Modalities Used in Wound Care

Question 1

List some modalities used in wound care.

Answer 1

Hydrotherapy, E-stim, Hyperbaric oxygen, compression, Negative wound therapy, ultrasound

Question 2

What are the benefits of whirlpool treatment?

Answer 2

softens adherent necrotic tissue
increases blood flow and metabolic rate
proliferation and granulation tissue and epithelial cells
exudate removal to decrease infection
wound cleansing

Question 3

What are the negatives of whirlpool treatment?

Answer 3

Maceration, dependent position, potential for burns, cytotoxic additives

Question 4

What are the contraindications for whirlpool treatment?

Answer 4

CHF/LE edema
pulmonary disease
acute phlebitis
lethargy
gangrene
renal failure

Question 5

What are the treatment parameters for hydrotherapy?

Answer 5

92-96 degrees F

10-15 minutes

Question 6

Why do you use pulsed lavage with suction?

Answer 6

Used for cleansing and debridement (cleaning wound and removal of toxic residuals)

Question 7

What are the treatment parameters for pulsed lavage?

Answer 7

10-15 minutes

Question 8

What are the precautions and considerations of pulsed lavage?

Answer 8

Precautions: tissue damage can occur if pressure is too high
Considerations: can be done at bedside, can be expensive

Question 9

How does electrical stimulation affect wounds?

Answer 9

stimulates fibroblasts to enhance collagen and DNA synthesis
increases number of receptor sites for growth factors
alters the direction of fibroblast migration, activates cells in the wound site, improves tissue perfusion, decreases edema
increases cutaneous oxygen transport
controls infection
stimulates wound contraction and scar healing

Question 10

What are the indications to use e-stim?

Answer 10

pressure ulcers stage 1-4, diabetic ulcers, venous ulcers, traumatic wounds, surgical wounds, ischemic wounds, donor sites, flaps, burn wounds

Question 11

What are contraindications for e-stim treatment?

Answer 11

osteomyelitis, pregnancy, malignancy, pacemaker, over the carotid sinus or across heart, laryngeal musculature, along regions of phrenic nerve, over topical substance containing metal ions, over povidine iodine or mercurochrome

Question 12

Can you apply e-stim directly to the wound or periwound?

Answer 12

Yes

Question 13

Will medicare pay for e-stim as your very first wound care treatment?

Answer 13

No.

Only after the wound is not progressing following traditional treatment for 30 days

Question 14

What are the settings for e-stim?

Answer 14

Pulse width: 20-200 microseconds

Pulse frequency: to 100 pulses per second

Question 15

What are the different characteristics of polarity for e-stim?

Answer 15

Cathode (-): used during the inflammatory phase for bacteriostatic effect and to dissolve necrotic tissue
Anode (+): used during the proliferative phase to accelerate wound healing, increase fibroblastic formation, increase epithelialization, stimulate protein and DNA synthesis

Question 16

What is the timing of use for e-stim? (days)

Answer 16

In the proliferation phase you use the cathode for 1-5 days, then change to the anode until healed
In the maturation phase you alternate between the cathode (3 days) and the anode (3 days)

Question 17

What are the parameters for e-stim treatment?

Answer 17

45-60 minutes
5-7 times per week
Voltage/Intensity: 100-150 volts

Question 18

What are the effects of hyperbaric oxygenation?

Answer 18

Hyperoxygenation and decreases edema
toxin inhibition, antibiotic synergy
restores body’s defense against infection, increases the rate of killing some common bacteria, inhibits growth of anaerobic organisms
angiogenesis

Question 19

What are the indications of hyperbaric oxygenation?

Answer 19

acute burns, chronic wounds, radiation induced injury, necrotizing infection, sepsis, chronic osteomyelitis, carbon monoxide poisoning
Must be well debrided

Question 20

What are the contraindications of HBOT?

Answer 20

claustrophobia, pneumothorax, COPD, seizure disorders, upper respiratory infection, optic neuritis, malignant tumors, acidosis, drugs (steroids, alcohol, nicotine)

Question 21

What are the treatment guidelines for HBOT?

