WK11- Irrigation and Modalities

Question 1

What factors should you consider when selecting irrigation type ?

Answer 1

purpose of irrigation, wound presentation, wound etiology, intervention availability

Question 2

What PSI can traumatize the wound bed ?

Answer 2

greater than equal to 15psi

Question 3

Describe infection control for patients and therapists when conducting pulsed lavage on a wound.

Answer 3

Therapists should have full PPE including: face shield, mask, gown, gloves, hair covers

Patient should be masked, visitors should not be present, appropriate ventilation, cover exposed tubes, ports, wounds not being treated, cover wound supplies and personal items

Question 4

For pulsed lavage what wounds should be done daily ?

Answer 4

most wounds

Question 5

For pulsed lavage what wounds should be done twice daily ?

Answer 5

greater than 50% necrotic, purulent drainage, sepsis

Question 6

For pulsed lavage what wounds should be done 3 times/week ?

Answer 6

full granulation base, NPWT being used

Question 7

When should you discontinue pulsed lavage ?

Answer 7

wound closed, no increase in granulation for 1 week, no decreased necrotic tissue for 1 week

Question 8

What kind of electrical stimulation is used for wound healing and why ?

Answer 8

HVPC
the use of bioelectric current attracts cells to increase wound healing ( galvanotaxis)
stimulating cell migration, proliferation, bactericidal effects, and autolytic debridement

Question 9

For what kind of wound is HVPC indicated ?

Answer 9

indicated for chronic or recalcitrant wounds that are clean or infected; stage III or IV pressure ulcers; recalcitrant stage II ulcers

Question 10

What are the protocols for HVPC ?

Answer 10

Negative Polarity:
inflammatory phase
freq: 100-128pps
intensity: 100-150 V
Duration: 60 minutes, 5-7x/week

Positive Polarity:
promote granulation tissue/ proliferation
freq: 100-128pps
intensity: 100-150 V
Duration: 60 minutes, 5-7x/week

Question 11

For what conditions is negative pressure therapy indicated ?

Answer 11

venous leg ulcers, traumatic wounds, skin grafts, pressure ulcers, partial thickness burns, flaps, diabetic ulcers, dehisced wounds, chronic wounds, acute wounds

Question 11

What are the contraindications for HVPC in wounds ?

Answer 11

malignancy, osteomyelitis, DVT, pacemaker, over carotid sinus, over uterus if pregnant, where there are metal ions ( like in silver nitrate impregnated gauzes)

Question 12

What are the treatment parameters for NPWT?

Answer 12

50-175mmHg
dressing change every 2-3 days

Question 13

When is NPWT contraindicated ?

Answer 13

foam in direct contact with exposed blood vessels, anastomotic sites, organs, or nerves
malignancy in wounds
untreated osteomyelitis
non-enteric and non-lewis and clarked fistulas
necrotic tissue with eschar present

precautions: blood thinners

Question 14

Explain the parameters for ultrasound with the purpose of wound healing

Answer 14

Frequency:
Superficial=3.0MHz
Deep Wounds= 1.0Mhz

Intensity:
Pulsed, 0.5-1.0 W/cm squared
Continuous, up to 1.5 W/cm squared

Question 15

What is a hyperbaric oxygen chamber ?

Answer 15

The administration of 100% oxygen administered at 1.5 ATM for chronic or slow healing wounds

Question 16

What are the indications of HBO ?

Answer 16

wagner 3s, failed grafts/flaps, necrotizing fasciitis, late effects of radiation wounds, Hx of severe anemia, crush injuries or compartment syndromes, thermal burns, gas gangrene, acute traumatic peripheral ischemia/arterial insufficiency, decompression sickness

Question 17

What are the contraindications and precautions to HBO ?

Answer 17

uncontrolled CHF, DVT, claustrophobia, pregnancy, severe arterial insufficiency, relative COPD, non-complicated wounds

Question 17

What is the protocol for HBO ?

Answer 17

Chamber: 1.5-2.5 ATM for 90-120 minutes
2x/day to 3x/week, 10-60 sessions

Question 18

What are some of the promising modalities ?

Answer 18

UVC ( 200-290nm): has been shown to be germicidal, increase vascular permeability, enhance cell proliferation and granulation tissue formation, promotes GF release

Infrared and Laser: improvement of circulation, healing by stimulating cells and improving scar tensile strength.

Question 18

For draining and granular wounds what modalities are available ?

Answer 18

pulsed lavage w/ suction, whirlpool, E-stim, low-freq. US, HBO ?

Question 19

For draining and necrotic wounds what modalities are available ?

Answer 19

whirlpool, pulsed lavage w/ suction, e stim, periwound US, low freq US, HBO ?

Question 20

For non-draining and granular wounds what modalities are available ?

Answer 20

pulsed lavage, e stim, US, HBO

Question 21

For non-draining and necrotic wounds what modalities are available ?

Answer 21

whirlpool, pulsed lavage, e stim, low freq. US, HBO