conservative sharp debridement

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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 BOARDS POSITION Written P& P in place All documents in employee file Written MD order for EVERY procedure. - PowerPoint PPT Presentation

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  • Conservative Sharp Debridement

    Nursing Care Responsibilities(Physical Therapy Too)

    Patricia Gill, MSN, RN, CWON, CHRN

  • KNOW THE RULESOBTAIN A COPY OF YOUR LICENSING BOARDS POSITIONWritten 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 tissueIncreased risk of bleeding (ASA, anticoagulation, disease process)Dry eschar, especially if on heel or suspect calciphalaxisPoor 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 DebridementAutolyticMechanicalBiologicChemicalUltrasonicSurgical

  • Know What You Are Cutting OutDead tissueTendonMuscleFascia

  • KNOW YOUR LIMITATIONS

  • STOPPainBleedingYou cant seeStructure visibleMeet fascial planeThe patient says enoughYOU 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 ProceduresSaline 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

  • DOCUMENT DOCUMENT

    DOCUMENT

    Sharp Debridement Course9/7/02Pat Gill, RN*

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