Jemell Geraghty Tissue Viability Lead CNS and Lydia Barry Tissue Viability CNS Royal Free Presentation to LNNM Conference 2017

1. Wound Care
Practicalities and Self-Care
LNNM Conference, Friday 12th May 2017
Jemell Geraghty, Lead Nurse Tissue Viability
Lydia Barry, Specialist Sister Tissue Viability
Royal Free London, NHS Foundation Trust.
NW3 2QG
jemell82@hotmail.com

2. Background: Wound Care Support
Accessing health care is problematic for
homeless people due to:
• Difficulties in registering with a GP
• Lack of access to phone or transport
• Disordered lifestyle
• Previous experience of attitudes from health
care professionals
(Crisis, 2002).
We need to improve client experience in general practice
and make every contact count
Crisis (2002) Critical Condition – Homeless People’s Access to GPs.
London: Crisis

3. Types of wounds
• Traumatic wounds
• Burns
• Leg Ulcers
• Abscesses
• Self – harm wounds
• Chronic sinuses
• Surgical wounds
• Diabetic foot ulcers
• Skin related
conditions or wounds
• Fragile scars

6. When do clients appear with
wounds?
• Increase in pain
• Infection and
symptoms
• Other associated
problems such as
leg/groin pain/cramp
• Excess bleeding
• Fear
• Desperation
• Trust

7. Wound development: Why?
History
• Previous occurrence of
wound or ulcers
• Varicose veins
• IVDU or skin popping
• Diabetes
• Renal impairment
• Immunosuppression
• Medication
• Skin conditions
• Injury or trauma
• Allergy or skin condition
• Poor diet -malnourished

8. Wound Assessment: Diagnosis
• Examine
• When did it
occur?
• How?
• Previous
occurrence?
• Describe what
you see
• Feel, palpate
surrounding skin
• Assess pain
• Other
contributing
factors
Wound
Location
Wound
Bed
Wound
Edges
Wound
Assessment
Wound
Size
Signs
Of
Infection
Surround
skin:
Colour &
Temp

9. TIME: Model for Wound Bed
Preparation
T – Tissue Viable
or non viable
I – Infection or
Inflammation
M – Moisture
Imbalance or
balance
E – Edges of
Wound
International Advisory Board on Wound Bed Preparation. Schultz GS,
Sibbald, RG, Falanga V et al (2003) Wound bed preparation: systematic
approach to wound management Wound Rep Reg 11; 1-28
T - Does the wound contain non
viable tissue such as necrotic
tissue, slough, non-viable
tendon or bone?
I - Does the wound have signs
of bacterial contamination,
infection or inflammation?
M -Does the wound have
excess exudate or is the wound
too dry?
E - Edge wound undermined
and is the epidermis failing to
migrate across the granulation
tissue?

10. Wound bed: Tissue Types
Necrosis: Otherwise known as non viable or dead
tissue. Necrotic tissue occurs when certain skin
cells in or on one part of the wound die off, either
due to an infection, disease or age. Often presents
as black hard tissue or brown. It can be wet or dry.
* Be aware of underlying bone/tendon

11. Wound bed: Tissue Types
Slough: Non viable, devitalised yellowish tissue. Is
formed by an accumulation of dead cells. Must not
be confused with pus or fatty tissue. It can present
as yellow stringy, moist tissue but it can also be dry.

12. Wound bed: Tissue Types
Granulating: Pink, red healthy tissue the wound
rebuilding its structure preparing for the final stages
of healing. It should not be friable/bleed easily and
there should be no malodour.

14. Infection: Observe
• Localised pain
• Smell
• Increase in
inflammation &
redness
• Oedema
• Exudate increase &
change in colour
• Surrounding skin
• Friable wound bed
• Systemic unwell:
temperature/febrile
Collier, M. (2004). Recognition and Management of
Wound Infection. World Wide Wounds,
http://www.wounds-uk.com/pdf/content_11934.pdf

15. Observe it may be a skin condition,
allergy or sensitivity!

16. Case examples: What to look out for!
Skin Damage
Critical Ischaemia
CellulitisCarcinoma (SCC)
Calciphylaxis
Diabetic Foot

17. Wound Management: Practicalities
& Self Care
• Cleansing
• Moisturising
• Protecting the
surrounding skin &
wound edge
* Be aware paraffin based products are highly
flammable - if used in large quantities

18. Surrounding skin:
Excoriation: Excessive exudate in
contact with skin over a period of time
can cause what often presents as
superficial skin stripping and often
described as “burning”.
Disturbs the skin pH and causes
damage.
Maceration: Maceration is defined as
the softening and breaking down of
skin resulting from prolonged exposure
to moisture. Maceration is caused by
excessive amounts of fluid remaining in
contact with the skin or the surface of a
wound for extended periods.
Need: Regular dressing
changes, cleansing and
skin barrier cream/films.

19. Wound Management: Moist Wound
Healing

20. Antimicrobials: Prevent & treat
wound infection
MEDIHONEY® is a natural
product and has been used on
wounds in adults and children
of all age
Do not use MEDIHONEY®:
• On third degree burns
• If you have a known
sensitivity to honey, algae or
seaweed.
• To control heavy bleeding

21. Antimicrobials: Prevent & treat
wound infection
Should not be used where:
• There is a known iodine hypersensitivity;
before and after the use of radio-iodine (until
permanent healing);
• If the patient is being treated for kidney
problems
• Is pregnant or breastfeeding;
• In cases of Duhring's herpetiform dermatitis
(a rare skin disease). Must be used under
medical supervision:
• In patients with any thyroid diseases;
• In newborn babies and infants up to the age
of 6 months as povidone-iodine may be
absorbed through unbroken skin;
• When treating deep ulcerative wounds,
burns or large injuries

22. Antimicrobials: Prevent & treat
wound infection
Although there are no known
contra-indications to the use of
Aquacel Ag, the dressing will
be of little value if applied to
wounds that are very dry, or
covered with hard black
necrotic tissue.
Silver: The presence of sodium ions from
wound exudate, the silver ions are
released to exert a sustained antimicrobial
effect against a wide range of organisms
including methicillin-resistant
Staphylococcus aureus (MRSA), and
vancomycin-resistant Enterococcus
(VRE), thus preventing colonization of the
dressing and providing an antimicrobial
barrier to protect the wound.

23. Retention Dressings:

24. Why bandage?
Keeps dressing in place
Covers wound/ulcer
Prevent contamination
Manage exudate and malodour
Support the limb
Comfort
Help reduce oedema
Protection
Foundation for compression
Can be used safely in nearly all
cases
Can be applied by almost all
clinicians
Easy to learn and share skill

25. How to promote self care and
concordance.
• Establish trust and
respect
• Listen to their story
• Engage and promote
independence
• Promote concordance
• Give encouragement
and positivity about
wound healing
• Chronic wounds can
cause isolation and
depression

26. Copyright: Geraghty (2015)

27. Copyright: Geraghty (2015)

29. Participant 03 diary :
“When I started this
journey my ulcers were
as below... (participant
has drawn a picture of
her own leg ulcers before
and after with this
comment ...looked like I
had been bitten by a
shark!”).
“Ulcers starting to
“Fizz” because
the dressings need to
be changed”.
“They haven’t got a clue and
this thing about methadone
being a painkiller that’s a
massive belief that people
think .”

31. Questions
Thank you!
jemell82@hotmail.com