Debridement involves removing necrotic (dead) tissue to allow underlying healthy tissue to regenerate. Mechanical debridement procedures include irrigation, hydrotherapy, and dead tissue excision with forceps and scissors. The procedure may be done at the bedside, in a procedure room, or tub room. Chemical debridement attacks the collagen in tissue and helps remove dead tissue.
Burn wound debridement removes eschar (hardened, dead tissue). This prevents or controls infection, promotes healing, and prepares the wound surface to receive a graft. Ideally, the wound should be debrided daily during the dressing change. Frequent, regular debridement guards against hemorrhage resulting from more extensive and forceful debridement. It also reduces the need to conduct extensive debridement under anesthesia.
If thick eschar is present in a third-degree burn that is circumferential, an escharotomy may be performed. The thick eschar does not allow for expansion when fluid resuscitation is given and may directly impact circulation to an extremity. Electrical burns are at greater risk. When Doppler pulses and oximetry decrease or cease, this procedure becomes imminent. Ventilating the lungs may become difficult for a patient with thick eschar in a circumferential burn of the trunk/chest. Physicians perform this procedure. The eschar is opened longitudinally and sometimes laterally down to the subcutaneous tissue to relieve the pressure. The area is dressed just as the burn is thereafter and will fill in over time.
Combo order
Mechanical debridement may be combined with other debridement techniques, such as chemical/enzymatic debridement (with topical agents that dissolve dead tissue) or surgical excision and skin grafting (usually reserved for deep burns or ulcers). Typically, the patient receives a local or general anesthetic.
Ordered pain medication 
two pairs of sterile gloves two gowns shoe covers mask cap sterile scissors sterile forceps 4'' × 4'' sterile gauze pads sterile solutions and medications as ordered hemostatic agent as ordered.
Be sure to have the following equipment immediately available to control hemorrhage: needle holder gut suture with needle.
- Identify the patient using two patient identifiers, per facility policy.
- Explain the procedure to the patient to allay his fears and promote cooperation. Teach him distraction and relaxation techniques, if possible, to minimize his discomfort.
- Assess level of pain.
Early start
- Provide privacy. Administer an analgesic 20 minutes before debridement begins and/or give an I.V. analgesic immediately before the procedure.
- Keep the patient warm. Expose only the area to be debrided to prevent chilling and fluid and electrolyte loss.
- Perform hand hygiene and put on a cap, mask, gown, shoe covers, and sterile gloves.
Flip back a few pages
- Remove the burn dressings and clean the wound. (For detailed instructions, see “Burn care,”)
- Remove your gown and dirty gloves and change to another gown and sterile gloves.
- Lift loosened edges of eschar with forceps. Use the blunt edge of scissors or forceps to probe the eschar. Cut the dead tissue from the wound with the scissors. To avoid cutting into viable tissue, leave a ¼'' (0.6 cm) edge on the remaining eschar.
If bleeding occurs
- Because debridement removes only dead tissue, bleeding should be minimal. If bleeding occurs, apply gentle pressure on the wound with sterile 4'' × 4'' gauze pads. Apply the hemostatic agent if needed. If bleeding persists, notify the doctor and maintain pressure on the wound until arrival. Excessive bleeding or spurting vessels may warrant ligation.
- Perform additional procedures, such as application of topical medications and dressing replacements, as ordered.
- Work quickly, with an assistant if possible, to complete this painful procedure as soon as possible. Limit procedure time to 20 minutes if possible. (See Documenting mechanical debridement.)
- Debride no more than a 4'' (10-cm) square area at one time.
Outline