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
BOARD’S POSITION
 Written P& P in place
 All documents in
employee file
 Written MD order for
EVERY procedure
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
Conservative Sharp Debridement
Differs from surgical
debridement
Definition
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Removal of loose, avascular tissue
No pain
No bleeding
Topical 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 healing
 Awareness that debridement may make the
wound larger initially
 Frequent debridement will actually increase
the rate of healing
Develop the Goal of Treatment
 Healing vs Palliative Care
 Infection vs Colonization
 Comfort or Odor Control
 Include patient, family, staff, other
treating MDs
Other Types of Debridement
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Autolytic
Mechanical
Biologic
Chemical
Ultrasonic
Surgical
Know What You Are Cutting Out
 Dead tissue
 Tendon
 Muscle
 Fascia
KNOW YOUR LIMITATIONS
STOP
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Pain
Bleeding
You can’t see
Structure visible
Meet fascial plane
The patient says “enough”
YOU GET UNCOMFORTABLE
Notify the Physician if:
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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...
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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
Post Debridement Procedures
 Saline dressing first 24 hours
 Sterile dressing 8 – 24 hours if there has
been bleeding
 May need more frequent dressing changes
Safe Practitioners...
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Know A & P
Set goals of treatment
Know when to stop
Regularly update skills and competencies
DOCUMENT
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DOCUMENT
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