Basic Chronic Wound Management: Prinsip Perawatan Luka Irma P. Arisanty, SKp, RN, WOC(ET)N

KAPAN LUKA DIKATAKAN KRONIK? ………………………. CONTOH LUKANYA? ……………………….. BISA SEMBUH? ……………………… BAGAIMANA MERAWATNYA?

KARAKTERISTIK LUKA KRONIK Delayed healing karena luka yang berulang Faktor sistemik & lingkungan sangat berperan (wound severity): penyakit penyerta Faktor lokal penting diperhatikan (wound burden): infeksi, benda asing, jaringan nekrosis Contoh luka: DM / leg ulcer, PU, Luka kanker

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PRINSIP MANAJEMEN LUKA Kontrol & hilangkan penyebabnya Pressure, shear, friction, moisture, neurophathy Ciptakan dukungan sistemik Nutrisi & cairan, edema, GDS Ciptakan & pertahankan lingkungan luka Cegah infeksi, kebersihan luka, jaringan mati, lembab, dll

PINSIP MANAJEMEN LUKA KRONIK Pengkajian berkelanjutan Persiapan dasar luka Kebutuhan penanganan dengan prinsip steril atau bersih Peningkatan kualitas hidup pasien Pendidikan kesehatan pasien dan keluarga Perbaikan aktivitas sehari-hari pasien hingga kemampuan optimal

WOUND BED PREPARATION / PERSIAPAN DASAR LUKA 3 M: MENCUCI MENGANGKAT JARINGAN MATI MEMILIH BALUTAN (wocare, 2007)

WOUND BED PREPARATION

M: MENCUCI LUKA Tujuan: mengatasi inflamasi – infeksi Inflamasi: TCRD Infeksi: TCRD & HPO exudate, sistemik data Cairan pencuci Dressing yg tepat (topikal antimicrobial & antiseptik) Sistemik therapy (jika perlu)

blister

Cairan pencuci luka Efektif cara mencuci Pilih cairan yang tepat Swab Tekanan Irigasi Pilih cairan yang tepat Iodine / chlorhexidine / asam asetat 10 % / herbal dg astrigen /feracrylum 1 % / Alkohol / Hypochlorite Air & sabun/normal salin/air hangat

Antibiotics Chlorhexidine Antibacterials Heavy metals - silver Plant resin packs Aromatic wood burning Frankincense Fresh urine, salt, vinegar Honey, sugar, butter 1811 Iodine 1825 Chlorine 1860 Phenol 1870 Carbolic acid 1900’s Heavy metals - silver 1950’s Chlorhexidine Antibiotics 1982

Hypochlorite solutions - EUSOL; Milton; Dakin’s Chlorine Hypochlorite solutions - EUSOL; Milton; Dakin’s Gram positive Gram negative Acid fast In vitro activity Rapidly inactivated by organic matter, is extremely toxic to granulation tissue and may bleach the surrounding skin. There is evidence to show that chlorine based solutions destroy the micro-circulation of the wound and slow down the healing process

Hydrogen peroxide No evidence of antimicrobial activity Gram positive Gram negative Acid fast No evidence of antimicrobial activity Toxic to granulation tissue and should not be used on a routine basis.

Iodine Under anaerobic conditions Gram positive Gram negative Acid fast Under anaerobic conditions Aktivitas iodine akan menurun pada udara terbuka. Korosif dan merusak jaringan granulasi. is an effective antiseptic, its use is limited by the possibility of sensitivity to iodine and of systemic absorption during prolonged use.

Ethyl alcohol; isopropyl alcohol Alcohols Ethyl alcohol; isopropyl alcohol Gram positive Gram negative Acid fast Mudah menguap – efeknya sangat cepat

M : MENGANGKAT JARINGAN MATI Hilangkan jaringan mati & benda asing Debridemang: Surgical CSWD: tanpa nyeri & berdarah Enzymatic: hewan / herbal (enzim proteolitik) Autolytic: Moisture balance Mechanical: kasa basah kering, hydroterapi, swab Chemical: Hydrogen peroxide, iodine cadexomer Bilogical: maggot

CARA DEBRIDEMANG Enzymatic, misal: papain, honey Mechanical : gauze, pinset Autolytic Debridement CSWD Biological: maggot When thinking about wound bed preparation there are four methods of debridement surgical, mechanical, autolytic and enzymatic. While there are advantages and disadvantages for each method, there are also clinically appropriate indications for each method. It is important to consider the patient’s overall condition and the goals for care when selecting the method of debridement.

MEKANIKAL DEBRIDEMANG DENGAN PINSET DENGAN KASA KERING

Autolytic Debridement

CSWD (Conservative Sharp Wound Debridement)

CSWD

MAGGOT THERAPY

Combination

Combination

M: MEMILIH BALUTAN Pertahankan lembab yg seimbang (winter, 1962) Manajemen: Dressing yg tepat, luka kering vs luka basah Kompresi ??

LUKA BANYAK – SANGAT BANYAK EXUDATE MOISTURE BALANCE Calsium alginate, hydrofiber, hydocoloid pasta/powder, foam, Salep Tribee-gauze hydrofiber, foam lembaran / cavity, extra padding, wound/ostomy bag Hydrogel, hydrocolloid, semiermiable film, calsium alginate, Salep Tribee Hydrogel, hydrocolloid, Interactive wet dressing, Salep Tribee LUKA KERING LUKA MINIMAL EXUDATE LUKA MODERATE EXUDATE LUKA BANYAK – SANGAT BANYAK EXUDATE

M: Moisture Balance

E: Epithelial edge advancement

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