Fundamentals Of Wound Management. Julie Hewish Senior Tissue Viability Nurse
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1 Fundamentals Of Wound Management Julie Hewish Senior Tissue Viability Nurse
2 Wound Management What are we trying to achieve?
3 Maintaining a controlled set of local conditions that is able to sustain the complex cellular activity occurring in wound healing should be the primary aim of wound management (Flanagan, 2000)
4 Wound Bed Preparation the management of a wound in order to accelerate endogenous healing or to facilitate the effectiveness of other therapeutic measures (Falanga, 2000)
5 In an ideal world. A well vascularised wound bed with granulation tissue Adequate oxygen and nutrients Rich source of viable epidermal cells at the wound edge The management of bacteria/devitalised tissue
6 How do we choose a dressing?
7 What are wound dressings for? Wound protection To manage exudate To promote healing To provide an optimum healing environment To assist autolysis when debriding To manage symptoms such as odour, pain etc To reduce inflammatory status
8 Are there disadvantages to dressings Can increase problems if used inappropriately (Skin stripping, infection, inflammation, excoriation/ maceration, friction, trauma) Patients can develop sensitivities/ allergies to them Too much choice? Confusion re what they actually do can result in inappropriate use. Cost (Oxford = M per year)
9 How do we obtain dressings in Oxford? 1 st line products = ONPOS 2 nd line (Antimicrobials, step up superabsorbents, charcoal, Urgotul) = FP10 Specialist dressings (Larvae, Protease inhibitor/ Urgostart contact, Specialist gel sheets, or alternatives to formulary options that a patient may have reacted to) = TV approval only.
10 What s New... Adaptic touch Allevyn life Biatain super adhesive Sorbion sachet extra
11 Specialised Dressings
12 How do we achieve consistent wound bed management? Tissue Infection/Inflammation Moisture Edges (Schultz et al, 2003)
13 issue Type
14 So what do we do about it? Debridement is the removal of devitalised tissue or foreign material from a wound Sharp Surgical Enzymatic Larval Mechanical Maintenance debridement (NICE, 2001)
15 Promoting Natures Way Autolytic Debridement: Selective process which liquefies & separates dead tissue from healthy tissue (schultz et al, 2003) Hydrogels Alignate Dressings Specialist debriders
16 Debriders
17 Skin Matters!!
18 Protecting the birthday suit! Protection Sensation Heat regulation Storage & synthesis Excretion Absorption Water resistance
19 Getting the right Moisture Skin has as acid mantle of ph that s a mean ph of 5.5 Acid mantle is a mixture of secretions Skin is acidic to kill bacteria Cleaning with soap and water can contribute to the development of wounds. Emollients and Creams ( Cooper&Gray,2001)
20 Moisture - a fine balance The theory of moist wound healing: - George Winter(1967): Compared the healing rate of surgically created wounds covered with a flim dressing compared with those left exposed to the air. Demonstrated that epithelialisation and regeneration of connective tissue is increased with a moist wound bed. Dry wound bed = scab formation = delayed healing Occlusion promotes warm environment
21
22 Not enough moisture...
23 Moisturisers/Barriers
24 Absorbents
25 nfection
26 What are the primary objectives Optimising host resistance... Is this localised or systemic? Cellulits extending at least 1cm beyond wound margin and underlying deep structures Bacteraemia/sepsis Definite diagnosis of pathogens Immunosuppressed such as diabetics (
27 Localised action!
28 Bringing Closure Sound wound bed preparation is required. Ultimate aim of wound care Epithelialisation will not occur unless T.I.M have been achieved.
29 Causes of Pain?
30
31 Getting to the heart of the issue Ask the questions Acknowledge the patients issues Indentify their key needs Address these in your management plan Follow-up next visit Patient objectives are not always ours Patient education = Patient empowerment (Acton, 2011)
32 DOCUMENTATION Specific clear care plans Measured - meaningful objectives Achievable action orientated Realistic - within your capabilities Timely specific re-assessment dates
33 What are you recording? Diagnosis Risk factors to healing Treatment objectives Management Plan
34 The Wound Management Cycle Start with patient Healed Identify wound aetiology Treat and evaluate TIME Interventions Perform TIME assessment and agree clear goals (Dowsett and Newton, 2011)
35
36 Evidence-Based Practice European Wound Management Association Wounds International
37 Thank- you!
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