Wound Update Target 2018 Learning Outcomes Factors affecting wound - - PowerPoint PPT Presentation

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Wound Update Target 2018 Learning Outcomes Factors affecting wound - - PowerPoint PPT Presentation

Sep 30, 2022 528 likes •1.06k views

Wound Update Target 2018 Learning Outcomes Factors affecting wound healing Wound assessment Choosing correct dressing Management of over-granulation Managing infection/sepsis Wound Types The Stages of Wound Healing There

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SLIDE 1

Wound Update Target 2018

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SLIDE 2

Learning Outcomes

  • Factors affecting wound healing
  • Wound assessment
  • Choosing correct dressing
  • Management of over-granulation
  • Managing infection/sepsis
  • Wound Types
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SLIDE 3

Adult Services

The Stages of Wound Healing

There are four stages of wound healing:

  • Vascular response
  • Inflammation
  • Proliferation
  • Maturation

(Flanagan M, 1997)

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SLIDE 4

Adult Services

Factors affecting wound healing

INTRINSIC

  • Presence of systemic

disease

  • Nutritional status
  • Smoking
  • Medication
  • Adequate skin perfusion
  • Age of individual and

wound

  • PH of wound surface
  • Dehydration (local and

systemic)

  • Presence of infection
  • Wound temperature
  • Psychological factors
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SLIDE 5

Adult Services

Factors affecting wound healing

EXTRINSIC

  • Poor wound care
  • Dressings
  • Hygiene
  • Social problems
  • Radiotherapy
  • Ability to elevate the limb
  • Wound location
  • Mechanical stress

(pressure, friction and shear)

  • Presence of foreign

bodies

  • Extent of tissue loss and

type of tissue involved

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SLIDE 6

Adult Services

Wound Assessment

When

  • Baseline
  • Deterioration
  • At least monthly

How

  • Wound assessment

template

  • Map/measure
  • Photograph
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SLIDE 7

Adult Services

The Ideal Wound Environment

  • Moist environment at the

wound/dressing interface

  • Gaseous exchange able

to take place

  • Impermeable to micro-
  • rganisms
  • Absorption of excess

exudate

  • Absorption of toxins
  • Insulation from low

temperature

  • Free from other particles

and other contaminants

  • Protection from trauma
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SLIDE 8

Adult Services

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SLIDE 9

Adult Services

Epithelialising wound

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Adult Services

Epithelialising Wounds

Treatment aim - to protect new fragile tissue

  • Hydrocolloids
  • Films
  • Low absorbent foams
  • NA Dressings
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SLIDE 11

Adult Services

Granulating Wounds

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Adult Services

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Adult Services

Granulating Wounds

Treatment aim: to maintain a healthy wound bed for epithelialisation

Low Exudate

  • Hydrocolloids
  • NA dressings
  • Low absorbent foams

High Exudate

  • Hydrofibres
  • Alginates
  • Foams
  • High absorbent pads
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SLIDE 14

Sloughy Wound

Adult Services

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SLIDE 15

Sloughy Wound

Adult Services

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Adult Services

Sloughy Wounds

Treatment aim: to remove slough and provide clean base for granulation tissue

Low Exudate

  • Hydrogels – with caution

contact TVN

  • Hydrocolloids
  • Low absorbent foams

High Exudate

  • Hydrofibres
  • Alginates
  • Foams
  • High absorbent pads
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SLIDE 17

Necrotic Wound

Adult Services

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SLIDE 18

Adult Services

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Adult Services

Necrotic Wounds

Most necrotic/sloughy wounds auto-debride naturally. NB: Diabetic/ischaemic foot wounds – keep dry to minimise risk of infection and consider referral to WPMS Nurse or vascular Dressing choices:

  • N/A Dressing
  • Hydrocolloids
  • Absorbent dressings
  • Films
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SLIDE 20

Adult Services

Cavities

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Adult Services

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Adult Services

  • Cavities should not routinely be packed in order

to allow free drainage of exudate

  • Given the lack of high quality evidence,

decisions to pack may be based on local practices or patient preferences. Guideline for the Treatment of Wounds Healing by Secondary Intention including Sinuses and Cavities. Leeds Health Pathways (2017)

  • http://nww.lhp.leedsth.nhs.uk/common/guidelines

/detail.aspx?ID=5239

Cavity Wounds

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Adult Services

Overgranulating Wounds

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Adult Services

Overgranulation

  • Occurs at the proliferation stage of wound

healing

  • Granulation tissue continues to be laid down

and stands proud of the rest of the skin

  • Possibly related to wound infection/inflammation,
  • r friction from tubing or excess exudate
  • It prevents epithelial cells from spreading across

the wound surface delaying the final stage of wound healing

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Adult Services

Overgranulation – Management and Prevention

  • Foam dressings – with a topical antiseptic

underneath, e.g. povidone or cadexomer iodines

  • Corticosteroid cream- Haelan Cream/Tape

(Liciensed) 1% Hydrocortisone cream – not licensed for this purpose

  • Silver Nitrate pencil 95% - as last resort can

cause trauma to healthy tissue (Nelson A, 1999)

