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Conservative Sharp Debridement

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.

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Conservative Sharp Debridement

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  1. Conservative Sharp Debridement Nursing Care Responsibilities (Physical Therapy Too) Patricia Gill, MSN, RN, CWON, CHRN

  2. 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

  3. 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

  4. Conservative Sharp Debridement Differs from surgical debridement

  5. Definition • Removal of loose, avascular tissue • No pain • No bleeding • Topical anesthesia only (and only with a written order EVERY time)

  6. 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)

  7. 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

  8. Develop the Goal of Treatment • Healing vs Palliative Care • Infection vs Colonization • Comfort or Odor Control • Include patient, family, staff, other treating MDs

  9. Other Types of Debridement • Autolytic • Mechanical • Biologic • Chemical • Ultrasonic • Surgical

  10. Know What You Are Cutting Out • Dead tissue • Tendon • Muscle • Fascia

  11. KNOW YOUR LIMITATIONS

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

  13. 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

  14. 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

  15. Post Debridement Procedures • Saline dressing first 24 hours • Sterile dressing 8 – 24 hours if there has been bleeding • May need more frequent dressing changes

  16. Safe Practitioners... • Know A & P • Set goals of treatment • Know when to stop • Regularly update skills and competencies

  17. DOCUMENT DOCUMENT DOCUMENT

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