Adjunct modalities Flashcards
How does E stim work for wound care?
- Measurable currents are found in the skin, in wounds, and in specific cells involved in healing
- Macrophages = negative polarity
- Fibroblasts = positive polarity
- E stim is intended to mimic normal currents to facilitate wound healing by galvanotaxis
What current is recommended for E stim in wound care?
HVPC due to least risk of skin irritation
Effects of E stim on wound healing
- Increased tissue oxygenation
- Bactericidal effect
- Facilitates debridement
- Increased blood flow
- Decreased edema
- Increased rate of healing per week
Contraindication to E stim for wound care
- Cancer in the wound or periwound
- Untreated osteomyletis
- Electrode placement that might interfere with cardiac function
Guidelines for treatment with HVPC
- Intensity = 75-200 V
- Pulse = 50-100 pps
- Stim frequency = 80-125 HZ
- Duration = 45-60 mins/day qd until closure
Current clinical recommendation for selecting polarity for E stim
Start with negative stim over wound bed for first 3 treatments, then switch to positive stim
How is monopolar E stim set up on a wound?
- Treatment electrode directly over the wound
- Nontreatment electrode on intact skin 15-30 cm from wound
How is bipolar E stim set up on a wound?
- 2 treatment electrodes on intact skin immediately adjacent to the wound
- One dispersive electrode 15-30 cm from the wound
Criteria for reimbursement for E-stim
- Stage III-IV pressure ulcers
- Arterial/venous ulcers
- Diabetic ulcers
- Only after no measurable signs of healing for at least 30 days of “standard wound therapy”
Effects of ultrasound on wound healing
- Accelerates inflammatory process
- Accelerates wound contraction by stimulation of myofibroblasts
- Increases capillary development in granulation tissue
- Pulsed US results in more elastic scar tissue during remodeling phase
Ultrasound protocol for full thickness wound
- Pulsed mode
- Direct technique: fill cavity with amorphous hydrogel, cover with hydrogel sheet
- Periwound technique: apply US gel to periwound tissue
What is the MIST system?
- Non-contact low freq US
- Increased healing rates in chronic wounds
- Produce and propel gentle mist of sterile saline to wound bed to stimulate cellular activity and destroy bacteria
What is the Qoustic wound therapy system?
Contact ultrasound for wound debridement
Effects of negative pressure wound therapy
- Increased blood flow
- Enhanced tissue perfusion
- Removes exudate
- Facilitates granulation tissue formation
- Facilitates wound contraction
What wounds does negative pressure wound therapy treat?
- Pressure ulcers
- Acute and subacute wounds
Protocols for negative pressure wound therapy
- 125 mmHg continous for 1st 48 hrs
- Intermittent mode: 5 mins on/ 2 mins off for 24 hrs/day (this protocol heals faster)
How big does a wound have to be to qualify for negative pressure wound therapy?
- 1cm x 1cm x 1cm
- 97605 = NPWT surface area < or = 50 sq.cm
- 97606 = NPWT surface area > 50 sq.cm
How to set up negative pressure wound therapy?
- Foam dressing placed in wound bed after being cut to fit
- Drape that overlaps with wound edges with hole in center
- Vacuum attachment on the hole
- Stop if there is bright red blood present
Negative pressure wound therapy contraindications
- Dry necrotic wounds
- Over malignancies
- Over exposed blood vessels
- Untreated osteomyelitis
- Presence of excessive black eschar
What is hyperbaric oxygen therapy?
- Oxygen delivered to arterial blood by having pt breath in 100% O2 in a sealed chamber @ 2-2.5 atmospheric pressure
- Allows hyperoxgenation of tissue involved in healing
Precautions of hyperbaric oxygen chamber
- URI
- Seizures
- Emphysema
- High fever
- Hx spontanous pneumothorax
- Thoracic sx
- Viral infection
