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 §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 §Autolytic §Mechanical §Biologic §Chemical §Ultrasonic §Surgical

Know What You Are Cutting Out §Dead tissue §Tendon §Muscle §Fascia

KNOW YOUR LIMITATIONS

STOP §Pain §Bleeding §You can’t see §Structure visible §Meet fascial plane §The patient says “enough” §YOU GET UNCOMFORTABLE

Notify the Physician if: §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... §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... §Know A & P §Set goals of treatment §Know when to stop §Regularly update skills and competencies

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