Practice development Innovations How to...


Practice development How to...Ten top tips for wound debridement Author: Kathleen Leak


How to... Ten top tips for wound debridement


D


ebridement of non-viable tissue from any wound is an accepted principle of wound care and is primarily aimed


at achieving wound healing. However, a 2010 consensus document highlighted the fact that many clinicians undertake this process without adequate knowledge or preparation: 'Upskilling practitioners in the most recent advances in debridement tools and techniques will help to ensure that the appropriate and optimum treatment options are implemented, thus improving patient care and clinical outcomes'[1]


. As it is recognised that there is a lack of


standardised guidelines and that variations in practice exist, this article provides a simple set of tips for clinicians to bear in mind when considering the use of debridement.


METHODS The debridement methods most frequently seen in current practice, and outlined below,


References 1. Gray D, Acton C, Chadwick P, et


al. Consensus guidance for the use of debridement techniques in the UK.Wounds UK 2011; (7)1: 77–84.


2. NHS Wirral. Procedure for


Conservative Sharp Debridement. 2009. Available at: Nhttp://


www.wirral.nhs.uk/document_ uploads/Policies_Nursing/ ProcedureConservative


SharpDebridementJune09.pdf (accessed 2 December, 2012).


3. Vowden K, Vowden P. Wound debridement Part 1: non-sharp


techniques. J Wound Care 1999a; 8(5): 237–40.


4. Leaper D. Sharp technique


for wound debridement. 2002. Available at: http://www.


worldwidewounds.com/2002/ december/Leaper/Sharp-


Debridement.html (accessed 2 December, 2012).


include: n Mechanical n Larval n Sharp n Autolytic n Hydrosurgical n Ultrasound n Surgical.


As with any treatment, it is important to


explain the process to the patient and gain consent before attempting any of these procedures.


PRINCIPLES OF DEBRIDEMENT The following are guidelines only and clinicians should always consult local and national protocols when considering the use of debridement.


1 21


Environment: the room chosen to be used for treatment should be suitable for the


Wounds International Vol 2 | Issue 2 | ©W ol 3 | Issue 1 | ©Wounds International 2011 tional 2012


process and adequate disposal facilities and equipment should be available, for example, a sharps box in the case of sharp debridement, or the protective clothing and goggles required when undertaking hydrosurgical debridement. The windows and doors should be closed to prevent cross-contamination — the closed door will also allow the clinician to concentrate without distraction. Fans should also be turned off several minutes before the treatment commences to allow the air to settle.


2


Inspection of the wound: objectives should only be set following a thorough


assessment of the wound bed, focusing on the tissue structures that are to be removed. It is vital to ensure that no organs, ligaments or blood vessels are involved with the necrosis or debris to be removed, thereby avoiding the risk of traumatic injury. Clinicians should ensure that the amount of tissue that requires removal is appropriate for the chosen method of debridement — the anatomical location of the wound will influence this decision.


3 4


Competency: it is important that the clinician's chosen method of debridement falls within their own competency. Clinicians should never attempt processes such as sharp debridement without undergoing structured training and fulfilling the appropriate competencies as outlined in local guidance[2] Always assess if pain control is appropriate


.


for the chosen technique and topical or oral top-up may be needed.


Autolytic debridement: this is performed with an occlusive or semi-occlusive dressing,


such as a hydrogel, hydocolloid, alginate or film, and the aim is to rehydrate the necrotic tissue. This is a slow process and can safely be undertaken by the majority of clinicians following a structured wound assessment. It can, however, lead to malodour and maceration of the periwound skin. This technique is usually used prior to another form of tissue debridement and


Page 1  |  Page 2  |  Page 3  |  Page 4  |  Page 5  |  Page 6  |  Page 7  |  Page 8  |  Page 9  |  Page 10  |  Page 11  |  Page 12  |  Page 13  |  Page 14  |  Page 15  |  Page 16  |  Page 17  |  Page 18  |  Page 19  |  Page 20  |  Page 21  |  Page 22  |  Page 23  |  Page 24  |  Page 25  |  Page 26  |  Page 27  |  Page 28  |  Page 29  |  Page 30  |  Page 31  |  Page 32  |  Page 33