New approach to understand wound care

By Khalid Remaly
Metaphors illuminate all kinds of
concepts.

Williams Harvey described the heart as a
pump and, as
we couldn’t know much a...
Farming is a team activities devoted primarily

    to the practice of producing and managing
    crops.

    Farmer job ...
Understand your         Patient and wound
                       
    challenges              assessment.

    Plan to o...
Remove dead tissue and control

    contamination
Why do We Want to Remove Necrotic Tissue?


    Necrotic tissue inhibits healing



    Necrotic tissue is a medium for i...
Using of anti septic

    should be limited to the
    early stage of highly
    contaminated wound.

    For the further...
presence of exudate in a wound

    will provide an environment that
    stimulates healing.
                            ...
Absorbent dressing in heavily exudation

    wound.




    Moist retentive dressing in dry wound.

Take the necessary procedures to keep the

    wound warm.

    Warm up saline before cleansing.



    Use dressings of...
Proper selection of the dressings.



    Remove dressing gently.



    Avoid fibrous dressing on wound bed.

Inspect skin

    Moisture control

    Proper positioning and transfer

    techniques
    Nutrition

    Avoid press...
Alterations in mobility

    Level of incontinence

    Nutritional status

    Alteration in sensation or response to
...
Friction

                            Immobility
Shear
             Pressure
             Ulcers

 Pressure               ...
Location


    Stage and Size


    Periwound


    Undermining


    Tunneling


    Exudate


    Color of wound b...
Wound and Risk Assessment every visit




    Documentation on Wound Assessment Form every 7

    days when 1 or more pr...
Stage I   Stage II   Stage III   Stage IV
Overall strategy and scope of the
      treatment plan depends on
  patient’s condition, prognosis,
  and reversibility of...
Prevent complications or the deterioration

    of an existing wound

    Prevent additional skin breakdown



    Promo...
Dressing considerations should
 include:

    Patient’s condition and prognosis

    Ease of use

    Ability to maintai...
Cleanse Debris from the

    Wound
    Possible Debridement

    Absorb Excess Exudate

    Promote Granulation

    a...
Indicated for Mechanical Debridement ONLY

    Causes Injury to New Tissue Growth

    Is Painful

    Predisposes Wound...
Goal is to minimize the    Decrease Frequency

    frequency of dressing     of Dressing Changes
    change
    Daily dre...
Assess “Risk for Breakdown”

    Utilize skin creams and lotions for

    dry skin

    Utilize barrier products as need...
Remove Wound Debris

    Sustain Moist

    Environment
    Soften Necrotic Tissue

    Debride the Wound

    Reduce ...
Dry to Minimal

    Exudate

    Moderate Exudate



    Copious Exudate

TREATMENTS:
GOALS:
    Maintain skin integrity

    Skin to remain clean and odor   Preferred agents (dry skin)

    fre...
Dry to Minimal Exudate

GOALS:
                                TREATMENTS:
    Minimize dressing changes


    Maintain m...
Moderate Exudate

GOALS:                        TREATMENTS:
    Minimize dressing

    changes                   Preferre...
Copious Exudate

GOALS:                        TREATMENTS:
    Minimize dressing

    changes                   Preferred...
Mechanical Debridement



    Autolytic Debridement



    Sharp or Surgical Debridement*

Treatments:
Goals:
 Removal of exudate
                             Preferred Agents
 Odor control
                     ...
Treatments:
Diagnosis of wound infection:
 Based on clinical signs
                                Preferred agents:
  (f...
Comfort and Shear
 Reduction Products:

    Pillows


    Heel/Elbow         DO NOT USE DONUT TYPE

                    ...
Multiple Pressure Points (greater than 2 turning
  surfaces)
 Standard Mattress
 3-4” Eggcrate Overlay on Standard Bed
...
High quality crops.




    High economical value




    Happy customer

High quality healing

    results.

    Saving hospital costs.





    Happy patients.

