Chapter 7: Debridement
Chapter 11: Debridement
Authors: Erin Rajhathy, MCISc-WH, BScN, RN, NSWOC, WOCC(C); Nancy Parslow, MCISc-WH, RN, NSWOC, WOCC(C) and Mary Hill, MN, BScN, RN, NSWOC, WOCC(C).
Learning Objectives
- Describe the purpose and the mechanisms of action for six methods of wound debridement
- Identify indications, contraindications and special considerations for each method of debridement
- Determine each debridement method prerequisites to avoid potential patient harm related to each method of debridement
- Describe the roles and importance of collaboration with the interprofessional team in making debridement decisions
Abstract
Debridement is an essential component of wound bed preparation. There can be a high level of risk to the patient, especially when performed by someone who has not completed advanced, curriculum based theoretical and practical education programs specific to wound management and debridement. Advanced knowledge and experience is required to accurately identify anatomical structures, the various tissue types, and structures that lay beneath the skin to avoid serious harm to the patient. Ability to differentiate healthy tissue from nonviable tissue is required by all health care professionals prior to performing debridement. Advanced education, both theoretical and practical, exist to provide health care professionals with appropriate training in managing wounds, care plan development and debridement decisions. Health care professionals with appropriate education and experience understand the importance of collaboration with the interprofessional team when making wound management and debridement decisions. regarding the management of wounds and debridement. In addition to proper education and experience, health care professionals should understand the risks of patient harm associated with all methods of debridement when performed in various settings.
Clinical Case
![This picture illustrates a hard black eschar on the heel of a foot]](https://ecampusontario.pressbooks.pub/app/uploads/sites/2095/2022/02/Hard-black-eschar-.jpg)
Mr. Jones is a 75-year-old man with shooting pain in his leg during his morning walk.He also injured his foot one month ago while working in the garage. A black scab formed (Figure 1) that he complains “won’t go away”. During your assessment, he tells you he used to smoke one package of cigarettes a day for 25 years but quit five years ago. His doctor is monitoring his blood sugar levels for diabetes and told him to avoid sugar and lose some weight, which is why Mr. Jones has started to walk every day. Is debridement appropriate for this wound? Let’s find out together by considering Mr. Jones throughout this chapter
Introduction
The word necrosis comes from the Greek word nékrōs meaning dead body, or corpse. Today, necrosis refers to localized death of living tissue (Merriam-Webster, n.d.). Necrotic tissue, herein referred to as nonviable tissue, is a well-known causative factor in delayed wound healing. Nonviable tissue contains cellular and metabolic waste, senescent fibroblasts and epithelial cells, and often harbours bacteria increasing the risk of wound-related infection. Nonviable tissue may prolong the inflammatory phase of healing; thereby, delaying wound closure (Sibbald et al., 2021).
Debridement, originally defined as an unbridling or removal of damaged tissue from the wound, first appeared as a clinical term in France during the 17th century. Debridement is a core component of wound bed preparation (refer to Chapter 1 for details about wound bed preparation) and is often required to restore and further promote the process of wound healing (Harris, 2009). There are various methods of debriding wounds; however, all methods share the same goal of removing nonviable tissue, other proinflammatory components, and to enable better visualization of the wound bed (Harris, 2009; WOCN Society, 2018). Although debridement is considered by many to be a necessary step of wound bed preparation, it does come with varying levels of risk that may result in unintentional patient harm. Therefore, it is imperative for health care professionals to have the knowledge, skills, and judgment to initiate, or perform, debridement.
Nurses Specialized in Wound, Ostomy and Continence Canada (NSWOCC) Debridement: Canadian Best Practice Recommendations for Nurses (2021) highlights the importance of advanced education for all health care professionals involved in debridement, regardless of profession or discipline (NSWOCC, 2021). A competency-based education program for both advanced wound care and debridement, that contains theoretical and practical components, is strongly recommended as foundational requirements prior to engaging in debridement. In addition to a rigorous education program, it is imperative for regulated health care professionals to work within their professional scope of practice (NSWOCC, 2021). This chapter will use Mr. Jones to guide the reader through appropriate assessment parameters and considerations for the different types of debridement.
