Wounds and wound Care Pressure Ulcer Staging Negative Pressure Wound Therapy Supplementation for wound healing Treatment Principles HealthySuccess12@hotmail.com

Pressure Ulcer Staging National Pressure Ulcer Advisory Panel (NPUAP)Guidelines - Based on depth of tissue injury, not size Typically over bony prominences, but can occur over any area excessive pressure is applied

Stage 1 Non-blanchable erythema

Stage 2 Skin only – excoriation, blister, shallow ulcer

Stage 3 Involves subcutaneous tissue

Stage 4 Involves structures below the subcutaneous tissue – muscle, tendon, fascia, bone

Unstagable Necrotic tissue present which does not allow accurate staging

Unstagable - Kennedy

DTI Purple or maroon discoloration of the skin

Negative Pressure Wound Therapy “WOUND Vac”

Benefits Removes exudates, infectious material Reduces edema Promotes perfusion and angiogenesis Promotes granulation tissue formation

NPWT / NWPTi

SmaLL pORTABLE NPWT PICO – Smith & Nephew SNaP - Spiracur NPD 1000 – Kalypto Medical

Nutritional supplementation for wound healing The Dietician is my friend!

Wounds = hypermetabolic state Calories 30-35 Kcal/Kg 35-40 Kcal/Kg – underweight or loosing weight Protein 0.8-1.0 g/Kg – Adults 1.0-1.2 g/Kg – Elderly 1.0-1.5 g/Kg – At risk for pressure ulcers 1.2- 1.5 g/Kg – Promote wound healing Adequate hydration 30-40 ml/Kg/day 1- 1.5 ml/Kcal Increased requirements with wound drainage, fever

Vitamin C Works with the amino acids proline and lysine during collagen synthesis Angiogenesis Fibroblast and leucocyte function 500 mg twice daily Renal failure – 250mg/day – avoid oxalate deposits

ZINC Cofactor in collagen synthesis Cellular proliferation and synthesis – enzyme and immune function Can adversely affect copper status ZnS04 220 mg (50 mg elemental) once daily for 2 - 3 weeks

iRON Hemoglobin Synthesis and collagen formation Iron (FESO4) - 325mg 1 to 3 times/day for iron deficiency Vitamin C aids absorption Can have adverse affects if excess leads to tissue deposition

VITAMIN a Collagen synthesis and cross linking Stage I-II: Replete only if deficient 10, 000 – 25,000 IU x 10 days Stage III-IV: 5000 IU per 1000 kcal Concomitant glucocorticoid use: 10,000-15,000 IU x 7 days

B vITAMINS Collagen linkage. Healthy immune system Protein and DNA synthesis. Formation of red blood cells Multivitamin unless specific deficiency

Other considerations Glycemic control - proper cell function Copper - cofactor in connective tissue formation - collagen polymerization and cross link formation Arginine - conditionally essential amino acid - increase collagen deposition and blood flow Glutamine - facilitates nitrogen metabolism - supports protein synthesis - critical substrate for the cellular immune HMB (hydroxymethybutarate) – metabolite of leucine – promotes tissue building, increase in muscle mass EFAs

Wound healing Dressing choice and frequency depends on many factors Maintain optimal moisture for wound healing – exceptions stable dry heel eschar and severe arterial disease Control bacterial colonization and infection Control inflammation Promote tissue proliferation Outpatient - Patient convenience and ability - Requirement for nursing assistance Wound team follow up typically weekly unless longstanding or stable non-healing