Wound Care Consulting
Kris Dalseg, MS PT CWS CLT now offers the following contract services in the state of Texas:
- Development of your wound care program
- On-site instruction with regards to wound assessment, wound dressing progression, and training of therapists and nurses on your wound care team
- Establishing a plan of correction
- Documentation review
Please contact Kris Dalseg, PT CWS CLT to schedule an onsite appointment.
Wound Care FAQ’s
1. What is a “Chronic Wound”?
By Medicare’s definition, a chronic wound is one that has been present for 30 days. This is 30 days from onset of the wounds. It is not necessarily 30 days from when the patient entered your healthcare facility.
2. What are the causes of chronic wounds?
There can be many causes of chronic wounds. The most common is infection.
3. What is the best way to treat wounds?
Generally speaking, moist wound healing is considered the standard protocol for wound care treatments. (A moist wound bed is typically damp.) The wound should not be too dry, for the new cells will not be able to migrate across the newly forming tissue. In addition, in a wound that is too moist, newly forming cells will be washed right out of the wound! As far as a general treatment or dressing: it is best to cleanse most wounds with normal saline. When choosing the type of wound dressing, consider one will control the drainage (remember, not too wet, and not too dry).
4. How can I prevent infections?
Always wash your hands! That is the primary way to reduce any chance of infection. In healthcare settings, the treating wound care clinician should always wear gloves. While in the home setting, (if you are treating your own wound), gloves may not be readily available. So, remember to wash your hands! The duration of hand washing is typically described as (the duration of singing the “happy birthday” song twice). Remember to remove jewelry (or at the very least wash underneath your rings).
5. Can I treat my wound on my own (or do I need special treatment?)?
This will depends on the wound! Remember the signs and symptoms of infection. If you believe that the wound is infected, always seek medical attention. (Signs and symptoms of an infection include: redness around the wound, swelling, fever, and increased pain) Also, if a wound is not responding to the treatment that you are doing at home, seek medical attention.
6. What is a pressure ulcer?
The National Pressure Ulcer Advisory Panel (www.npuap.org) defines a pressure ulcer as a pressure ulcer is localized injury to the skin and/or underlying tissue usually over a bony prominence, as a result of pressure, or pressure in combination with shear and/or friction. A number of contributing or confounding factors are also associated with pressure ulcers; the significance of these factors is yet to be elucidated.
7. How do we prevent pressure ulcers?
A good reference for this is npuap.org under prevention tips. If you are in a healthcare facility, a patient’s skin should always be assessed upon admission. Depending on your facility type (whether the patient has been admitted to the ICU in a hospital, or a long-term care facility) will depend upon how often the patient’s skin is reassessed after the first 24 hours. Also, the initial skin assessment may determine how often the patient’s skin is reassessed. For example, in the hospital setting, the patient’s skin may be reassessed every 24 hours. Initially in a long-term care facility, a patient’s skin may be reassessed every week. Pressure ulcer prevention tips include: moisturizing skin, good nutrition and looking at the patient’s support surfaces (in bed and in wheelchair).
8. What is the Braden?
The Braden Scale is a tool for predicting a patient’s risk for developing pressure ulcers. (For an example of this form, please see www.bradenscale.com)
9. How does nutrition affect wound healing?
A patient will not be able to heal their wounds without good nutrition. A blood test to check their prealbumin level is used to assess the patient’s current protein levels.
10. What is “clean technique”?
“Clean Technique” is the terminology used to describe a wound dressing change in any environment besides the surgical area. (During surgery, sterile technique is performed.)
11. What are the different types of dressings?
There are several different types of dressings. Generally speaking, the dressing are categorized as follows: gauze, hydrogel, hydrocolloid, foam, transparent film, calcium alginates, chemical debriding agents, growth factors, compression dressings, and biological dressings.
12. What kind of support surfaces do we need to assist in healing of a pressure ulcer?
Support surfaces, such as alternating air mattresses are used to reduce the pressure on an open wound. Per The NPUAP the definition of a support surface is as follows:
“A specialized device for pressure redistribution designed for management of tissue loads, micro-climate, and/or other therapeutic functions (i.e. any mattresses, integrated bed system, mattress replacement, overlay, or seat cushion, or seat cushion overlay).”
There are several different components of a support surface (such as air, foam, gel, water).
13. What are the signs of poor circulation?
When assessing a patient’s lower extremity, the signs and symptoms of poor circulation include: dry, scaling skin; loss of hair, pale shiny skin, thickened fungal toenails, decreased pedal pulse, rubor dependency. A patient with poor peripheral circulation may complaint of pain at night (with their legs elevated in bed). They may describe having to “hang their leg off the bed, to get relief”. They also might describe getting up at night to walk around (“to get the blood flowing to my legs”.)
The physician may order vascular studies to assess the patient’s circulatory status. The test ordered is typically an ABI or ankle/brachial index to assess arteriole status.
14. What are the different types of wounds?
Typically, wounds are classified by their etiology: pressure, arteriole insufficiency, venous insufficiency, diabetic ulcers, trauma (such as skin tears), surgical, and burns.
15. What is Peripheral neuropathy?
Peripheral neuropathy is the term for damage to nerves of the peripheral nervous system, which may be caused either by diseases of the nerve or from the side effects of systemic illness.
16. What is a diabetic ulcer?
A diabetic ulcer is an open wound secondary to systemic changes due to longstanding effects of diabetes mellitus. These wounds are usually secondary to the effects of repetitive trauma on a nonsensate foot. Typically with longstanding diabetes, the patient will present with structural (both boney and muscular) changes in their feet and diminished sensation in their feet. With these changes, the patient will experience repetitive trauma to their feet (usually the plantar aspect of the forefoot) and not realize it.
17. What is lymphedema?
Lymphedema is chronic edema (usually in the extremities, but not confined to) caused by damage to the lymphatic system. The lymphatic system is the bodies filtering system that aids in destroying pathogens, filtering wastes, removes excessive fluid, and assists the circulatory system to deliver nutrients, oxygen and hormones.
18. How is physical therapy involved in wound healing?
Physical therapists play an essential role as a member of a wound care team. Therapists:
- Have vital knowledge with regards to wound debridement (on a superficial level) and wound dressings
- Use of modalities to increase circulation, reduce pain, reduce edema, and decrease wound bioburden
- Positioning in the bed and wheelchair to offload the wound site
- Add mobility services to improve the patient’s overall functional status
19. What are the different types of advanced modalities?
The physical therapist has many modalities to assist with wound healing. Your therapist may use the following:
- Electrical stimulation
- Traditional ultrasound (high frequency)
- Low frequency ultrasound:
1. Contact US (Misonix, Soring, and Arobella)
2. Non-contact US (MIST therapy by Celleration)
3. Pulsed shortwave diathermy
4. Pulsed lavage with suction