Technique of Sharp Wound Debridement

Preparation for debridement:

• Physician order for sharp debridement

• Developing a strategy: What are the goals? To heal or not to heal? Will all your work be in vain?

• Know the patients past and current medical history, wound assessment, vascular status, neurological status, medications

• Obtain patient or family consent

• Instruments and supplies

• Apprehension (yours VS. the patient’s)

• Location, location, location

Physician order for sharp debridement:

• Is the order specific to exactly what needs to be done?

• Has the physician seen the wound recently or is this an order called in over the phone?

Developing a Strategy: What are the goals? To heal or not to heal? Will all you work be in vain?

• To remove necrotic tissue

• To reduce bacterial count

• To allow granulation to occur

• Just keeping the wound clean or do we realistically expect the wound to heal. Dictates treatment plan: expensive Vs. non expensive modalities

• You just spent 15 minutes upside down debriding a necrotic plantar foot wound. Your back hurts. You come back next week and look at the patient and find out they’ve participated in Tango lessons for 5 of the last seven days.

Know the patients past and current medical history, wound assessment, vascular status, neurological status, medications:

• Do not take a sharp instrument to a patient without knowing the above information. It is a poorly planned procedure if you do!

Obtain patient or family’s consent

“Sure, go ahead and cut on my mother.”

Informed consent: Explain expectations, risks and benefits

Instruments and Supplies

• Iris Scissors

• Tissue Forceps with and without teeth

• Curettes

• Hemostat

• Rongeur

• Scalpel #3 handle with blade #11, #15, #10 disposable

• Bandage scissors

• Wound measuring device

• Camera

Instruments and Supplies

• Gloves sterile or non sterile

• Sterile/clean field i.e. chuck, drape

• Syringes and needles

• Topical or injectable anesthetic if needed

• Gauze

• Cotton tipped applicators

• Saline

• Hemostatic product i.e. Silver nitrate, Surgicel, etc.

• Hazardous waste bag -red

Rongeur

Curette

Tissue Forceps

Adson Brown Forceps

Iris Scissors

#10 Blade #15

Blade

Curette

Basic instruments

Adson Brown forceps with teeth

Apprehension: Yours Vs. the Patient’s

• Know your limitations

• How long is the procedure going to last?

• If you’re nervous, not confident, or have a gut feeling that something's not right, don’t proceed

• Is the patient comfortable, in pain or combative?

Location, Location, Location

• Patient should be in a comfortable position

• You should be in a comfortable position

• There should be adequate lighting

• Have an assistant if possible

• Aseptic field

Relax

Technique for sharp debridement with a scalpel or scissors

• Grasp the eschar or necrotic tissue with a tissue forceps or hemostat

• Using a scalpel or scissors, cut underneath staying parallel to the plane of the wound

• Be sure to visualize where the tip of the instrument is cutting

• Remove the tissue in layers if

unsure of how deep to go

Sharp Debridement

How much to debride?

• Depends on the amount of non viable tissue

• How much can the patient tolerate?

It is important to set limits

• A bedside debridement should take 5-30 minutes depending on location, amount of tissue removed, patient comfort and clinician fatigue

• Rate of debridement will also depend on your experience

• Following removal of non viable tissue the wound is cleaned with normal saline. Check for any uncontrolled bleeding and perform hemostasis if necessary.

• If indicated, take cultures of the wound. Deep tissue cultures/samples are preferred to superficial swab cultures.

• The wound is then dressed per orders.

• Debridement may have to be daily, weekly or

on a PRN basis.

• Physician orders should reflect this.