1 De huid................................................................................................................................................5
2 Definitie wonde...................................................................................................................................5
3 Wondgenezingsproces.........................................................................................................................5
3.1 Ontstekingsfase (0 tot 6 d)............................................................................................................6
3.1.1 Opruimfase............................................................................................................................6
3.1.2 Klinische tekens ontstekingsfase...........................................................................................6
3.2 Proliferatie of granulatiefase (3 tot 24 d).....................................................................................6
3.3 Maturatiefase (tot 6 mnd)............................................................................................................7
3.4 Littekenvorming............................................................................................................................7
3.4.1 Stoornissen in littekenvorming..............................................................................................7
4 Types wondgenezing...........................................................................................................................7
4.1 Genezing pet primam...................................................................................................................7
4.2 Genezing per secundam...............................................................................................................8
4.3 Regeneratieve wondgenezing van een oppervlakkige wonde......................................................8
5 Indeling van wonden...........................................................................................................................8
5.1 Uitzicht en vorm...........................................................................................................................8
5.2 Oorzaak.........................................................................................................................................8
5.2.1 Traumatische wonden...........................................................................................................8
5.2.1.1 EHBO – Mechanische wonden: Algemeen......................................................................9
5.2.1.2 EHBO – Thermale wonden – Algemeen........................................................................10
5.2.1.3 EHBO – Chemische wonden..........................................................................................10
5.2.1.4 EHBO – Stralingswonden..............................................................................................10
5.2.2 Iatrogene wonden...............................................................................................................10
5.2.3 Chronische wonden.............................................................................................................10
5.2.4 Ulcera...................................................................................................................................11
5.3 Infectiegraad...............................................................................................................................11
5.3.1 Besmette of gecontamineerde wonde.................................................................................11
5.3.2 Gekoloniseerde wonde........................................................................................................11
5.3.3 Kritisch gekoloniseerde wonde............................................................................................12
5.3.4 Geïnfecteerde wonden........................................................................................................12
5.3.5 Grens tussen kolonisatie en infectie....................................................................................13
5.3.6 Een goede wondverzorging.................................................................................................13
5.4 Kleur, exsudaat (vochtig of droog) en diepte..............................................................................13
5.4.1 Principes van TIME-Concept................................................................................................14
6 Wondgenezing...................................................................................................................................15
6.1 Beïnvloedende factoren.............................................................................................................15
1
, 6.1.1 Factoren eigen aan de wonde..............................................................................................15
6.1.2 Factoren eigen aan de patiënt.............................................................................................15
7 Diagnostiek van de wonde.................................................................................................................16
7.1 Wondbeeld.................................................................................................................................16
7.2 Patiëntbeeld...............................................................................................................................16
8 Wondverzorging................................................................................................................................17
8.1 Doel............................................................................................................................................17
9 Materiaalkennis.................................................................................................................................17
9.1 Verbandmaterialen.....................................................................................................................17
9.1.1 Actief/passief verband.........................................................................................................17
9.1.2 Passieve verbandmiddelen..................................................................................................18
9.1.2.1 Gaaskompres................................................................................................................18
9.1.2.2 Absorberend verband...................................................................................................19
9.1.2.3 Kant en klaar verband...................................................................................................19
9.1.2.4 Geïmpregneerd verband zonder medicinale toevoeging..............................................20
9.1.3 Secundair verband en/of fixatiemateriaal...........................................................................20
10 Wondhechting.................................................................................................................................20
10.1 Doel..........................................................................................................................................20
10.2 Hechtingsmateriaal...................................................................................................................21
10.2.1 Indeling..............................................................................................................................21
10.2.1.1 Haken of agraven........................................................................................................21
10.2.2 Hechtingsdraad..................................................................................................................22
10.2.2.1 Oppervlakkige of primaire hechtingen........................................................................22
10.2.2.2 Diepliggende of secundaire hecthing of steunhechtingen..........................................23
10.2.2.3 Wondlijm....................................................................................................................23
10.2.2.4 Zelfklevende sluitstrips...............................................................................................23
