Department & Location Protocol Number
Nursing Cooperative Wide Conservative Sharp Debridement of Wounds Page 1 of 4
To define the nursing assessment and management of wounds requiring sharp debridement.
Conservative sharp wound debridement may only be done by RN who has received GHC training and
supervision of performance evaluation by a certified wound care specialist – recommend a minimum of five
supervised opportunities to demonstrate this skill.
Training and Competency Validation must be documented and is required to be part of the RNs personnel
Individual performing conservative sharp wound debridement will provide documentation of education and
An order from the attending physician will be obtained before the procedure, or physician practice protocols
will be in effect permitting the procedure.
Conservative sharp wound debridement is the removal of loose, avascular (non-viable) tissue using surgical
instruments (e.g., scissors, scalpel, forceps) without inflicting pain or precipitating bleeding.
? Facilitates visualization of the wound wall and base for accurate and thorough assessment and
? Reduces the bioburden (volume of pathogenic microbes) of the wound by removing necrotic tissue
and foreign matter. Devitalized tissue supports bacterial growth with increased risk for wound
? Controls and potentially prevents infections.
? Interrupts at the molecular level the cycle of the chronic wound so that protease and cytokine levels
more closely approximate those of the acute wound (Schultz, 1999)
? Essential to optimal wound management
? Indicated for any wound, acute or chronic, when necrotic tissue or foreign bodies are present or
when infected. (contraindications to debridement include arterial insufficiency, pressure ulcers on
the heel/toes, ischemic wounds, or those with dry gangrene.
(AHCPR, 1994; Goode and Thomas, 1997; Robson, 1997; Stotts and Hunt, 1997)
2. Various forms of necrotic tissue
? Eschar is firm, dry, leathery appearance of desiccated and compressed tissue layers.
? Slough contains fibrin, bacteria, intact leukocytes, cell debris, serous exudate, and quanties of DNA.
May be adherent to the wound bed and edges or loosely adherent and stringy. May appear brown,
yellow, or gray. Slough, when dries and hardens, becomes eschar.
3. Various methods of debridement include:’
? Selective Conservative (only necrotic tissue removed-no bleeding results)
? Non selective (viable as well as nonviable tissue is removed)
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Nursing Conservative Sharp Debridement of Wounds Protocol # Cooperative Wide Page 2 of 4
EQUIPMENT FOR SELECTIVE CONSERVATIVE SHARP WOUND DEBRIDEMENT
Clean gloves-other PPE as appropriate Silver nitrate sticks Normal saline for irrigation
Sterile Instruments (forceps, scalpel, scissors) Magnifying lens Disposable drape
Sterile 4x4’s Sterile cotton applicators
PROCEDURE KEY POINTS
TOPIC: General Debridement Guidelines
1. Explain procedure to patient
Prevent microbial contamination of supplies. 2. Hand hygiene prior to assembling supplies
Establish separate clean and dirty. 3. Assemble supplies and prepare work surface
4. Ensure adequate lighting and magnification
Use red bag only if generating saturated bloody 5. Position bagged kick bucket or open bag on
gauze or large amounts of tissue. surface for accessible disposal of waste
6. Apply clean gloves. Gown and wear mask with Masks prevent touching of face and prevents eye protection when irrigating or using deposit of employee’s respiratory droplets on Dremel. Masks recommended but not required. wound site. 7. Position patient for procedure. Place blue pads Placing barriers under the wound site prevents or towels under wound site environmental contamination. 8. Remove old dressing and discard. Disposable wound drainage canisters are to be
9. Cleanse site with normal saline sealed and placed in the biohazard container in the
clinics, and inpatient setting. Home care may seal 10. Grasp loosely adherent nonviable tissue with them and place in patient’s home trash. forceps, pull tautly, exposing a clear line of
11. If eschar cannot be removed, using a scalpel
blade carefully serrate eschar to allow penetration of topical debridement ointment Pain and bleeding are signs of viable tissue. 12. Cut or snip loose tissue Bleeding that requires immed. assistance: 13. Irrigate wound with normal saline (see Wound ? Bleeding you can’t see the source of Irrigation Procedure)
? Bleeding you can hear (squirting sound) 14. For minor bleeding
? Apply pressure for 10 minutes
? apply silver nitrate
? topical agents like gel foam
17. Remove gloves and perform hand hygiene.
18. If culture needed, don clean gloves and follow
Prevent camera contamination. Place only on clean Wound Culturing Procedure
surface and handle only after sanitizing hands or 19. Photograph and measure wound wearing clean gloves. Wipe with disinfectant after 20. On completion of procedure, bag waste, using. remove gloves and wash hands before exiting
21. Document and advise staff of status
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Nursing Conservative Sharp Debridement of Wounds Protocol #
Cooperative Wide Page 3 of 4
Principles of treatment include sharp debridement of the wound’s callous collar, establishing a clean wound
base, covering and protecting the wound, and off-loading pressure of the affected foot.
? If necessary and appropriate to the wound, first remove all surrounding, dry, callus tissue via sharp
? Gently irrigate wound with Normal Saline. Wear gown, mask with eye protection, and gloves. ? Apply dressing coverage of non-adherent gauze, then afix 4X4 over the non-adherent gauze, wrap or
cover to hold dressing in place (without occluding circulation or putting pressure on surrounding tissue.
Physician will be notified immediately when:
A. Possible contraindications to debridement
2. Excessive undermining
3. Presence of gross purulence
4. Abnormal findings
7. Complicated patient condition
8. Bleeding tendencies
9. Heel/toe eschar
10. Ischemic wounds (poor arterial blood flow) B. Possible complications
1. Bleeding without known source
2. Bleeding in excess of 15 minutes
3. Bleeding that is squirting
C. When more extensive debridement is indicated (may need referral to surgeon)
A. Document in Patient Record summary of procedure:
1. Physician order
2. Time and date
3. Condition of wound
4. Problems during procedure
5. Type of wound covering
6. Extent/description of debridement
7. Signature of person debriding
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Nursing Conservative Sharp Debridement of Wounds Protocol # Cooperative Wide Page 4 of 4
thBryant, R. (2000). Acute and chronic wounds: Nursing management. (6 ed.). Mosby, St Louis. Agency for Health Care Policy and Research, Public Health Service. Clinical Practice Guideline:
Treatment of Pressure Ulcers. Number 15. December 1994.
Fowler, E., et al. Using wound debridement to help achieve the goals of care. Ostomy/Wound Management.
Volume 41, No 7A. August 1995, 23S-36S.
Written by: Gwenda Felizardo, BSN, CIC, RN, Infection Control
Original date: March 2002
Reviewed by: Jan Crosman, MN, ARNP, ONC, RN, Orthopedics
Barb Fugleberg, MN, RN, Puget Sound Regional Division Administration
Ruth Gregersen, PhD, RN, Home and Community Services
Karen Severson, MSN, RN, Hospital System Practice and Process Improvement
Carmen Suazo, MN, RN, Nursing Operations
Reviewed/Revised date(s): 1/03, 1/05
Administrative Approval: ______________________________________________
Director, Nursing Resources
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