What method Debridement do you use in your Burn Unit now days?

[ARDS]

Hello. How are you? You know I first want to add that I believe that there is a special place in Heaven that is for burn nurses. You truly do see the worst I believe. I think that Burn Unit nursing takes special hearts. There is nothing like Burn Unit nursing care from what I know. My question to you. What Debridement do you use in your Burn Unit? I know of two methods. From my knowledge this is what I know. Method number one is the Hubbard Tank The Hubbard Tank is the whirlpool method I think. I've never seen a Hubbard Tank in actual life but I know it's a tank. The next method I have heard of is the use of a shower like mode where three hoses are used and the Patient is wheeled under the trio of hoses on a stretcher. This is confusing to me though because when this method was used in the book that I read a while back they still referred to this room as the tank room. But then again maybe it was being called the tank room because they used a Hubbard Tank before they used the shower like mode. I don't know. But the most notable thing about Debridement I know is that the tank room was a burn Patients nightmare because even with high dose Morphine and sedation Patients said that the tank room was their most recalled points in their recovery process. The Burn Unit must deal with the most emotional stress known in the field of healthcare and I solute you all. God has a special place in his heart. I know.

[nikkicoliCCRN]

I am an ACNP student that is doing my internship in the biggest burn unit in the country. I have seen mostly surgical debridement. As a nurse for 15 years, mostly in critical care I think there is a level of separation. Except when there is a child. I don't care for those patients but I do tiptoe by.

[K+MgSO4, BSN]

Of course they remember morphine doesn't cause memory loss.

[nikkicoliCCRN]

Actually it really depends on the patients. Patients that are intubated often get fentanyl and versed. These patients often do not remember much of anything.

Not sure where you're getting your information but most patients are managed with many different medications but not a whole lot of morphine.

[marienm, RN, CCRN]

I work on a small burn unit and debridement is different for every patient based on the severity of the burn and the patient's tolerance of wound care... Most commonly I see surgical debridement followed by xenografting and then autografting in another week or so (again, different for every patient). Our unit will do moderate sedation at the bedside for patients who can't tolerate wound care without it. Not a great option, thougb, as they wind up missing meals because we make them NPO after midnight each time. Some burns get enzymatic debridement (santyl, usually). We do have a big giant tub and a hoist to lower patients into it, but it is rarely used and I think the hospital is going to replace it with a shower table. Not every patient is appropriate for the tub...the room isn't set up for vented patients and it's impossible to keep groin bacteria from getting in the burn if you submerge the patient in water!

Our most common pain med is fentanyl, but different people respond better to different meds, so we certainly have morphine and dilaudid PCAs as well as oral meds and gabapentin and benadryl for the itching that comes with healing. IV meds are obviously front-line during wound care.

Hope some of that helps! My understanding (I've only worked one place) is that there's a lot of variation among burn units.

[nmsumurse]

Yes there's a ton of variation. My unit we have a shower table, where mechanical debridment occurs with scrubbing, sometimes surgical with the bovie. 2% chlorahex soap is used during the process. We can take vented pt in the "tub room". Tub room procedure is very structured with timeouts and whatnot as the pt is very vulnerable during this time. End tidal is used on all pt, ekg monitor is attempted but mostly fails with water going everywhere. All vitals are taken q3 minutes, sedation nurse job is separated from the actual burn nurse dressing duties.