10.2.2.5 Externe fixator............................................................................................................24
10.2.2.5.1 Wondzorg............................................................................................................24
11 Wonddrainages...............................................................................................................................24
11.1 Definitie....................................................................................................................................24
11.2 Doel..........................................................................................................................................25
11.3 Soorten drainage......................................................................................................................26
11.3.1 Passieve drainage..............................................................................................................26
11.3.1.1 Tubulaire drain = open systeem..................................................................................26
11.3.1.2 Penrose of capillaire drain..........................................................................................27
11.3.1.3 Lamel..........................................................................................................................27
2
, 11.3.1.4 Tubulaire karteldrain..................................................................................................27
11.3.1.5 Drain van Kehr of T-drain............................................................................................28
11.3.1.6 Wieken........................................................................................................................29
11.3.2 Actieve drainage................................................................................................................29
11.3.2.1 Redondrainage............................................................................................................29
11.3.2.2 Jackson-Pratt...............................................................................................................31
11.4 Fixatiemogelijkheden drain......................................................................................................31
11.5 Aandachtspunten drain............................................................................................................31
11.6 Verzorging drain.......................................................................................................................31
12 Productkennis..................................................................................................................................32
12.1 Ontsmettingsmiddelen.............................................................................................................32
12.1.1 Wanneer is het zinvol de wonde te ontsmetten?..............................................................32
12.1.2 Keuze van het ontsmettingsmiddel....................................................................................32
12.1.3 Aanwijzingen bij het gebruik van alcoholische en waterachtige oplossingen....................33
12.1.4 Productkennis - Ontsmettingsmiddelen.............................................................................33
12.1.4.1 Alcoholen....................................................................................................................33
12.1.4.2 Chloorhexidine............................................................................................................34
12.1.4.3 Chloorverbindingen....................................................................................................34
12.1.4.4 Jodium en jodiumverbindingen..................................................................................34
12.1.4.5 HAC.............................................................................................................................35
12.1.4.6 Eosine.........................................................................................................................35
12.1.4.7 Azijnzuur.....................................................................................................................36
12.1.5 Besluit................................................................................................................................36
13 Wondspoeling..................................................................................................................................36
13.1 Soorten spoelvocht...................................................................................................................36
13.1.1 Chloramine-T 0.5% in waterige oplossing (Dakin-oplossing).............................................36
13.1.2 Hibidil®................................................................................................................................37
13.1.3 Iso-betadine® dermicum.....................................................................................................37
13.1.4 Azijnzuur 2%......................................................................................................................37
13.1.5 NaCl 0.9% of fysiologische oplossing.................................................................................37
13.1.6 Antibiotica..........................................................................................................................38
13.2 Gevaren en moeilijkheden bij het spoelen...............................................................................38
13.3 Soorten wondspoeling..............................................................................................................38
13.3.1 Onderbroken- of gefractioneerde wondspoeling..............................................................38
13.3.2 Semi-onderbroken spoeling...............................................................................................38
13.3.3 Ononderbroken- of permanente spoeling.........................................................................38
3
, 14 Staalname........................................................................................................................................39
14.1 belangrijk stadia........................................................................................................................39
14.2 Techniekbeschrijving................................................................................................................39
14.2.1 Wisser................................................................................................................................39
14.2.2 Aspiraat..............................................................................................................................39
14.3 Cultuur......................................................................................................................................40
14.4 Gramkleuring............................................................................................................................40
14.5 Antibiogram..............................................................................................................................40
15 Postoperatieve wondinfecties.........................................................................................................41
15.1 Infectiegebied...........................................................................................................................41
15.2 Soorten.....................................................................................................................................41
15.2.1 Oppervlakkige incisionele wondinfecties...........................................................................41
15.2.2 Diepe incisionele wondinfecties........................................................................................41
15.2.3 Postoperatieve infectie van een orgaan of lichaamsholte.................................................41
15.3 Bepaling van infectierisico........................................................................................................41
15.4 Preventie postoperatieve wondinfecties..................................................................................42
15.5 Reglement operatiekamer........................................................................................................42
