MANAJEMEN LUKA KRONIS

Prinsip Manajemen Luka Kronis

1. Pengkajian komprehensif, berkelanjutan dan manajemen faktor
intrinsik dan ekstrinsik yang menghambat proses penyembuhan
luka
2. Wound Bed Preparation
3. Menilai kebutuhan akan metode manajemen perawatan luka
(bersih atau steril)
4. Meningkatkan kualitas hidup klien
5. Pendidikan kesehatan klien
6. Meningkatkan recovery dan rehabilitasi sampai fungsi normal
dalam jangka waktu yang telah ditentukan.
KARAKTERISTIK LUKA KRONIK

Delayed healing 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, Luka kanker
PRINSIP MANAJEMEN LUKA

Kontrol & hilangkan penyebabnya

 Pressure, shear, friction, moisture, neurophathy

Ciptakan dukungan sistemik

 Nutrisi & cairan, edema, Blood Glucose

Ciptakan & pertahankan lingkungan luka

 Cegah infeksi, kebersihan luka, jaringan mati, lembab, dll
MANAJEMEN LUKA KRONIK
BENDA ASING GOOD LEMBAB
ETIOLOGI

TOPIKAL THERAPY
WOUND BED PREPARATION
JARINGAN MANAGEMENT AUTOLISIS
NEKROSIS SAFE SUPPORT
INFEKSI DEBRIDMENT PENYEMBUHAN
WOUND BED PREPARATION
Tissue management
 Hilangkan jaringan mati & benda asing
SAFE Debridement:
 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
DEBRIDEMENT

Objectives of debridement
 Promote and develop healthy wound bed that supports tissue regeneration
 Reduce bioburden of wound; prevent and control infection in deteriorating
wounds
 Remove necrotic, devitalized tissue without causing harm to surrounding tissue
or the host organization:
 Selective
 Zero to minimal Blood loss
 Cost and time efficient
 Tecnical ease and availability
Autolytic Debridement
1
SAFE 2

4 5

Debridement
Advantages and Disadvantages of Debridement Methods

Method Advantages Disadvantages

Surgical Debridement Fast and efficient. Requires medical intervention
Maximises asepsis when performed in a Expensive if using an operating theatre
traetment room or operating theatre Non-selective
Appropriate when extensive necrosis or Generaly requires an anaesthetic
infection or prior to skin grafting
Conservative Sharp Able to be performed in the clinical area by a Requires serile, sharp instruments
Wound Debridement registred nurse who is clinically competent to Conservative removal of loose, avascular and
perform the procedure insensate tissue only
Inexpensive
Enzymatic May soften eschar. Expensive
Debridement Can be used in conjunction with conservative Relatively slow method
sharp debridement May macerate sourounding skin
Autolytic Debridement Selective debridement, not harmful to May be slow
granulating or epithelialising tissue May maserate surounding tissue
Inexpensive May increase wound drainase. Autolising eschar
Appropriate partial to full thickness wounds malodours
Aids comfort Occlusive dressing are not recommended an
anaerobically infectedwound
Advantages and Disadvantages of Debridement Methods

Method Advantages Disadvantages

Mechanical May soften deep eschar
Debridement Appropriate for extensive tissue
(hydrotherapy, whirlpool)
Wet to dry dressings are inexpensive
May be slow and painful (wet to dry)
necrosis May be expensive if hydrotherapy, whirlpool,
mechanical irrgationsystem used or additional nursing
time is required for wet to dry dressins
Non selective

Chemical Debridement Bectericidal and bactereositic agents Chemical agents may be cytotoxic to healthy cells in
wounds
Some agents can be inactivated in the presence of
blood or pus

Biological or Parasitic Usually fast and efficient
Debridement Effective againts a wide range of bacteria
including Clostrydyum welchii, MRSA and
Pseudomonas aureginosa
Sterile larvae may be difficult to obtain
May be socially unacceptable
A slight pyrexia may occuras a result of lysis of
bacteria by larvae
Irritation may occur if larvae come in contact with
surrounding skin.
Inflammation & Infection control

 Cairan pencuci
 Dressing yg tepat (topikal antimicrobial &
antiseptik)
 Sistemik therapy (jika perlu)
Inflammation & Infection control
Critically colonised wounds can present with
alterations in tissue characteristics and these include:

 Static healing
 Increased exudate
 Pale grey or deep red coloured granulation tissue
 Frible granulation that bleeds on contact
 Hipergranulation
 Rolled wound edge
MASERASI
Cairan pencuci luka
 Efektif cara mencuci
 Swab
 Tekanan

Irigasi
 Pilih cairan yang tepat
 Iodine / chlorhexidine / asam asetat 10 % / herbal dg astrigen / PHMB / Hypochlorite
 Air & sabun/normal salin
Dressing Antibakterial

 Cadaxomer iodine
 Povidone iodine impregnated tulle gras
 Chlorehexidine impragneted tulle gras
 Wound honey
 Silver impregnated dressings
Moisture Balance

 Pertahankan lembab yg seimbang (winter,

1962)
 Manajemen:
Dressing yg tepat, luka kering vs luka basah
Kompresi ??
Moisture Balance
Dressing for Optimal Moisture Balance
Dry wounds: Moderate exudate:
 Hydrogels  Calcum alginates
 Hydrocolloids  Hydrofibre
 Interactive wet  Hydrocolloid/paste, powder
dressings
 Foams
Minimal exudate:
 Hydrogels Heavy exudate:
 Hydrocolloids  Foams sheet/cavity
 Semipermeable films  Extra absorbent dry dressing
 Calcium alginates  Wound/ostomy bag
Epithelial edge advancement

 Tepi luka yg baik?

 Manajemen:
Pencucian adekuat
Penipisan tepi luka
Moisture balance dressing
Epithelial edge advancement
Hypergranulation can be controlled by:
 Topical antimicrobials to correct bacterial imbalance
 Hypertonic impregnated to control oedema and
bacterial balance
 Local pressure application using a foam dressing and
either compression bandage of fixation tape
 CSWD
 Chemical debridement with caustic agents such as
silver nitrate and copper sulphate
 Topical corticosteroids
REPAIR & REGENERATION
Pilihan Terapi Lanjutan
Teknologi mencakup intervensi yang diberikan secara topikal dan
sistemik:
1. Oxygen (Systemic);
2. Growth Factor
3. Nitric Oxide
4. Tissue equivalent product.
5. NPWT
6. Systemic Pharmacotherapy
7. Protein-based nutritional supplements
SOCIAL-AND PATIENT-RELATED
1. Psychosocial Factors
2. Factors that affect Adherence
3. Physical and comorbidity factors
4. Ekstrinsic Factors
CONTOH KASUS

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 Surgical
Debridement

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THANK YOU