Conservative Sharp Debridement

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Conservative Sharp Debridement

• Nursing Care Responsibilities
• (Physical Therapy Too)
• Patricia Gill, MSN, RN, CWON, CHRN

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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

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New to ALL Facilities

• A written consent EVERY TIME
• A procedural checklist EVERY TIME
• A TIME OUT IMMEDIATELY PRIOR TO PROCEDURE EVERY
  TIME
• Dated and timed documentation with signatures of
  participating staff

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Conservative Sharp Debridement

• Differs from surgical debridement

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Definition

• Removal of loose, avascular tissue
• No pain
• No bleeding
• Topical anesthesia only (and only with a written
  order EVERY time)

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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)

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Patient and Family Education(sometimes staff too)

• Dead tissue prevents healing
• Awareness that debridement may make the wound
  larger initially
• Frequent debridement will actually increase the
  rate of healing

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Develop the Goal of Treatment

• Healing vs Palliative Care
• Infection vs Colonization
• Comfort or Odor Control
• Include patient, family, staff, other treating MDs

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Other Types of Debridement

• Autolytic
• Mechanical
• Biologic
• Chemical
• Ultrasonic
• Surgical

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Know What You Are Cutting Out

• Dead tissue
• Tendon
• Muscle
• Fascia

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KNOW YOUR LIMITATIONS
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STOP

• Pain
• Bleeding
• You cant see
• Structure visible
• Meet fascial plane
• The patient says enough
• YOU GET UNCOMFORTABLE

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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

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If There Is BLEEDING...

• APPLY PRESSURE
• Silver nitrate cauterization (need an order)
• Alginates (leave in place for 24 hours)
• Gelfoam or other stoppers
• Maybe hold VAC for 24 hours

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Post Debridement Procedures

• Saline dressing first 24 hours
• Sterile dressing 8 24 hours if there has been
  bleeding
• May need more frequent dressing changes

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Safe Practitioners...

• Know A P
• Set goals of treatment
• Know when to stop
• Regularly update skills and competencies

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DOCUMENT

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