Answer 21

2.0 ATA oxygen x 90 minutes

5x/week for 4 weeks = 20 sessions

Question 22

What are the goals of negative pressure wound therapy (NPWT)?

Answer 22

increase blood flow, decrease bacteria colonies, able to measure and assess wound fluid, increase granular tissue base, contraction of wound, epitheliazation

Question 23

What are the indications for NPWT?

Answer 23

acute wounds, PTW/FTW from burns, surgical wounds/incisions and dehiscence, diabetic wounds, venous/arterial wounds, pressure ulcers, graphs/flaps, enteric fistulas

Question 24

What are the contraindications for NPWT?

Answer 24

necrotic tissue with eschar, malignancy, untreated osteomyelitis, exposed blood vessels or organs, non-enteric or unexplored fistulas, acute bleeding

Question 25

What are the settings for NPWT?

Answer 25

``` Dressings are changes every 48-72 hrs Must be ON for 22-24 hrs Pressure between 75 mmHg and 150 mmHg intermittent versus continuous white foam, black foam, silver foam ```

Question 26

How long does someone receive NPWT, and when is it discontinued?

Answer 26

treatment usually lasts 4-6 weeks | should be discontinued when goals are met, no progress in healing for 1-2 weeks, patient is non-compliant

Question 27

What are the indications of ineffective VAC therapy?

Answer 27

Minimal changes in wound size, deterioration of the wound, changes in wound color, wound appears white, excessively moist or macerated, wound odor

Question 28

What are the indications for intermittent/pneumatic compression?

Answer 28

primary/congenital lymphedema, secondary lymphedema from lymph node resection after cancer, chronic venous insufficiency, venous stasis, venous ulcers, reduce and control peripheral edema

Question 29

What are contraindications of compression therapy?

Answer 29

phlebitis, CHF, PE, DVT, increase of venous/lymphatic return is not desired, caution in using on extremity with lack of sensation to pain

Question 30

What are the settings for compression therapy?

Answer 30

Daily to BID tx 30-60 minutes per tx pressure from 0-80 mmHg (set 20 below diastolic BP) monitor BP pre and post therapy

Question 31

Why do we use a Unna boot?

Answer 31

used in AMBULATORY patients to aid the calf muscle pump

Question 32

What are the layers of the unna boot?

Answer 32

first layer is gauze impregnated with zinc oxide, glycerine, and calamine, outer layer is gauze and/or self-adherent or compressive bandage

Question 33

What are the treatment parameters of the unna boot (time, precautions)?

Answer 33

Leave it on for ~ 1 week | Do not get it wet

Question 34

What is MIST ultrasound?

Answer 34

A non-contact US which administers continuous US energy via an atomized saline solution Used for cleansing and debridement

Question 35

What does Ultrasound (US) do physiologically?

Answer 35

accelerates acute inflammatory phase, stimulates fibroblasts to secrete collagen, provides heat to deeper tissue prior to stretch, accelerates wound contraction, promotes strong, more elastic scars, increases blood flow

Question 36

What are contraindications to US?

Answer 36

thrombophlebitis, actute infection, pregnancy, malignancy, over the eye, hemophiliacs not covered by factor replacement, concurrent or post radiation, over bony prominence

Question 37

What are the indications for US use?

Answer 37

colonized wounds, arterial/venous wounds, diabetic foot ulcers, chronic leg ulcers, pressure ulcers, burns, acute wounds, post operative wounds, sickle cell ulcers

Question 38

What are the parameters for US treatment?

Answer 38

Use a hydrogel dressing or sterile saline | 1-2 minutes for area 1.5x the size of applicator

Question 39

What are the settings for US treatment?

Answer 39

``` Frequency: 3 MHz Duty cycle: 20% Intensity: <.5 watts (thermal) Duration: 1-2 minutes per zone TxFreq: 1-2 times per day until inflammation subsides, then decrease to 2-3x/wk ```

Question 40

How are leeches used?

Answer 40

used to diminish venous congestion with reattachment surgery saliva of leeches has anticoagulant properties feed for 20 minutes at a time

Question 41

How are maggots used?

Answer 41

selectively debride necrotic tissue | 48-72 hours, 2 times per week