When do you debride and when do you just leave a wound alone?

[IcanHealYou]

One question asked what I would do with a diabetic foot ulcer. I picked debride it 3 times a day. The answer was use sterile technique to change do the dressing change.

The rationale for not debriding this wound is to allow for granulation to form. When would we have to debride a wound? And when do we allow it to granulate?

Also wet to dry and wet to damp dressing serve the same purpose, to debride and prevent infection correct?

Thank you again.

[SandraCVRN]

tlc2u,

GREAT answer, I'm glad I read ahead before typing out my reply.

Also, anyone that took the NCLEX within the last 5 or 6 years should have been able to see why that was the correct answer. Or course, the original question did not give the other answers or state it was an NCLEX-type question.......

[jjjoy, LPN]

I don't see that it's clear that sterile technique is absolutely ESSENTIAL in every instance of a dressing change of a diabetic foot ulcer. After all, the question doesn't even specify if the patient is in a hospital setting. So I don't see that focusing on the word "essential" shows why 3 is the best answer.

A different perspective is that the question is about a DRESSING CHANGE and the sterile technique answer is the only answer that addressed the process of dressing change, as opposed to an intervention done in conjunction with a dressing change. Also, there are or may be good reasons not to do the other listed inteventions, whereas there would be no contraindication to using sterile technique. It takes more time and uses more expensive supplies, but it wouldn't hurt.

It seems that sterile technique is *not* always *essential* in the dressing change of a diabetic foot ulcer, but that's the "best" answer of your available choices. So, it seems that the best answer, the correct answer, a isn't totally accurate!

[leslie :-D]

I don't see that it's clear that sterile technique is absolutely ESSENTIAL in every instance of a dressing change of a diabetic foot ulcer. After all, the question doesn't even specify if the patient is in a hospital setting. So I don't see that focusing on the word "essential" shows why 3 is the best answer.

well, from this nurse's perspective, i would think sterile would be essential for any diabetic.

too many risk factors in this population.

leslie:twocents:

[lsyorke, RN]

Whoever is writing the questions isn't up on the latest wound care stuff. Isyorke? Yes, yorke is!

Thanks...yup, as a wound care certified nurse, working in a wound care center for years now, I think I have it down! LOL!

Here's a good article on wet to dry dressings. One thing that was beat into us in our certification was "a dry cell is a dead cell"!

http://www.medscape.com/viewarticle/470257_2

Sadly, we still see this all the time despite the new evidence to the contrary. Nursing schools are the worst for keeping up with new procedures.

Here's some interesting reading on "sterile vs clean" also.

http://www.wocn.org/pdfs/WOCN_Library/Position_Statements/clvst.pdf

http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=2539027

In the case of the question asked, the "best" answer is sterile dressings, since the others are absolutely wrong.