Wondzorg
4
2 Definitie wonde...................................................................................................................................5
3 Wondgenezingsproces.........................................................................................................................5
3.1 Ontstekingsfase (0 tot 6 d)............................................................................................................6
3.1.1 Opruimfase............................................................................................................................6
3.1.2 Klinische tekens ontstekingsfase...........................................................................................6
3.2 Proliferatie of granulatiefase (3 tot 24 d).....................................................................................6
3.3 Maturatiefase (tot 6 mnd)............................................................................................................7
3.4 Littekenvorming............................................................................................................................7
3.4.1 Stoornissen in littekenvorming..............................................................................................7
4 Types wondgenezing...........................................................................................................................7
4.1 Genezing pet primam...................................................................................................................7
4.2 Genezing per secundam...............................................................................................................8
4.3 Regeneratieve wondgenezing van een oppervlakkige wonde......................................................8
5 Indeling van wonden...........................................................................................................................8
5.1 Uitzicht en vorm...........................................................................................................................8
5.2 Oorzaak.........................................................................................................................................8
5.2.1 Traumatische wonden...........................................................................................................8
5.2.1.1 EHBO – Mechanische wonden: Algemeen......................................................................9
5.2.1.2 EHBO – Thermale wonden – Algemeen........................................................................10
5.2.1.3 EHBO – Chemische wonden..........................................................................................10
5.2.1.4 EHBO – Stralingswonden..............................................................................................10
5.2.2 Iatrogene wonden...............................................................................................................10
5.2.3 Chronische wonden.............................................................................................................10
5.2.4 Ulcera...................................................................................................................................11
5.3 Infectiegraad...............................................................................................................................11
5.3.1 Besmette of gecontamineerde wonde.................................................................................11
5.3.2 Gekoloniseerde wonde........................................................................................................11
5.3.3 Kritisch gekoloniseerde wonde............................................................................................12
5.3.4 Geïnfecteerde wonden........................................................................................................12
5.3.5 Grens tussen kolonisatie en infectie....................................................................................13
5.3.6 Een goede wondverzorging.................................................................................................13
5.4 Kleur, exsudaat (vochtig of droog) en diepte..............................................................................13
5.4.1 Principes van TIME-Concept................................................................................................14
6 Wondgenezing...................................................................................................................................15
6.1 Beïnvloedende factoren.............................................................................................................15
1
, 6.1.1 Factoren eigen aan de wonde..............................................................................................15
6.1.2 Factoren eigen aan de patiënt.............................................................................................15
7 Diagnostiek van de wonde.................................................................................................................16
7.1 Wondbeeld.................................................................................................................................16
7.2 Patiëntbeeld...............................................................................................................................16
8 Wondverzorging................................................................................................................................17
8.1 Doel............................................................................................................................................17
9 Materiaalkennis.................................................................................................................................17
9.1 Verbandmaterialen.....................................................................................................................17
9.1.1 Actief/passief verband.........................................................................................................17
9.1.2 Passieve verbandmiddelen..................................................................................................18
9.1.2.1 Gaaskompres................................................................................................................18
9.1.2.2 Absorberend verband...................................................................................................19
9.1.2.3 Kant en klaar verband...................................................................................................19
9.1.2.4 Geïmpregneerd verband zonder medicinale toevoeging..............................................20
9.1.3 Secundair verband en/of fixatiemateriaal...........................................................................20
10 Wondhechting.................................................................................................................................20
10.1 Doel..........................................................................................................................................20
10.2 Hechtingsmateriaal...................................................................................................................21
10.2.1 Indeling..............................................................................................................................21
10.2.1.1 Haken of agraven........................................................................................................21
10.2.2 Hechtingsdraad..................................................................................................................22
10.2.2.1 Oppervlakkige of primaire hechtingen........................................................................22
10.2.2.2 Diepliggende of secundaire hecthing of steunhechtingen..........................................23
10.2.2.3 Wondlijm....................................................................................................................23
10.2.2.4 Zelfklevende sluitstrips...............................................................................................23
10.2.2.5 Externe fixator............................................................................................................24
