Pressure ulcers are major health problems in the U. S. Pressure ulcers are major health problems in the U. S

Assessment of the wound must be done to evaluate the healing and the treatment of the wound.

Necrotic tissue must be removed and present infection must be treated for healing to occur.

• Necrotic tissue must be removed and present infection must be treated for healing to occur.

• The necrotic tissue may be removed by different types of debridement.

Why is it needed for pressure ulcers?

• Why is it needed for pressure ulcers?

• To promote healing
• To allow the healing process to occur
• To protect against bacteria
• To remove dead tissue

Enzymatic

• Enzymatic

• Surgical

• Autolytic

• Mechanical

Enzymatic debridement

• Enzymatic debridement

• Use of exogenous proteolytic enzymes to removed dead tissue.
• Used in wounds with large amount of debris.
• Advantages
• Minimal damage to healthy tissue
• Bleeding disorders
• Very effective in most patients
• Disadvantages
• Expensive
• Topical agents
• Needs to be softened

Surgical debridement

• Surgical debridement

• Removal of layers of necrotic tissue using a laser, scissors forceps, or curette using sterile technique.
• Sharp debridement can be done by nurses with training.

Autolytic debridement

• Autolytic debridement

• Stimulation of natural enzymatic activity by the use of the endogenous enzymes used to digest the dead tissue.
• Used for larger pressure ulcers and deep wounds.
• Semi-occlusive or occlusive dressing using transparent films, hydrocolloids, hydrogels
• Advantage
• Selective
• Painless
• Disadvantages
• Time
• Risk for infection

Mechanical debridement

• Mechanical debridement

• The removal of slough or necrotic tissue by use of wet-to-dry dressing or whirlpool treatment.
• Used in wounds with a great amount of necrotic tissue.
• Advantages
• Cost
• Disadvantages
• Painful
• Takes off healthy tissue
• Trauma to wound
• Infection (whirlpool)
• Least recommended

Select the appropriate dressing for the wound

• Select the appropriate dressing for the wound

• Consider the wound’s characteristics: location, phase of healing, infection, frequency of dressing changes, product availability, cost.
• The choice of the dressing should change as the wound heals.

• Moist wound dressings

• Advantages
• Keeps the wound bed moist.
• Eliminates dead space.
• Controls the exudates.

Nondraining Wounds

• Nondraining Wounds

• Use transparent film, hydrocolloid, or hydrogel dressings.

• Draining Wounds

• Use foam, alginate, or collagen dressings.

Hydrocolloid dressings

• Hydrocolloid dressings

• Shown to have a lesser risk of infection than gauze dressings.
• Should not be used on infected wounds or wounds with undermining, tunneling, or sinus tracts.
• Hydrocolloid dressings have a greater affect on wound healing than saline gauze or paraffin gauze.

• Infected wounds

• Do not use occlusive dressings when an anaerobic bacterial infection is present or suspected.
• Positive correlation between gauze dressings and rates of infection, because they lower wound temperature and impede fluid evaporation.