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Adult Services

Infection

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Adult Services

Signs of Local Infections

  • Abscess/pus
  • Cellulitis/excessive inflammation
  • Erythema
  • Oedema
  • Heat
  • Unexpected pain/tenderness
  • Malodour
  • Dehiscence
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SLIDE 28

Adult Services

Infected Wounds

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SLIDE 29

Adult Services

Anti-microbial dressings

  • Four main categories:
  • Silver – should only be used when symptoms or signs
  • f clinical infection are present. There is some evidence

to suggest they delay wound healing

(BNF 2015)

  • Honey – osmosis promotes autolytic debridement,

should not be used on patients with allergies to bee products, diabetic patient should be monitored (BNF 2015)

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Adult Services

  • Iodine – cadexomer-iodine releases free

iodine when exposed to wound exudate

  • povidone-iodine knitted viscose

dressing facilitates diffusion of the iodine but is rapidly deactivated by wound exudate

  • PHMB Dressings – impregnated with

polyhexamethylene biguanide

  • DACC dressing (dialkycarbamoyl chloride)
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Adult Services

Signs of Systemic Infection

  • Pyrexia/fever
  • Flu-like symptoms
  • Sweats and chills
  • Unexplained confusion
  • Blood results = > CRP / > WCC
  • Unstable blood sugar in diabetics
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Adult Services

Sepsis Screening

  • Acute confusion, disorientation, reduced

conscious level

  • Blood glucose non diabetic >7.7
  • Temperature >38.3 or <36
  • Respiratory rate > 20 per min >25 per min
  • Heart rate >90 per min >130 per min
  • Systolic B.P. <90mmHg,
  • Oxygen sats <91%
  • Purpuric rash
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Adult Services

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Adult Services

When to Swab

  • Enlarging of the wound
  • Abnormal bleeding
  • Increased pain
  • Increasing Odour or exudate
  • Cellulitis
  • Pyrexia
  • To check effectiveness of current antibiotic therapy
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Adult Services

Types of wounds

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Adult Services

Leg Ulcers

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Adult Services

Venous leg ulcer

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The Evidence

Compression vs no compression More patients heal with compression than without (Cullum et al 2001) Results of VenUs 4 Compared 4 layer compression bandaging system with 40mmHg treatment hosiery kits Treatment hosiery had similar healing rates to those randomised to compression bandages. Quality of life improved for patients wearing hosiery Promotes self care and independence

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SLIDE 39

Venous Leg Ulcer Myth Busters

Best Practice Statement: Management of Venous Leg Ulcers 2017

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Lower Leg Injury

  • Complete doppler within two weeks of initial

assessment if no signs of improvement

  • 0.8 – 1.3 Suitable for full compression
  • >1.3 ? calcification – refer to WPMS or vascular
  • 0.6 - 0.8 = Mixed aetiology – refer to WPMS
  • <0.6 Refer to vascular team
  • < 0.4 Urgent referral to vascular team
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Frequency of Doppler

3 Monthly

ABPI below < 0.8 and > 1.3 in hosiery/bandages Active foot/leg ulceration Change in medical condition History of unstable dopplers over 12 months

6 Monthly No ulcer

ABPI within range 0.8-1.3 History of recurrent lower limb ulceration/lymphoedema Multiple co-morbidities with an established regime Diagnosed with new condition which affects circulation

12 Monthly No Ulcer

ABPI within range 0.8 – 1.3 Stable lymphoedema/ oedema Healed ulcer and no recurrence in 12 months Limited or well controlled co-morbidities (Stephen-Hayes, 2015)

adopted by LCHT for leg ulcer guidelines 2016

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Compression Hosiery

Contact your local company reps to arrange a training session.

BSN Medical (Jobst) Jo Whittaker-Cox: 07850 659 658 Activa Rose Richardson: 07973 862 780 Medi UK Adam Hopkinson: 07469 858 357

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In Summary

  • Doppler lower leg wounds as

soon as possible

  • Start compression if safe.
  • Refer to Wound service if no

improvement

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SLIDE 44

Further Info: Wounds UK Best Practice Statements: Venous Leg Ulcers Compression Hosiery

  • Local Leg Ulcer Guidelines on

Leeds Health Pathways

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Pressure Ulcers

Adult Services

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Adult Services

Pressure Ulcers

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Pressure Ulcer Risk Factors

  • Immobility
  • Existing pressure ulcer
  • Previous pressure damage
  • Perfusion
  • Diabetes
  • Nutrition
  • Sensory perception
  • Moisture

Pain!

Adult Services

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SLIDE 48

Foot Ulcers

Adult Services

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Non Diabetic Foot

Adult Services

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Diabetic Foot

Adult Services

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How to access referrals on LHP

Click: -Leeds Health Pathways

  • Referral Pathways
  • Referral Pathways and Forms

“Non Diabetic feet – screening and referral pathway” “Diabetic Limb salvage Service – Urgent” “Community Diabetes Team: Foot Protection Service”