CBWT Certified Basic Wound Therapy
BASIC BA SIC CHR CHRONIC ONIC WOUND MANAGEMENT : P E R S I A PA N DA S A R L U K A BASIC ADVANCE ADVANCE WOUND WOUND CARE PROGRAM PROGRAM (BAWCP)
PLC – Professional Learning Center 2017
KAPAN LUKA DIKATAKAN KRONIK? ……………………….
CONTOH LUKANYA? ………………………..
BISA SEMBUH? ………………………
BAGAIMANA MERAWATNYA? ………………………..
KARAKTERISTIK LUKA KRONIK •
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Delayed healing yang terus berulang Delayed Fakt Fa ktor or si sist stem emik ik & li ling ngku kun nga gan n sa sang ngat at be berp rper eran an (wound sev severity): erity): penyakit peny penyerta erta Fakt Fa ktor or lo loka kall pe pent ntin ingg dip iper erh hat atik ikan an (w (wou ound nd burden):
infeksi, bend be nda a as asin ing, g, jaringan nekr nekrosis. osis.
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Contoh luka: DM / leg ulcer ul cer,, PU, Luka kanker
TIPE LUKA? BISA SEMBUH ????
TIPE LUKA? BISA SEMBUH ????
TIPE LUKA? BISA SEMBUH ????
PRINSIP MANAJEMEN LUKA
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Kontrol & hilangkan penyebabnya •
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Ciptakan dukungan sistemik •
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Pressure, shear, friction, moisture, neurophathy Nutrisi & cairan, edema, GDS
Ciptakan & pertahankan lingkungan luka •
Cegah infeksi, kebersihan luka, jaringan mati, lembab, dll
PINSIP MANAJEMEN LUKA KRONIK
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Pengkajian berkelanjutan Persiapan dasar luka (WOUND BED PREPARATION / WBP)
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 •
T: Tissue management
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I : Inflammation & Infection control
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M: Moisture Balance
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E: Epithelial edge advancement
(Falanga, 2004)
WOUND BED PREPARATION
PERS IAPAN DASAR LUKA
T: TIS SUE MAN AGEMENT •
Hilangkan jaringan mati & benda asing
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Debridemang: •
Surgical
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CSWD: tanpa nyeri & berdarah
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Enzymatic: hewan / herbal (enzim proteolitik)
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Autolytic: hypermoist- moisture balance
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Mechanical: kasa basah kering, hydroterapi, swab, pinset
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Chemical: Hydrogen peroxide, iodine cadexomer
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Biological: maggot
CSWD (CO NSERVATIV E SHA RP WOUN D DEBRIDEMENT)
CSWD
MEKANIKAL DEBRIDEMANG
DENGAN PINSET
DENGAN KASA KERING
AUTOLYTIC DEBRIDEMENT DENGAN MENGGUNAKAN TOPICAL AB
MAGGOT THERAPY
I : INFLAMMATION & INFECTION CONTROL •
Inflamasi: TCRD
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Infeksi: TCRD & HPO exudate, sistemik data
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Cairan pencuci
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Dressing yg tepat (topikal antimicrobial & antiseptik) Sistemik therapy (jika perlu)
CAIRAN PENCUCI LUKA •
Pilih cairan yang tepat •
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Iodine / chlorhexidine / asam asetat 10 % / herbal dg astrigen /feracrylum 1 % / Alkohol / Hypochlorite Air & sabun/normal salin/air hangat
Efektif cara mencuci •
Swab
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Tekanan
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Irigasi
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Kompres
BLISTER
CHLORINE Hypochlorite solutions - EUSOL; Milton; Dakin’s
In vitro activity
Gram positive
Gram negative
Acid fast
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
Toxic to granulation tissue and should not be used on a routine basis.
IODINE
Under
Gram positive
anaerobic conditions
Gram negative
Acid fast
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.
ALCOHOLS
Ethyl alcohol; isopropyl alcohol
Gram positive
Gram negative
Acid fast
Mudah menguap – efeknya sangat cepat
M: MOISTURE BALANCE •
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Pertahankan lembab yg seimbang (winter, 1962) Manajemen: •
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Dressing yg tepat, luka kering vs luka basah Kompresi ??
MOISTURE BALANCE •
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Hydrogel, hydrocolloid, Interactive wet dressing, Salep Tribee
LUKA KERING
LUKA BANYAK SANGAT BANYAK hydrofiber, foam lembaran / cavity, extra EXUDATE
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padding, wound/ostomy bag
Hydrogel, hydrocolloid, semiermiable film, calsium alginate, Salep Tribee
LUKA MINIMAL EXUDATE
LUKA MODERATE EXUDATE
Calsium alginate, hydrofiber, hydocoloid pasta/powder, foam, Salep Tribee-gauze •
M: MOISTU RE BALANCE
E: EPITHELIAL EDGE ADVANCEMENT
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Tepi luka yg baik?
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Manajemen: •
Pencucian adekuat
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Penipisan tepi luka
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Moisture balance dressing
E: EPITHELIA L ED GE ADVANCEMENT
BISA SEMBUH ???
DAFTAR PUSTAKA •
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Arisanty IP. Panduan Praktis Pemilihan Balutan Luka Kronis. 2012. Mitra Wacana Medika. Bekasi: Indonesia. Arisanty IP. Konsep Dasar Manajemen Perawatan Luka. 2013. EGC. Jakarta: Indonesia. Carville K. Wound Care Manual. 2010. Silver Chain Foundation. Australia. Bryan AR. Acute and Chronic Wound Management. Mosby. Australia. 2006.
