Providing home care to the aged and ailing is not an easy task. It needs professionalism, careful considerations of all the aspects and meeting with the varying and often strange needs of the suffering patient. It is all about their emotional condition that needs to be ascertained to understand their temperament and deliver exactly what is required according to their physical, mental and medical conditions.
One such consideration to make by the home care professional is the Debridement. This actually is a special process for treatment that is especially used to remove the dead necrotic tissue. This reduces the chances of bacterial growth on wounds, if any, on the patient.
Ideally, debridement method may be followed to remove the moist necrotic tissue from the wound even when healing it is not the primary focus. This helps the caregiver to meet the goal of palliative wound care which comprises of several things such as:
• To control and reduce pain
• To manage and reduce infection
• To prevent or hide odor
• To stop or control bleeding and
• To reduce excessive exudation.
It is therefore elementary to choose the appropriate method so that it provides wound stability and comfort to the patient. This will in turn result in an improved quality of life for the patient as well as help the caregiver to overcome the challenges that it imposes and provide the best possible care, at home.
However, and unfortunately, not all home care agencies are able to provide such well-thought, planned and executed comprehensive care especially when the patient is suffering from an injury or wound for a long time. It is for this reason you should rely only on professionals and experts in home care Philadelphia to get the best results and care.
A brief overview of debridement
Debridement is a process that is especially followed when a patient suffers from any injury or wound. This is the process can be achieved through different means such as:
• Mechanical and
However, the type of approach to be followed will largely depend on the potential of the patient for healing. It will also depend on different other factors such as:
• The type of necrotic tissue o be removed
• The amount of its growth
• The presence of any infection or absence of it
• The tolerance level of the patient
• The condition and need of the wound as well as
• The economic considerations.
Each method has its potential benefits as well as risks for the patient. Therefore, it needs a long and proper discussion with the family of the patient before taking any decision. It is required to consider the palliative goals of wound care and management as well as weigh the benefits of each process with the burden.
Aspects of different debridement methods
As said earlier, different methods of debridement have different characteristic features and requirements and the dressing choice may vary accordingly.
• For mechanical debridement the most common dressing choice is wet-to-dry dressing. This involves covering of the wound with a dressing that is saline-moistened. It is then allowed to dry before it is removed. This method is labor intensive as it needs frequent dressing changes. This may be a burden for the caregiver and may also result in the damage of the healthy granulation tissue.
It may further cause excessive bleeding and increase in pain. This method is therefore no longer in use or recommended as a treatment. On the other hand, whirlpool baths and high-pressure irrigation method using water is also used to debride wounds but then again, these methods may cause peri-wound maceration. It is for this reason these mechanical methods are not suitable for home care setting.
• Chemical debridement is another method to debride wounds using topical agents. The objective of this method is to disrupt chemically or digest the devitalized proteins existing in the wound. However, the success of the method depends on the type of product used because there may be some that may not be viable for use because these cannot differentiate the devitalized tissue from the good ones when used.
Therefore, it can produce an inflammatory response in the wound with an increase in pain. On the contrary, the enzymatic agents need to be applied with care and must be discontinued when the wound is cleaned. Detergents and silver in dressings may deactivate the enzyme. However, these enzymes must be applied once or twice in a day which once again increases the burden of the caregiver.
• Excisional debridement is also known as sharp debridement and is one of the most aggressive and fastest methods. It involves use of a pair of scissors, a scalpel, or curette to cut the devitalized tissues, necrosis, or slough away. Excisional debridement is typically performed at the bedside as is considered to be more cost-effective method. It results in faster healing time.
It is best done in a skilled nursing facility done by a wound care specialist. This is because frequent changes in dressing may be necessary because there may be lot of bleeding, pain and damage caused in the process as it is not easy to determine exactly how deep the necrotic tissue has extended to damage the healthy tissue.
• Lastly, the autolytic debridement method involves dressings that helps to maintain the moisture content within the wound bed. This actually supports the own ability of the body to cleanse itself. The enzymes that are present in the wound fluids actually break down and digested while the process liquefies the necrotic tissue. The most significant advantage of this method is that it is selective, noninvasive, and needs minimal expertise. Another good thing about autolytic debridement process is that it causes very little or no pain. This slow process is ideal for patients who cannot take or are not fit for any other debridement process due to chances of infection.
To end, debridement is a process that has good healing power and can help in symptom management of any nonhealing wound. For the palliative patients having a very short life expectancy or poor healing potential, this method should however be limited to soft slough.