Debridement Policy

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Debridement Policy
SUBJECT: DEBRIDEMENT
GOAL: To optimize efficacious wound care by removing non-viable (necrotic) tissue.
RATIONALE: Devitalized tissue, such as eschar and slough promote growth of pathogens and
inhibits wound healing. Consideration of patient goals, clinical condition and nature and amount of
devitalized tissue is indicated when determining a method of debridement. The body produces
proteases to break down and remove dead tissue via autolysis and white blood cells to engulf and
digest debris via phagocytosis. Individuals with chronic wounds often require external sources of
debridement because their bodies are not able to debride the unhealthy tissue. There are several
methods of wound debridement, all of which require a physician’s order.
DATE EFFECTIVE: ___________________
DATE REVISED: _____________________
DATE REVIEWED: Annually
APPROVED BY: ______________________
ISSUING DEPARTMENT: ________________________
APPROVED FOR USE IN: ________________________
POLICY:
1. Consider the following debridement methods.
2. Select the best debridement option in consideration with patient’s goals, clinical condition, type
and amount of devitalized tissue and past benefit from debridement type, as applicable.
3. Notify the physician or prescribing individual of the need for wound debridement and obtain
orders.
4. Monitor the wound for signs of infection (erythema, warmth, induration, increased exudate
unrelated to debridement process). Notify physician of wound deterioration.
5. Monitor wound for effectiveness of debridement type. Notify physician if method ineffective and
obtain new orders.
6. Notify physician when debridement complete and obtain new orders.
DEBRIDEMENT TYPE
CONSIDERATIONS
1. Autolysis: Dressings may include
hydrocolloids, hydrogels, transparent film,
polymers. {List facility products}
1a. Complete debridement
may take weeks.
1b. Do not use on infested
wounds or wounds at risk
for developing infection.
2. Chemicals/enzymes: Pharmaceutical
ointments. Collagenase digests denatured
collagen in necrotic tissue, releases the
necrotic tissue from the underlying healthy
tissue. Papain-urea (protease + denaturing
2a. Removes non-viable
tissue over time.
2b. Dressings changed
daily to BID depending on
product selection.
ingredient) digests and liquefies necrotic
2c. Some people may
tissue. {List pharmacy products used at facility} experience a slight
irritation of the skin next to
the wound.
2d. Most topical
antimicrobials are
compatible with enzyme
debriding agents.
2e. Refer to package
insert.
3. Mechanical: Wet to dry normal saline.
3a. Moisten one layer high
mesh gauze with normal
saline and wring out till just
damp. Apply to wound.
3b. Used in larger wounds
with moderate to heavy
necrotic tissue.
3c. Non-selective, may
be painful if adheres to
viable tissue at wound
margin.
3d. Generally change BID
4a More than one
application may be needed
to fully clean the wound.
4b. Some people may
4. Biological debridement: Maggot Therapy experience a tickling
sensation
4c.Remove and carefully
discard maggots when
removed.
5. Conservative sharps
5. Requires skilled PT or
nurse to perform. Refer to
“Conservative Bedside
Sharps Debridement”
policy.
This policy is a guideline and educational tool for the provision of patient care. Deviations from this
policy may occur as the situation warrants.
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