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Debridement agents: Nursing Pharmacology

Notes

Notes

DEBRIDEMENT AGENTS
DRUG NAME
collagenase (Santyl)
trypsin, balsam peru, 
castor oil (Granulex)
CLASS
Debridement agents
MECHANISM OF ACTION
  • Breaks down collagen in dead tissue and helps with the formation of granulation tissue
  • Trypsin: activates metalloproteinases that break down the intercellular matrix, helping with desquamation
  • Balsam peru: stimulates blood flow to the wound  and inhibits bacterial and fungal growth
  • Castor oil: prevents breakdown of healthy skin cells and inhibits bacterial and fungal growth
INDICATIONS
  • Burns
  • Ulcers
  • Wounds
ROUTE(S) OF ADMINISTRATION
  • TOP
SIDE EFFECTS
  • Erythema
  • Burning
  • Itching
  • Tingling
  • Increased risk of local infection
CONTRAINDICATIONS AND CAUTIONS
  • None
NURSING CONSIDERATIONS: DEBRIDEMENT AGENTS
ASSESSMENT AND MONITORING
Assess
  • Health conditions affecting healing; e.g., impaired mobility, impaired circulation, diabetes, deficient nutrition
  • Wound
    • Location, size, measuring length, width, and depth
    • Necrotic tissue
    • Signs of local infection, including redness, swelling, drainage, warmth, pain, foul odor
    • Demarcation between the necrotic tissue and healthy tissue
  • Laboratory test results, CBC, albumin, hemoglobin, hematocrit; blood glucose, HbA1C
Intervention
  • Clean wound bed with normal saline
  • Apply debridement agent
  • Dress the wound
  • Promote healing
    • Nutrition, glucose control
Evaluate
  • Signs of healing, wound bed clear of necrotic tissue and debris, free of infection
CLIENT EDUCATION
  • Purpose of medication: remove dead tissue, promote healing, prevent infection
  • Tingling or burning sensation with application
Transcript

Debridement agents are a group of medications that are used to remove debris or dead tissue from a burn, ulcer, or wound, which helps promote healing and decrease the risk of infection.

Some commonly used debridement agents include collagenase, and a combination medication containing trypsin, balsam peru, and castor oil. These medications come in the form of ointments that are applied topically on the skin.

Once applied, collagenase is an enzyme that acts by breaking down collagen in non-viable tissue, and helps in forming granulation tissue, which contains healthy cells that fill up the dead tissue from the wound and fight off infections.

Similarly, sutilain breaks down proteins of the intercellular matrix, which fills the spaces between neighboring skin cells. This allows the cells of the outer skin layers to shed, which is known as desquamation.

Finally, trypsin activates an enzyme called metalloproteinase, which breaks down the intercellular matrix, making it easier for skin cells to slough off; while balsam peru stimulates blood flow to the wound area, as well as castor oil, which prevents the breakdown of healthy skin cells.

Additionally, both balsam peru and castor oil help prevent wound infection by inhibiting bacterial and fungal growth in the skin.

Unfortunately, debridement agents may cause side effects, such as skin irritation, which can manifest as pain, erythema, as well as a burning, itching, or a tingling sensation.

Luckily, there are no contraindications for the use of debridement agents.

If a client with a necrotic wound is prescribed a debridement agent, first review their medical record for any health conditions that could affect healing, such as impaired mobility, impaired circulation to the wound site, deficient nutrition, or conditions like diabetes mellitus.

Then, perform a baseline assessment of the affected area, noting the location, and size, measuring length, width, and depth of the wound, and the amount of necrotic tissue.

Next, assess for signs of local infection, including redness, swelling, warmth, pain, drainage, or foul odor, and be sure there is a clear line of demarcation between the necrotic tissue and healthy tissue.

Sources
  1. "Focus on Nursing Pharmacology" LWW (2019)
  2. "Pharmacology" Elsevier Health Sciences (2014)
  3. "Mosby's 2021 Nursing Drug Reference" Mosby (2020)
  4. "Goodman and Gilman's The Pharmacological Basis of Therapeutics, 13th Edition" McGraw-Hill Education / Medical (2017)
  5. "Mast cell tryptase and photoaging: possible involvement in the degradation of extra cellular matrix and basement membrane proteins" Archives of Dermatological Research (2007)
  6. "Sleep Hygiene and Melatonin Treatment for Children and Adolescents With ADHD and Initial Insomnia" Journal of the American Academy of Child & Adolescent Psychiatry (2006)