Sunday, October 16th, 2016

Principles of Wound Treatment

November 9, 2012 by  
Filed under Clinical Experience

  • Debridement: mechanical debridement, enzymatic debridement, tissue autolysis
  • Antibacterial: airtight, antimicrobial dressings, antibiotics
  • Moisture: moist wound dressing (wet healing theory)
  • Drainage: wet yarn, oil, wet dressing
  • Healing: various growth factors, growth hormones and other
  • Painless: light analgesia before dressing, handling, wet dressing

1. Clear the stimulus source: thermal burns, chemical burns must immediately abort burn source, put the wound under running water washing 30min, removal of attached to the wound and the skin surface stimuli. Carefully remove each time you replace the dressing adhere to the wound surface infection of necrotic tissue and exudate, the remnants of note don’t cotton fibers on the wound, making it a foreign body, influencing wound healing.
2. Clear the necrotic tissue: a view of modern wound care: the necrotic tissue should be cleared as soon as possible. Reason: ① necrotic tissue wound after autolysis absorption can be a toxin, causing the body poisoning. ② necrotic tissue rich in protein, such as nutrition, is a good medium for bacterial growth and reproduction, and vulnerable to infection. ③ necrotic tissue wound can become attached to negative stimuli, influencing the growth of capillaries in reconstruction and to prevent growth of granulation tissue and epithelial regeneration, which could impede wound healing. Clear necrosis organization of method has 4 kind of: surgical Qing create (with knife cut cut off necrosis organization), and machinery Qing create (with forces wipe, tweezers pliers except necrosis organization), and enzyme solutions Qing create (water solutions enzyme, and Bacillus subtilis enzyme, decomposition necrosis organization), and since dissolved Qing create (with closed dressing stopped wound water, softened necrosis organization, wound seepage in the of enzyme dissolved liquefaction necrosis organization, with replaced dressing Shi clear).

3. Infection prevention and control: including cleaning the wound (cleaning the wound with sterile saline solution, cleaning and covering the wound around 2.5cm. Ideal pressure washing is 35ml empty 19th, needle flushing needle pump saline solution, reducing the number of local bacterial); strengthening the nutritional support to rectify the low protein blood syndrome; replacement of dressing wear sterile gloves, dedicated to prevent cross infection; do wound once a week training, monitoring infection.

4. Protect the wound and the surrounding tissue: respect of the wound and the surrounding tissue pressure using vacuum mat; keep the wound partially closed, secreta, excreta pollution prevention; or placing protective bracket protective posture.

5. To provide a moist wound healing environment: according to the wound size, depth, colour and volume of exudate, and so on, choose the proper dressing the wound closed dressing, provides a low oxygen for wound healing, a moist healing environment.

6. Controlling the outflow of liquids and gases: greater exudation (>10 ml/24 h), in particular of exudate wound, absorb exudate dressings should be used. If bath salts used dressings can absorb 20 times times their own weight of wound exudate or de wet Wei dressing in addition to seepage of liquid suction wound bacteria, available to a cave wounds closed negative pressure suction suction technology outflow of liquids and gases, so as not to adversely stimulate the wound and impregnated.

7. Make patients feel comfortable regardless of the means used, wound care patients or increase the pain should not be given, should take the way of reducing pain, make patients feel comfortable as much as possible, of comfort including somatic and psychological terms, therefore pay attention to the physical and psychological nursing in the wound care.

The Red wound

The Red wound

8. various types of wound specific guidelines

  • The Red wound: care principle is to protect the wound and surrounding tissue, keeping moist wound parts clean.
  • Yellow wound: care is to clean the wound and inflammation, clears the local infection purulent secretions and control.
  • Black wound: care principle is debridement, as soon as possible to clear dead tissue. debridement methods vary,//of undernourished in aged patients with chronic diseases autolytic debridement should be adopted. If dry black wound autolytic debridement should be adopted, wet bad? the wound should not be used.
  • Wound: 25% +75% black red wounds wound treatment principle: to clear the black necrotic tissue taking into account the protection of Red wound. 25% +75% Black Yellow wound wound treatment principle: to clear the black necrotic tissue, taking into account the removal of the yellow secretions, local infection control. 50% +50% yellow red wounds wound treatment principle: to clear the yellow secretions and devitalized tissue, taking into account the protection of Red granulation tissue.
  • Shallow wound: prevent and reduce infection, saving the remnants of epithelial tissue, epithelial provides an appropriate healing environment.
  • Full-thickness wounds: the removal of necrotic tissue and covering wound as soon as possible, to save the remnants of epithelial tissue, epithelial provides an appropriate healing environment.
  • Acute wound: this class wound nursing of purpose is as soon as possible recovery body of features and repair damaged of organization. processing principles: first stability patients emotional, estimated injuries and wound situation, then quickly Qing create. shallow table fragrant acute wound with closed dressing closed wound; full layer wound can Qing create Hou suture wound, to I period healing. on has tension of wound, selection appropriate of dressing closed wound protection wound or with moisturizing dressing conditioning wound, to II period healing.
  • Chronic wound: due to chronic wound formed time long, are has different degree of skin organization nutrition bad even necrosis, therefore its nursing principles is: correct estimated chronic wound of formed causes, and wound depth and the range, and tie degree, and subjective wishes,, used patients to accept of effective way Qing create, will chronic wound transformation for acute wound State, from physiological Shang provides cell by time order healing of opportunities. this based Shang using suitable of dressing further do wound conditioning, promoting healing.