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Metaphorical

  1. 1. New approach to understand wound care By Khalid Remaly
  2. 2. Metaphors illuminate all kinds of concepts. Williams Harvey described the heart as a pump and, as we couldn’t know much about how the heart worked until the water pump was invented
  3. 3. Farming is a team activities devoted primarily  to the practice of producing and managing crops. Farmer job is to provide the best conditions  for the planting as natural process to take place. It is long with multiple phase process. 
  4. 4. Understand your Patient and wound   challenges assessment. Plan to overcome. Plan to manage.  
  5. 5. Remove dead tissue and control  contamination
  6. 6. Why do We Want to Remove Necrotic Tissue? Necrotic tissue inhibits healing  Necrotic tissue is a medium for infection.  Necrotic tissue in a wound stimulates the  inflammatory response.
  7. 7. Using of anti septic  should be limited to the early stage of highly contaminated wound. For the further stage  you should switch to modern antimicrobial agent.
  8. 8. presence of exudate in a wound  will provide an environment that stimulates healing. WBC ENZYMES GROTH FACTORS Exudate contains various  components, including: lysosomal enzymes, WBC's, EXUDATE lymphokines and growth factors.
  9. 9. Absorbent dressing in heavily exudation  wound. Moist retentive dressing in dry wound. 
  10. 10. Take the necessary procedures to keep the  wound warm. Warm up saline before cleansing.  Use dressings of low frequency change.  Change secondary dressing before getting  wet.
  11. 11. Proper selection of the dressings.  Remove dressing gently.  Avoid fibrous dressing on wound bed. 
  12. 12. Inspect skin  Moisture control  Proper positioning and transfer  techniques Nutrition  Avoid pressure on heels and bony  prominences Monitor and document 
  13. 13. Alterations in mobility  Level of incontinence  Nutritional status  Alteration in sensation or response to  discomfort Medications that delay healing  Decreased blood flow to lower  extremities when ulceration is present
  14. 14. Friction Immobility Shear Pressure Ulcers Pressure Incontinence Malnutrition
  15. 15. Location  Stage and Size  Periwound  Undermining  Tunneling  Exudate  Color of wound bed  Necrotic Tissue  Granulation Tissue  Effectiveness of Treatment 
  16. 16. Wound and Risk Assessment every visit  Documentation on Wound Assessment Form every 7  days when 1 or more pressure ulcer exists Physician assessment and documentation on  Physician Wounds Care Assessment tool
  17. 17. Stage I Stage II Stage III Stage IV
  18. 18. Overall strategy and scope of the treatment plan depends on patient’s condition, prognosis, and reversibility of the wound.
  19. 19. Prevent complications or the deterioration  of an existing wound Prevent additional skin breakdown  Promote wound healing 
  20. 20. Dressing considerations should include: Patient’s condition and prognosis  Ease of use  Ability to maintain moisture  balance Frequency of change 
  21. 21. Cleanse Debris from the  Wound Possible Debridement  Absorb Excess Exudate  Promote Granulation  and Epithelialization When Appropriate Possibly Treat Infections  Minimize Discomfort 
  22. 22. Indicated for Mechanical Debridement ONLY Causes Injury to New Tissue Growth  Is Painful  Predisposes Wound to Infection  Becomes a Foreign Body  Delays Healing Time 
  23. 23. Goal is to minimize the Decrease Frequency  frequency of dressing of Dressing Changes change Daily dressing changes  increase chances of infection and disrupts the healing of tissue Optimal wear time is  3-7 days
  24. 24. Assess “Risk for Breakdown”  Utilize skin creams and lotions for  dry skin Utilize barrier products as needed  to minimize irritation from incontinence Reposition frequently  Use pillows in bed for positioning 
  25. 25. Remove Wound Debris  Sustain Moist  Environment Soften Necrotic Tissue  Debride the Wound  Reduce the Risk of  Bacterial Contamination and Infection Reduce Odor 
  26. 26. Dry to Minimal  Exudate Moderate Exudate  Copious Exudate 
  27. 27. TREATMENTS: GOALS: Maintain skin integrity  Skin to remain clean and odor Preferred agents (dry skin)  free Aloe Vesta skin cream  Protect and moisturize skin Preferred agents (at risk for  breakdown due to incontinence/pressure) Aloe Vesta protective  ointment
  28. 28. Dry to Minimal Exudate GOALS: TREATMENTS: Minimize dressing changes  Maintain moist  Preferred agents: environment Prevent infection  Hydrocolloid  Prevent additional skin  (DuoDERM ) breakdown
  29. 29. Moderate Exudate GOALS: TREATMENTS: Minimize dressing  changes Preferred Agents: Maintain moist Hydrofiber (Aquacel)   environment Hydrocolloid (DuoDERM)  Prevent infection  Prevent additional skin  breakdown
  30. 30. Copious Exudate GOALS: TREATMENTS: Minimize dressing  changes Preferred Agents: Manage Exudate Hydrofiber (Aquacel)   Prevent infection  Prevent additional skin  breakdown
  31. 31. Mechanical Debridement  Autolytic Debridement  Sharp or Surgical Debridement* 
  32. 32. Treatments: Goals:  Removal of exudate Preferred Agents  Odor control Non-Adherent Gauze   Pain control Dressing . Zinc Oxide Paste  (Viscopaste) Non-Pharmacological Activated Charcoal Dressing measures to control odor  (Carboflex) include:  Oil of Wintergreen Atropine solution may be  Charcoal briquettes or used to control bleeding Coffee grounds  Dryer Sheets Metrogel cream can be used to control odor
  33. 33. Treatments: Diagnosis of wound infection:  Based on clinical signs Preferred agents: (fever, increased pain,  Hydrofiber (Aquacel Ag) friable granulation tissue, foul odor) DO NOT USE: Providine Iodine  Iodophor  Dakin’s solution  Hydrogen peroxide  Acetic Acid 
  34. 34. Comfort and Shear Reduction Products: Pillows  Heel/Elbow DO NOT USE DONUT TYPE  DEVICES IN WHEELCHAIRS Protectors Foot Cradles  Sheepskin Pads 
  35. 35. Multiple Pressure Points (greater than 2 turning surfaces)  Standard Mattress  3-4” Eggcrate Overlay on Standard Bed  Gel Mattress Overlay  Wheelchair Foam Pad  Wheelchair Gel Pad Multiple Pressure Points (fewer than 2 turning surfaces)  Static Air Mattress  Alternating Pressure Pad and Pump  Low Air Loss Mattress (requires approval)
  36. 36. High quality crops.  High economical value  Happy customer 
  37. 37. High quality healing  results. Saving hospital costs.  Happy patients. 

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