Granulating Clean Granulating Necrotic Healable Necrotic Epithelializing Wound, Wound NOT Wound Wound Decreasing in Decreasing in Size (Debridement is Wound Surface Area 20-30% in 3-4 Appropriate) (Debridement is in 3-4 NOT Weeks* Appropriate) Irrigate with < 7 PSI Irrigate with < 7 PSI Irrigate with 7-15 PSI Irrigate with 7-15 PSI Do not irrigate or pressure, or pour pressure, or pour pressure. pressure. cleanse the solution over the solution over the wound itself (the wound bed. bed. intent is to allow the necrotic tissue Use at least 150cc’s of Use at least 150cc’s Use at 100cc’s of Use at least 100cc’s to dry out and solution, at room or of solution, at room solution, at room or of solution, at room stabilize). body temperature. or body temperature. body temperature. or body temperature. Cleanse the Cleanse the Cleanse the Cleanse the periwound skin of periwound skin of periwound skin of periwound skin of debris, exudates. debris, exudates. debris, exudates. debris, exudates. If there is exudate *Granulating wounds No antimicrobial No antimicrobial present on the not decreasing in size solutions. solutions. periwound skin, may have a localized gently cleanse it infection. and pat dry. Topical application of proviodine-iodine solution or Chlorhexadine to the wound surface is appropriate, i.e. paint with Proviodine. Malignant Wounds Wound with Debris Wound with Debris * Localized And/Or Maintenance or Contamination/ or Contamination/ Spreading Infection Wounds Superficial & Partial Superficial & Partial Thickness Burn Thickness Burn
Epithelializing Wound Granulating Wound, Decreasing in Surface Area in 3-4 Weeks* Clean Granulating Wound NOT Decreasing in Size 20-30% in 3-4 Necrotic Healable Wound (Debridement is Appropriate) Necrotic Wound (Debridement is NOT Appropriate) Irrigate with < 7 PSI pressure, or pour solution over the wound bed. Use at 100cc’s of solution, at room or body temperature. Cleanse the periwound skin of debris, exudates. No antimicrobial solutions. Irrigate with < 7 PSI pressure, or pour solution over the bed. Use at least 100cc’s of solution, at room or body temperature. Cleanse the periwound skin of debris, exudates. No antimicrobial solutions. Irrigate with 7-15 PSI pressure. Use at least 150cc’s of solution, at room or body temperature. Cleanse the periwound skin of debris, exudates. *Granulating wounds not decreasing in size may have a localized infection. Irrigate with 7-15 PSI pressure. Use at least 150cc’s of solution, at room or body temperature. Cleanse the periwound skin of debris, exudates. Do not irrigate or cleanse the wound itself (the intent is to allow the necrotic tissue to dry out and stabilize). If there is exudate present on the periwound skin, gently cleanse it and pat dry. Topical application of proviodine-iodine solution or Chlorhexadine to the wound surface is appropriate, i.e. paint with Proviodine. Malignant Wounds Wound with Debris or Contamination/ Superficial & Partial Thickness Burn Wound with Debris or Contamination/ Superficial & Partial Thickness Burn * Localized And/Or Spreading Infection Maintenance Wounds
Venous%20and%20Mixed%20Venous%20Leg%20Ulcers.docx