CBWT

Certified Basic Wound Therapy

BASIC CHRONIC WOUND

MANAGEMENT :
PERSIAPAN DASAR LUKA
BASIC ADVANCE WOUND CARE PROGRAM (BAWCP)

PLC – Professional Learning Center 2017

KAPAN LUKA DIKATAKAN KRONIK?
……………………….

CONTOH LUKANYA?
………………………..

BISA SEMBUH?
………………………

BAGAIMANA MERAWATNYA?
………………………..
 KARAKTERISTIK LUKA KRONIK

• Delayed healing yang terus 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, PU, Luka kanker
TIPE LUKA? BISA SEMBUH ????
TIPE LUKA? BISA SEMBUH ????
TIPE LUKA? BISA SEMBUH ????
 PRINSIP MANAJEMEN LUKA

• Kontrol & hilangkan penyebabnya

• Pressure, shear, friction, moisture, neurophathy
• Ciptakan dukungan sistemik
• Nutrisi & cairan, edema, GDS
• Ciptakan & pertahankan lingkungan luka
• Cegah infeksi, kebersihan luka, jaringan mati,
lembab, dll
 PINSIP MANAJEMEN LUKA KRONIK

• 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

• I : Inflammation & Infection control

• M: Moisture Balance

• E: Epithelial edge advancement

(Falanga, 2004)
WOUND BED PREPARATION
PERSIAPAN DASAR LUKA
 T: TISSUE MANAGEMENT

• Hilangkan jaringan mati & benda asing

• Debridemang:
• Surgical
• CSWD: tanpa nyeri & berdarah
• Enzymatic: hewan / herbal (enzim proteolitik)
• Autolytic: hypermoist- moisture balance
• Mechanical: kasa basah kering, hydroterapi, swab, pinset
• Chemical: Hydrogen peroxide, iodine cadexomer
• Biological: maggot
 CSWD
(CONSERVATIVE SHARP WOUND
DEBRIDEMENT)
CSWD
MEKANIKAL DEBRIDEMANG

DENGAN PINSET DENGAN KASA KERING

AUTOLYTIC DEBRIDEMENT
DENGAN MENGGUNAKAN
TOPICAL AB
MAGGOT
THERAPY
 I : INFLAMMATION &
INFECTION CONTROL

• Inflamasi: TCRD
• Infeksi: TCRD & HPO exudate, sistemik data
• Cairan pencuci
• Dressing yg tepat (topikal antimicrobial &
antiseptik)
• Sistemik therapy (jika perlu)
 CAIRAN PENCUCI LUKA

• Pilih cairan yang tepat

• Iodine / chlorhexidine / asam asetat 10 % / herbal dg
astrigen /feracrylum 1 % / Alkohol / Hypochlorite
• Air & sabun/normal salin/air hangat

• Efektif cara mencuci

• Swab
• Tekanan
• Irigasi
• 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 anaerobic conditions

Gram positive 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

• Pertahankan lembab yg seimbang

(winter, 1962)
• Manajemen:
• Dressing yg tepat, luka kering vs luka
basah
• Kompresi ??
 MOISTURE BALANCE

• Hydrogel, hydrocolloid,
• Hydrogel, hydrocolloid,
semiermiable film,
• Interactive wet
calsium alginate, Salep
dressing, Salep Tribee
Tribee

LUKA
LUKA
MINIMAL
KERING
EXUDATE

LUKA
BANYAK – LUKA
SANGAT MODERATE
• hydrofiber, foam BANYAK EXUDATE • Calsium alginate,
lembaran / cavity, extra EXUDATE hydrofiber, hydocoloid
padding, pasta/powder, foam, Salep
wound/ostomy bag Tribee-gauze
M: MOISTURE BALANCE
E: EPITHELIAL EDGE ADVANCEMENT

• Tepi luka yg baik?

• Manajemen:
• Pencucian adekuat
• Penipisan tepi luka
• Moisture balance dressing
E: EPITHELIAL EDGE
ADVANCEMENT
BISA SEMBUH ???
 DAFTAR PUSTAKA

• 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.
TERIMA KASIH