Transcript No Slide Title

Technique of Sharp Wound
Debridement
Preparation for debridement:
• Physician order for sharp debridement
• Developing a strategy: What are the goals? To heal or
not to heal? Will all your work be in vain?
• Know the patients past and current medical history,
wound assessment, vascular status, neurological status,
medications
• Obtain patient or family consent
• Instruments and supplies
• Apprehension (yours VS. the patient’s)
• Location, location, location
Physician order for sharp debridement:
• Is the order specific to exactly what needs to be done?
• Has the physician seen the wound recently or is this an
order called in over the phone?
Developing a Strategy: What are the goals? To heal or
not to heal? Will all you work be in vain?
• To remove necrotic tissue
• To reduce bacterial count
• To allow granulation to occur
• Just keeping the wound clean or do we realistically
expect the wound to heal. Dictates treatment plan:
expensive Vs. non expensive modalities
• You just spent 15 minutes upside down debriding a
necrotic plantar foot wound. Your back hurts. You
come back next week and look at the patient and find
out they’ve participated in Tango lessons for 5 of the
last seven days.
Know the patients past and current medical history,
wound assessment, vascular status, neurological status,
medications:
• Do not take a sharp instrument to a patient without
knowing the above information. It is a poorly planned
procedure if you do!
Obtain patient or family’s consent
“Sure, go ahead
and cut on my
mother.”
Informed consent: Explain expectations, risks and benefits
Instruments and Supplies
• Iris Scissors
• Tissue Forceps with and without teeth
• Curettes
• Hemostat
• Rongeur
• Scalpel #3 handle with blade #11, #15, #10
disposable
• Bandage scissors
• Wound measuring device
• Camera
Instruments and Supplies
• Gloves sterile or non sterile
• Sterile/clean field i.e. chuck, drape
• Syringes and needles
• Topical or injectable anesthetic if needed
• Gauze
• Cotton tipped applicators
• Saline
• Hemostatic product i.e. Silver nitrate, Surgicel, etc.
• Hazardous waste bag -red
Tissue
Forceps
Iris
Scissors
Curette
Adson
Brown
Forceps
#10
Blade
Rongeur
#15
Blade
Curette
Basic instruments
Adson Brown forceps with teeth
Apprehension: Yours Vs. the Patient’s
• Know your limitations
• How long is the procedure going to last?
• If you’re nervous, not confident, or have a gut feeling
that something's not right, don’t proceed
• Is the patient comfortable, in pain or combative?
Location, Location, Location
• Patient should be in a comfortable position
• You should be in a comfortable position
• There should be adequate lighting
• Have an assistant if possible
• Aseptic field
Relax
Technique for sharp debridement with a scalpel or
scissors
• Grasp the eschar or necrotic tissue with a tissue
forceps or hemostat
• Using a scalpel or scissors, cut underneath staying
parallel to the plane of the wound
• Be sure to visualize where the tip of the instrument is
cutting
• Remove the tissue in layers if
unsure of how deep to go
Sharp Debridement
How much to debride?
• Depends on the amount of non viable tissue
• How much can the patient tolerate?
It is important to set limits
• A bedside debridement should take 5-30 minutes
depending on location, amount of tissue removed, patient
comfort and clinician fatigue
• Rate of debridement will also
depend on your experience
• Following removal of non viable tissue the wound is
cleaned with normal saline. Check for any uncontrolled
bleeding and perform hemostasis if necessary.
• If indicated, take cultures of the wound. Deep tissue
cultures/samples are preferred to superficial swab
cultures.
• The wound is then dressed per orders.
• Debridement may have to be daily, weekly or
on a PRN basis.
• Physician orders should reflect this.