10.2.2.5.1 Wondzorg............................................................................................................24
11 Wonddrainages...............................................................................................................................24
11.1 Definitie....................................................................................................................................24
11.2 Doel..........................................................................................................................................25
11.3 Soorten drainage......................................................................................................................26
11.3.1 Passieve drainage..............................................................................................................26
11.3.1.1 Tubulaire drain = open systeem..................................................................................26
11.3.1.2 Penrose of capillaire drain..........................................................................................27
11.3.1.3 Lamel..........................................................................................................................27
2
, 11.3.1.4 Tubulaire karteldrain..................................................................................................27
11.3.1.5 Drain van Kehr of T-drain............................................................................................28
11.3.1.6 Wieken........................................................................................................................29
11.3.2 Actieve drainage................................................................................................................29
11.3.2.1 Redondrainage............................................................................................................29
11.3.2.2 Jackson-Pratt...............................................................................................................31
11.4 Fixatiemogelijkheden drain......................................................................................................31
11.5 Aandachtspunten drain............................................................................................................31
11.6 Verzorging drain.......................................................................................................................31
12 Productkennis..................................................................................................................................32
12.1 Ontsmettingsmiddelen.............................................................................................................32
12.1.1 Wanneer is het zinvol de wonde te ontsmetten?..............................................................32
12.1.2 Keuze van het ontsmettingsmiddel....................................................................................32
12.1.3 Aanwijzingen bij het gebruik van alcoholische en waterachtige oplossingen....................33
12.1.4 Productkennis - Ontsmettingsmiddelen.............................................................................33
12.1.4.1 Alcoholen....................................................................................................................33
12.1.4.2 Chloorhexidine............................................................................................................34
12.1.4.3 Chloorverbindingen....................................................................................................34
12.1.4.4 Jodium en jodiumverbindingen..................................................................................34
12.1.4.5 HAC.............................................................................................................................35
12.1.4.6 Eosine.........................................................................................................................35
12.1.4.7 Azijnzuur.....................................................................................................................36
12.1.5 Besluit................................................................................................................................36
13 Wondspoeling..................................................................................................................................36
13.1 Soorten spoelvocht...................................................................................................................36
13.1.1 Chloramine-T 0.5% in waterige oplossing (Dakin-oplossing).............................................36
13.1.2 Hibidil®................................................................................................................................37
13.1.3 Iso-betadine® dermicum.....................................................................................................37
13.1.4 Azijnzuur 2%......................................................................................................................37
13.1.5 NaCl 0.9% of fysiologische oplossing.................................................................................37
13.1.6 Antibiotica..........................................................................................................................38
13.2 Gevaren en moeilijkheden bij het spoelen...............................................................................38
13.3 Soorten wondspoeling..............................................................................................................38
13.3.1 Onderbroken- of gefractioneerde wondspoeling..............................................................38
13.3.2 Semi-onderbroken spoeling...............................................................................................38
13.3.3 Ononderbroken- of permanente spoeling.........................................................................38
3
, 14 Staalname........................................................................................................................................39
14.1 belangrijk stadia........................................................................................................................39
14.2 Techniekbeschrijving................................................................................................................39
14.2.1 Wisser................................................................................................................................39
14.2.2 Aspiraat..............................................................................................................................39
14.3 Cultuur......................................................................................................................................40
14.4 Gramkleuring............................................................................................................................40
14.5 Antibiogram..............................................................................................................................40
15 Postoperatieve wondinfecties.........................................................................................................41
15.1 Infectiegebied...........................................................................................................................41
15.2 Soorten.....................................................................................................................................41
15.2.1 Oppervlakkige incisionele wondinfecties...........................................................................41
15.2.2 Diepe incisionele wondinfecties........................................................................................41
15.2.3 Postoperatieve infectie van een orgaan of lichaamsholte.................................................41
15.3 Bepaling van infectierisico........................................................................................................41
15.4 Preventie postoperatieve wondinfecties..................................................................................42
15.5 Reglement operatiekamer........................................................................................................42
Wondzorg
4
