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Aim:

Clinical nurses specialist - Tissue Viability Nurses (TVNs) are no exceptions to significant change and challlenges in terms of their role and scope of practice. The use of advanced treatment modalities such as Conservative sharp debridement (CSD) and Negative pressure wound therapy (NPWT) are amongst the skill they posses for the healing of complex wounds. Debridement in wound bed preparation is a well recognised concept to aid wound bed prepation in order to facilitate wound healing. This can be an intergral part in the management of complex infected surgical wounds where devitalised tissue is present prior to application NPWT. Sharp debridment over a vital organ is high risk, costly and can be life-threatening if done under aneasthetic. And CSD over bowel can equally be a high risk procedure and this will demand a surgeons skill for precision and safety. However, if left untreated this can impead wound healing and lead to other serious complications. Many TVNs are competent to perform CSD but the associated risk and complications of CSD over bowel cannot be ignored. This case study will look at the efficacy of the use of a Monofilament Fibre Lolly (MFL) by a TVN to debride devitalised tissue over bowel in a high risk patient.

Method:

Patient BH is a 46 year old lady who was admitted with a wound infection two weeks after a midline incisional hernia repair with application of mesh. She has asthma and was also diagnosed with alcoholic liver disease . On admission, she was septic and was treated with intravenous antibitiotic and she was taken to theatre for wound debridement. She went to theatre twice for repeat debridement of necrotic tissue causing significant bowel exposure at wound bed with some loose mesh. NPWT was used post-operatively by the surgical team to manage the wound. TVN input was sought to complete a wound assessment and for the re-application of NPWT due to patients compromised medical condition. And she was deemed unfit for anaesthetic. The use of the MFL was chosen as part of a product evaluation by the TVN. MLF was deemed to be atraumatic and has the ability to reach deep undermined areas to an open abdominal wound. It was moistened with 10mls of normal saline and was used to gently lift the devitalised tissue over the bowel using a circular motion with light pressure. Two MFL were used to cover all areas of the wound bed to effectively remove all devitalised tissue and reduce bacterial bioburden. NPWT was applied with careful consideration and protection applied over all exposed bowel.

Results / Discussion:

With the TVNs knowledge and competence in CSD the use of a new debridement tool such as MFL over bowel at the bedside was performed safely and in a timely fashion. MFL for debridement showed significant reduction of bacterial bioburden through removal of devitalised tissue and infected loose mesh with no complications such as bleeding and trauma that

are associated with other forms of debridement. 40% of slough/infected loose mesh were removed using the MFL and 60% were loosened and softened).

Conclusion:

This case study is an example of the increasing complexity of cases and ithe wound management faced by TVNs. With the availability of a new debridement tool such as the MFL, high risk patients not fit for anaesthetic are able to receive timely and safe wound bed preparation. The MFL was found to be less invasive compared to CSD and can be safely used over bowel.

Aim:

Time constraints and reimbursement for managing patients with chronic lymphedema present challenges for healthcare professionals. The case series demonstrates how a debridement device and a Velcro compression wrap were used to implement self-care as a solution.

Method:

20 patients with primary and secondary lymphedema were enrolled into the study. Following assessment of the patient’s condition and ability to understand and apply the treatment, each patient was educated and trained how to:

1. Use the monofilament fibre debridement pad for skin and wound preparation.

2. Apply the Velcro compression wrap system for treatment and maintenance.

3. Perform correct application and to record clinical improvements.

Time for each treatment episode, frequency of visits and overall treatment time were measured

Results / Discussion:

The number of treatment episodes reduced from 3 to 2 per week. The time for each episode reduced on average from 1 hour to 30 minutes. Improvements in the condition of each patient showed improvement in mobility, less independency, and leads to more time left for the patients. Additionally patients were able to participate in their care, giving them control.

Conclusion:

The use of simple solutions for self-care such as those used in this study could provide solutions to benefit the patient and healthcare professionals. Reductions in treatment times and the use of patients instead of a more costly therapist could equate to cost savings for the organisation.

Aim:

At present many care professionals are under pressure for time. Therefore there is a need to avoid delays in wound treatment due to mismanagement or incorrect treatment of the wound. Correct assessment and diagnosis should be the starting point for follow on management to implement good patient care and cost efficient wound treatment. Good debridement enables visualisation and assessment.

Method:

In this centre more than 200 patients have been treated according to the same protocol, all starting with wound debridement using a monofilament fibre debridement pad for acute and chronic wounds. Most of the patients had chronic wounds of varying duration, severity and causes. The case studies follow 4 patients with ulcer to show the wound status before and immediately after debridement. Photographs were taken.

Results / Discussion:

Photographic evidence was a very easy way of documenting outcomes when the debridement pad had removed devitalised tissue and the skin and wound were revealed. In all patients the average number of pads were 2 and the average time for debridement was 2 – 4 minutes per episode. Some patients required additional treatment episodes depending on the condition. Appropriate treatment regimens were implemented as a result of good assessment.

Conclusion:

Even wounds that appear non-complex often require debridement to aid diagnosis. The use of a very easy method which can be performed by all care professionals helps to simplify wound treatment and save time.

Aim:

Traumatic implantation of pigmented particles in the skin require removal as quickly as possible to prevent deeper penetration and persisting skin tattoo. We present the case of a patient with accidental contamination during his work as a channel digger. A cushions were inflated under pressure. the cushion burst when the patient was just 1-2 metres away. Water and mud exploded within the channel and covered the face and hands of the patient. Dirt particles penetrated the skin, eyes and cornea.

Method:

The particles in the eyes and cornea were removed surgically and a systemic antibiotic therapy was started. Laboratory examination revealed a C-reactive protein of 49.3 mg/l (normal: <5 mg/l). Cheeks and periocular region showed remarkable oedema. After a rehydration of the skin with aliphatic ointments (0.4 mg/ml Polihexanid in Unguentum leniens) under semi-occlusive dressing over 4 hours, a mechanical debridement with a monofilament fibre debridement pad* was performed.

Results:

Almost all particles could be eliminated leaving superficial skin lesions - pain-free. Antiseptic ointment (Clioquinol 5 mg/g) was recommended for the further skin treatment. The systemic antibiotic therapy was also continued. A follow-up two days after the debridement showed a decrease of oedema and inflammation and a skin totally cleared from dirt particles.

Conclusion:

The immediate comparison with the use of moistened compresses showed a clear predominance of the monofilament pad in the efficiency of particle removal. Usual treatments with scalpel blade or dermabrasion are time-consuming and painful for the patients. By the use of a monofilament fibre debridement pad in an early stage of traumatic tattoo, a very satisfying cosmetic result could be achieved.

Compression therapy is a key component in the effective management of people with lower limb problems associated with venous, lymphatic and fat disorders such as lipoedema. Individuals with lymphoedema, venous ulceration and lipoedema often require long-term compression therapy to prevent and manage problems such as chronic ulceration and skin changes, persistent swelling and shape distortion. There are challenges in achieving acceptable, safe, effective and cost-efficient compression therapy choices. Adjustable, compression-wrap devices incorporating hook-and-loop systems present new opportunities for improving treatment outcomes, supporting patient independence and selfmanagement in the use of compression therapy.