1. Hydrotherapy & Burn Wound Care
Bailey Burge RN, BSN
Burn Intensive Care Unit
April 28, 2011

2. Objective
Identify important aspects of hydrotherapy and wound care.

3. Hydrotherapy Room Procedure Room Water pressure
Environmental comfort
Patient’s room remains “safe-haven”
Water pressure
Availability of specialized equipment and products
Aids in maintenance of ROM
Burn care needs to be preformed in a warm environment. They do not have to worry about painful dressing changes being preformed in their room and the tank room has everything in the patients room. They are always connected to a monitor just like they are in their room. If lab draws, new Ivs are needed to be done, the supplies are available.
Very hard to clean a wound thoroughly in bed.
Water pressure: the water acts to loosen and remove sloughing tissue, exudate, and topical medications and minimize perineal-contaminated water (Wiegand & Carlson, 2005).
The tank bed is tilted at an angle, allowing the water to constantly drain. In the hydrotherapy room, equipment necessary for burn care is at finger tips. If escharotomies are needed to be done, the electrocautery is available.
Also, after dressings are removed and wounds observed, if another topical route is desired, the topicals are readily available with all the other supplies needed to do burn care.
Burn wounds contract during the healing phase. Stretching exercise through active or passive range of motion is necessary to prevent loss of function (Wiegand & Carlson, 2005). The warm water allows for full movement.

4. Hydrotherapy Room Patient monitor Hoses Suction Oxygen Supply cabinets
Music

5. Burn Wound Care Greatest threat to survival after resuscitation Goal:
Early wound closure
Maintain function
Prevent infection
Introduction of topical antibiotics has significantly reduced mortality
After the burn patient successfully passes the resuscitation period, the burn wound represents the greatest threat to survival.
Infections in burn patients continue to be the primary source of morbidity and mortality. Topical antimicrobial therapy remains the single most important component of wound care in hospitalized burn patients. The goal of prophylactic topical antimicrobial therapy is to control microbial colonization and prevent burn wound infection.

6. Process Cultures Debridement Pictures Clean Dressings Wrap
On admission and every Monday & Thursday
Assists in treatment modality & reduces cost
Debridement
On admission
Get between dead and viable tissue
Pictures
On admission, every Wednesday and graft T/D day
Clean
PI sponges & sterile gloves per body part
Dressings
Determined by cultures, degree of burn, staff experience, physician
Wrap
Kerlex, surginet, ace, burn vests
“Surveillance cultures are obtained
- to provide early identification of organisms colonizing the wound
- to monitor the effectiveness of current wound treatment
- to guide perioperative or empiric antibiotic therapy
to detect any cross-colonizations which occur quickly so that further transmission can be
prevented” (Weber & McManus, n.d. p. 3)
Use PI sponges after research. Research shows that

7. Supplies

8. Specific Agents Silver Dressings: Topicals: Temporary wound coverings:
Aquacel Ag
Silver Nitrate
Silver Matrix
Neosporin
Mafenide acetate (Sulfamylon)
Santyl
Bactroban
Nystatin
Povidone Iodine
Temporary wound coverings:
Porcine xenograft
Human cadaver allografts
Biobrane

9. Graft & Donor Sites Graft: Graft care: Split thickness skin graft
Meshed (1:1.5, 1:2, 1:3, 1:4)
Unmeshed (sheet graft)
Full thickness skin graft
Permanent wound coverage
Initial dressings provide security and compression
Splint applied if crosses joint
Protect from pressure, shear and movement
Keep initial dressing on until 3 days post-op
Take down day:
% adhered
Remove every other staple
Picture
Cultures
Depending on how much of the dermis is harvested by the surgeon.
Split thickness involves epidermis and part of dermis. Full thickness involves the epidermis and full thickness of the dermis (Beldon, 2007). Full thickness do not contract as much as split thickness so are good for cosmetic areas like face, neck and hands.
Full thickness burns are best treated with excision and grafting (Herndon, 2007). Grafts will cover a wound, accelerate healing and minimise scarring (Beldon, 2007).
Able to continue rehab and therapy activities
Adherence determined by color and immobility. Will be pink to red in color due to revascularisation. Graft should be firmly attached to wound bed.
Daily dressing changes after T/D with a nonadherent dressing so not to disturb the revacularisation of the graft. Compression dressing is used to minimize edema to continue graft adherence. After it has regained full skin integrity, daily dressing changes are not needed. Applying an emollient daily will be needed since the area is very dry inititallly.

10. Graft Site
Retrieved from:

11. Graft & Donor Sites Donor: Donor Care with Glucan:
Harvested tissue site
Painful
Monitor bleeding
Heals by reepithelialization
Initial dressing remains intact for 48 hrs post-op
Take down day:
Remove outer dressing
Observe site
May appear yellowish and “soupy”
Remove staples
May leave open to air
Treat like a scab
Painful because of the exposure of sensory nerve endings. Heals in about 7-10 days but can take longer depending on age and nutritional status (Beldon, 2007). Heals best in a moist environment. The dermis is richly supplied with capillaries and nerve endings, donor sites are at risk for bleeding in the first 24 hours and are very painful. They produce large volumes of serous exudate (Wiegand & Carlson, 2005, p.1046).
After healing is complete, donor sites can be reharvested.
Glucan used on most donor sites. May appear soupy and yellowish in color, which is normal. As it adheres, trim the excess part that is peeling off. If glucan still on donor site, it must be removed in six days post-op. “Float” off generous amount of ointment applied to help loosen. May take a couple of days to accomplish.

12. Donor Site
Retrieved from:

13. Summary
Hydrotherapy treatment continually washes away dead skin and bacteria and decreases the risk of infection
Patient’s room can remain a safe place
Burn wound care is performed to promote healing, maintain function and prevent infection and burn wound sepsis.

14. References
American Burn Association Advanced Burn Life Support Course: Provider Manual. Chicago, IL.: American Burn Association.
Beldon, P. (2007). What You Need to Know about Skin Grafts and Donor Site Wounds. Retrieved from
Herndon, D. N. (2007). Total Burn Care. Galveston, TX: Elsevier Health Sciences.
Weber, J., & McManus, A. (n.d.). Infection Control in Burn Patients. Retrieved from
Wiegand, D. & Carlson, K. (2005). AACN Procedure Manual for Critical Care. St. Louis, MO: Elsevier Saunders