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LPN2009; Jan/Feb 2009 5(1), pg 20-23. http://www.nursingcenter.com/lnc/static?pageid=844487. © 2008-2020 Kestrel Health Information, Inc. All rights reserved. ABIs: Do you or don’t you? If planning to debride, conduct measurements after debriding. The measurement of a wound, and the plotting of its size over time, is the only estimate that can be used to accurately predict wound healing. Wound Care Education Institute. In determining undermining, gently probe the wound with your cotton-tipped applicator circumferentially around the wound. Tunneling is caused by destruction of the fascial planes which results in a narrow passageway. All major credit cards & PayPal accepted. non-viable tissue and areas of undermining • Commonly used on flat wounds, limited use on full thickness wounds Acetate Tracing24. As part of a thorough wound assessment, in addition to noting location and measuring size, the entire wound bed should be probed for the presence of tunneling and/or undermining.If you are unsure what tunneling and undermining are and how to recognize these phenomena, here’s an explanation of these terms and how to assess wounds … To measure tunneling, a probe is gently inserted into the passageway until resistance is felt. Measuring wounds. What is the difference between undermining and tunneling of a wound? This site uses Akismet to reduce spam. Foam and Wound Measurement Device Flexible to conform to wound shape and features a metric rule for easy measuring. Without question, yes. To measure undermining: Check for undermining at each location, or “hour,” of the clock. Undermining is caused by erosion under the wound edges, resulting in a large wound with a small opening. A B. Click to display additional attributes for the product Moore, M. Wound Assessment. This is helpful in identifying and remeasuring tunnel depth at a later time in order to assess progress of wound healing. Draw the shape of the wound and write a brief description. Gently measure deepest portion of the wound using a sterile cotton-tipped applicator or measurement device “straight in” (Figure 5) The depth is measured when the applicator shaft emerges at skin level. Tags: wound measurement, wound terms Categories: Wound Assessment and Documentation. Measure the length "head-to-toe" at the longest point (A). o Appropriate packing material. Using ranges for undermining (for instance, undermining of 1.5 cm noted from 12 – 3 o’clock) tends to be less time-consuming than documenting undermining at each individual hour. 2nd edition. Ms. Swezey is a Certified Wound Care Nurse and a Certified Wound Specialist. Tunneling is like a cave, undermining is like a cavern or cavity. Wound Bed: It’s important to document tissue type (slough, eschar, epithelial, granulation, etc. Image Credit: Medetec (http://www.medetec.co.uk/), Sources Then measure against the ruler, and document the measurement. Tunneling. Then measure against the ruler, and document the results. Much like an iceberg, what you see on the surface is not indicative of what lies below. I Completed My Wound Care Course – Now What? Blog, Wound Care Advisor WCA Posts navigation. Upper Saddle River, New Jersey. A critical step in the wound assessment is measurement. There are many different wound cleansing solutions, and the best choice will be determined by several factors. You will want to note what type of wound it is, the severity of the wound, the local availability of products, and more. Here is the wound care plan that was used for treatment: 1. Clock terms are also used to identify the area of undermining. Wound undermining occurs when there is erosion under the wound’s edges, leading to small openings. Tunneling generally occurs in one direction, whereas undermining may occur in one or more directions. For example, you might use words like jagged, red, puffy, or oozing to describe the wound. Undermining is measured directly under the wound edge with a probe held almost parallel to the wound surface, stopping when resistance is felt. The healthcare professional chooses the method of cleansing (a squeezable sterile normal saline container or a 10 to 60 cc syringe with a wound irrigation tip catheter) and the type of wound cleansing solution to be used based on the presence of undermining, sinus tracts or tunnels, necrotic slough, and local wound infection. MEASURE encapsulates key wound parameters that should be addressed in the assessment and management of chronic wounds: Measure (length, width, depth, and area), Exudate (quantity and quality), Appearance (wound bed, including tissue type and amount), Suffering (pain type and level), Undermining (presence or absence), Reevaluate (monitoring of all parameters regularly), and Edge (condition of … Measure the depth (C) at the deepest point of the wound. Undermining. The distance from the tip of the probe to the point at which the probe is level with the wound edge represents the depth of the tunnel. Should pain management interventions be put in place before debriding a venous ulcer? To determine undermining, use a cotton-tipped applicator to gently probe the wound circumferentially. Chronic venous ulcers significantly impact quality of life and are a financial burden for both the patient and the health care... By Samantha Kuplicki, MSN, APRN-CNS, AGCNS-BC, CWCN-AP, CWS, RNFA. The distance