Noncontact US Method |
Fq: 25-40kHz Time: 20-60/cm2 -- min of 4 min for wounds <16cm Fq: 2-3day/wk |
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Advantages of US |
Use in any settling Quick Less setup/cleanup Does not hyperhydrate Does not req dependent positioning |
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Disadvanatges of US |
Less research support Not for large wounds Main be painfil of difficult to perform Risk of contamination |
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Alternatives to US |
Estim NPWT Topical growth factors Scar remodeling - paraffin, soft tissue mob, silicone dressing |
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Alternative terms for NPWT |
Topical negative pressure Subatmospheric pressure Vacuum-assisted closure |
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Describe NPWT |
Inc local blood flow, capillary filing, and lymphatic flow May help approximate wound edges and facilitate contraction and closure Insufficient evidence that NPWT is superior to standard care |
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Rational for NPWT |
Closes by negative pressure, Removes fluid, decompression, bactericidal effects, moist wound closure |
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Purpose of NPWT |
Inc blood flow Dec wound edema Inc Granulation/angiogen/epithelialization Dec Biodurden Promotes cell proliferation Maintains moist, warm environment |
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Indications for NPWT |
Post surgical wounds and grafts Wounds with exposed deep tissue or hardware Traumatic Wounds Chronic wounds Pressure injuries, diabetic ulcers Dehissed wounds |
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Contraindications/Precautions for NPWT |
Necrotic Body cavity wounds Untreated Osteomyelitis Exposed blood vessels Patients on anticoagulants (caution) |
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Method of NPWT |
Irrigate/debride - should be free of nectoric but can have <20% nonviable tissue Cute foam to size Protect periwound Place tubing within bed and conenct conister Cover with film drape = air tight seal NP: 50-175mmHg Constant or intermittent Time: 12-72 hours |
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Advantages to NPWT |
May cost less over time Can use in any setting Moist wound environment |
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Disadvantages to NPWT |
No standard for use Pain Noisy May hinder pt mobility Difficulty obtaining air-tight seal May cause skin damage Costly |
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Alternative interventions for NPWT |
Estim |
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Describe HBO |
100% oxygen administered at >1.5ATM Mono or multiplace chamber 14X greater O2 dissolved in plasma Tissue oxygen pressure must be >40mmHg for normal wound healing Requires physician on site |
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Rationale for HBO |
Revascularization Collagen synthesis Bactericidal Effects Edema reduction |
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Purpose of HBO |
Inc oxygen concentration gradient May reduce bacterial growth May enhance angiogen/granulation/epi May reduce edema |
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Indications for HBO |
Gas Gangrene Peripheral ischemia Crush injury Wagner grade 3 ulcer Progressive nectrotizing fasciitis Osteomyelitis Osteoradionecrosis Pressure/diabetic ulcers VI |
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Contraindications/precautions for HBO |
DVT CHF Claustrophobia Pregnancy Severe AI Thrombophelbitis Ischemic wounds Noncomplicated wounds |
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Method for HBO |
Pt in chamber breathing 100% O2 at 1.5-2.5 ATM Time: 90-120 Fq: 2x/day - 3x/wk 10-60 sessions |
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Parameters for HBO |
50mmHg 90min 15sec compress 2 sec Decompress |
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How do you know if HBO is not effective? |
If 50% dec in wound surface area is not noted after 10 treatments |
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Advantages to HBO |
TCOM test to predict efficacy May prevent limb loss |
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Disadvantages to HBO |
Extrememly high cost Extensive treatment time Avg pt requires 31-44 Rx costing 75k |
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Alternative Interventions |
Revascularization should be considered first Estim Trial |
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Ultraviolet Wavelengths |
UVC: 200-290 UVB: 290-320 UVA: 320-400 |
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UVC and bacteriocidal effects?**** |
Some have a max at 254 for bacteriocidal effects**** |
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Treating Psoriasis**** |
Wavelengths 280-400nm**** |
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Effects of UV |
Inc epithelial cell turnover Enhances cell proliferation Promotes GF release Stim Granulation Enhances capillary flow Inc Vascular permeability Reduces wound biodurden Enhance Ca abdorption and photochemical conversion of Provit D to Previt D |
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What can UVC faciliate with? |
Venous of AI ulcers Pressure injuries Neuropathic ulvers Short tern for critically conolonized 3-4 pressure injury |
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Penetration of UV energy |
0.1mm of skin*** Cosine Law - Inverse Square law |
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Other low intensity laser therapy treatments |
HeNe, GaAIA, or GaAs lasers Limited studies show success with VI, Pressure, or NP ulcers |
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Effects of Laser therapy |
Inc Cell proliferation Stimulates mitochondria Dec Inflam Bactericidal Stim GF Inc Collagen |
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Describe MIRE |
Monochromatic Infrared Energy Delivers near infrared energy at 890nm wavelengths by flexible diode pads improves blood flow by 400% Slight improvement in diabetic neuropathy |
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When should the modality intervention be discontinued? |
If no appreciable change in wound status after 2 weeks |
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Intervention for Granulat, nondraining |
Pulsed lavage Estim Ultrasound HBO* |
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Intervention for Granular, draining |
Pulsed lavage Whirpool EStim Low fq US HBO* |
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Intervention for Necrotic, non draining
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Whirpool Pulsed Lavage Estim Low Fq US HBO* |
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Intervention for Nectroic, Draining |
Whirlpoo Pulsed lavage Estim US to periwound Low Fq US HBO* |
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What intervention should be used on a closed scar with limited ROM? |
Continuous US |
