conservative sharp debridement nursing care responsibilities (physical therapy too) patricia gill,...
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Conservative Sharp Debridement
Nursing Care Responsibilities
(Physical Therapy Too)
Patricia Gill, MSN, RN, CWON, CHRN
KNOW THE RULES
OBTAIN A COPY OF YOUR LICENSING BOARD’S POSITION
Written P& P in placeAll documents in
employee fileWritten MD order for
EVERY procedure
New to ALL Facilities
A written consent EVERY TIMEA procedural checklist EVERY TIMEA TIME OUT IMMEDIATELY PRIOR TO
PROCEDURE EVERY TIMEDated and timed documentation with
signatures of participating staff
Conservative Sharp Debridement
Differs from surgical debridement
Definition
Removal of loose, avascular tissueNo painNo bleedingTopical anesthesia only (and only with a
written order EVERY time)
CONTRAINDICATIONS
Unable to clearly identify viable from nonviable tissue
Increased risk of bleeding (ASA, anticoagulation, disease process)
Dry eschar, especially if on heel or suspect calciphalaxis
Poor perfusion (arterial disease)
Patient and Family Education(sometimes staff too)
Dead tissue prevents healingAwareness that debridement may make the
wound larger initiallyFrequent debridement will actually increase
the rate of healing
Develop the Goal of Treatment
Healing vs Palliative CareInfection vs ColonizationComfort or Odor ControlInclude patient, family, staff, other
treating MDs
Other Types of Debridement
AutolyticMechanicalBiologicChemicalUltrasonicSurgical
Know What You Are Cutting Out
Dead tissueTendonMuscleFascia
KNOW YOUR LIMITATIONS
STOP
PainBleedingYou can’t seeStructure visibleMeet fascial planeThe patient says “enough”YOU GET UNCOMFORTABLE
Notify the Physician if:
Sinus tracts or undermining Infection or cellulitis No improvement in 2 – 3 weeks Patient becomes febrile or develops other
signs of systemic infection
If There Is BLEEDING...
APPLY PRESSURESilver nitrate cauterization (need an order)Alginates (leave in place for 24 hours)Gelfoam or other stoppersMaybe hold VAC for 24 hours
Post Debridement Procedures
Saline dressing first 24 hoursSterile dressing 8 – 24 hours if there has
been bleedingMay need more frequent dressing changes
Safe Practitioners...
Know A & PSet goals of treatment Know when to stopRegularly update skills and competencies
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