Debridement within the context of the EWMA s debridement guidelines. Emil Schmidt WCNS SDHB - Otago

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1 Debridement within the context of the EWMA s debridement guidelines Emil Schmidt WCNS SDHB - Otago

2 EWMA Debridement Document Expert consensus document, 2013 Contents Mechanical debridement options Autolytic Enzymatic Larval Sharp and Surgical Debridement options Technical solutions e.g. versa jet, LFUD Health economics: Wound management and debridement Debridement algorithm

3 Debridement process cycle The aim is to provide a clear decision of the general pathway of debridement, as well as a proposal for a structured approach to choosing between the appropriate techniques

4 Debridement process cycle Debridement must be understood as a process in conjunction with other treatment approaches with the aim to create a beneficial situation supporting various clinical goals (e.g. intermittent goals) related to wound management

5 The Patient 94 year-year-old women Lives at home independently with partner Large venous leg ulcer since 2 ½ years 46.8 cm2 SSG failed twice Very painful 8-10 /10 Hardly gets any sleep Unable to tolerate any compression because of pain Systemically healthy Takes regular Paracetamol

6 Debridement process cycle

7 Xylocaine gel in place Diagnosis of tissue type, bio burden and factors that influence debridement T= thick tenacious slough, unhealthy, friable, biofilm, biopsy NAD I = not infected, very sore to touch M = highly exudate E = macerated surrounding skin, non advancing, inflamed Factor s influencing debridement: Pain 10/10, ABPI 0.95, Patient expectations I want it to heal, don t give up on me I want to attend my grandsons wedding in a few month

8 Debridement process cycle

9 Decision: 1 st Goal = Reduce pain Set intermittent, realistic goals Decision on the outcome that should be achieved (less pain) The time by which it can be achieved (1-2 weeks) Depending on this the technique that should be used (autolytic debridement)

10 Debridement process cycle

11 Add on Additional measures needed to optimize debridement locally and systemically Protect surrounding skin from exudate Chronic wound fluid is a wounding agent Increase frequency of dressing changes

12 Debridement process cycle

13 Review: Has 1 st goal been achieved? Has outcome been achieved and whether the chosen debridement technique has proven to be valid Pain has decreased to 3/10 and she is able to sleep for a few hours The surrounding skin did also improve However, the wound bed itself didn t changed

14 Debridement process cycle

15 Where to from here? If optimal debridement result has been achieved continue with same treatment If not re-diagnose and repeat debridement cycle

16 Debridement process cycle

17 2 nd + 3 rd Goal Improve Wound Bed and reduce edema Start debridement process cycle again Diagnosis unhealthy friable tissue, thick Decision: Add on: adherent slough, edema LFUD +/- sharp debridement to reduce bio burden Local infiltration of xylocaine 1 % (ring block) Light compression bandaging Increase to full compression if possible

18 Review Goals achieved? Wound bed much improved Surrounding skin much improved 100 % red tissue, reduction in size over time Able to tolerate light compression bandaging After debridement Before debridement

19 4 th Goal Accelerate wound healing Start debridement process cycle again Diagnosis: healthy wound bed, surrounding skin and reduction in edema Decision: stop LFUD Add on: NPWT PICO, increase compression

20 Review

21

22 Yes, it has! Has it influenced my practice? A quality cycle for wound debridement that can work Diagnosis - Decision - Add on - Review Goals must be realistic and intermittent This Debridement cycle is a step in the right direction towards a common language in chronic wound healing Perhaps the Australasian wound societies could work with EWMA to develop this cycle further

23 Thank you for listening New Zealand wound Care Society 7th Annual Conference "Wound Care A Matter of Balance" 21 to 23 May 2015 Marlborough Convention Centre Blenheim

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