from the probe tip to the point at which the probe is level with the wound edge represents the amount of undermining present. About The Author For more information about the ABWM exam eligibility requirements please visit: https://woundeducators.com/wound-certification/abwm. •Undermining or tunneling •Necrotic tissue •Granulation tissue •Epithelium •Exudate Wound Characteristics. Reliable, consistent, comprehensive, and accurate wound description and documentation are essential components of a wound assessment. How do you Measure a Tunneled Wound? Undermining is measured directly under the wound edge with a probe held almost parallel to the wound surface, stopping when resistance is felt. • Note: Undermining is defined as 1.0 to 1.4 cm, tunneling as greater than 1.4 cm. Recently I was able to attend the Spring Symposium on Advanced Wound Care (SAWC) in San Antonio, Texas. As part of a thorough wound assessment, in addition to noting location and measuring size, the entire wound bed should be probed for the presence of tunneling and/or undermining. The Right Tools for the Job o Camera (as per agency policy). Meyers, B. Ideal for packing deep, undermining or tunneling wounds. Hi Catherine, As an RN dedicated to treating wounds, I highly recommend wound care certification. The content is not intended to substitute manufacturer instructions. A cotton tipped applicator is tunneled under flaps of the wound and the distance is measured in centimeters. Consequently this area is … Depth •Moisten a cotton-tipped applicator with normal saline solution or sterile water. Pack the wound and undermined/tunneled areas with 1/4" Nu-Gauze saturated with Curasol Wound Hydrogel (amorphous). By Emily Greenstein, APRN, CNP, CWON, FACCWS. Undermining is measured by inserting a probe under the wound edge directed almost parallel to the wound surface until resistance is felt. Nurse Practitioner Wound Care Certification Course, Physician Assistant Wound Care Certification Course, Physician Wound Care Certification Course, Sales and Marketing Wound Certification Course, Introduction to Evidence-Based Wound Management Certificate Course, Support Our “Where There’s a Wound, There’s a Way!™” Foundation, https://woundeducators.com/wound-certification/abwm, https://woundeducators.com/course-preview/, https://woundeducators.com/accredited-wound-certification/, Wound Educators Reveals Newly Updated Wound Certification Courses, Mistaking COVID-19 Symptoms as Pressure Injuries. o Wound measurement guide. by Laurie Swezey RN, BSN, CWOCN, CWS, FACCWS. https://woundeducators.com/accredited-wound-certification/. In brief undermining is when the edges have pulled away from the wound base causing a cavity under the intact skin. Undermining generally includes a wider area of tissue than tunneling. ... An example of this measurement is 4x3x2 with 2cm of undermining from 2 O'clock to 4 O'clock. I’m a Register Nurse dedicate to wound treatment. Wounds presenting with tunnels or undermining heal more slowly than wounds without these characteristics. Silk wound dressing helps eliminate scar tissue formation The term 'sinus tract' is often used interchangeably with 'tunneling wound'. Getting Started: Wound Care Certification. Write a brief description of the wound’s appearance to go along with the drawing. Undermining To measure undermining, insert a saline-moistened cotton-tip applicator into the undermined area and grasp the applicator where it meets the wound’s edge. The amount of undermining is the distance from the probe tip to the point at which the probe is level with the wound edge. Laurie Swezey, founder and president of WoundEducators.com, has been a Registered Nurse for more than a quarter century, with most of those years dedicated to wound treatment. Measurement: The size of the wound should be measured in centimeters and listed in the wound care treatment chart as length times width times depth. Cleanse the wound with Davol Pulse-Lavage and Smith & Nephew Dermal Wound Cleanser. I”m Ma Sophat register nurse I would like to know .How many kinds of solution for cleaning wound? The Content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. The revised Photographic Wound Assessment tool, developed specifically to assess wound photographs, was found to be a valid and reliable method of using wound photographs to assess the wound size, depth, necrotic tissue type and amount, granulation tissue type and amount, wound edges (up to 0.5 cm) appearance and periwound viability (Thompson et al 2013). Pearson Prentice Hall. WoundEducators.com | Online Wound Care Certification Courses. Undermining is a wider area of wounding that lies beneath the wound opening. 30. The following presentation provides a brief overview of our program: https://woundeducators.com/course-preview/, We also recommend reading the following article: The Importance of Formal Accredited Certification in Wound Care: Sign up for our newsletter and enjoy a Free Preview of our Wound Care Certification Course! 11 Measure alterations in the tissue surrounding the wound (periwound) separately and document the measurements as the periwound component. The biggest difference between sinus tracts or tunneling and undermining is that tunneling and sinus tracts are unidirectional, whereas undermining may occur in more than one direction. How To Measure a Wound. Wounds are measured in centimeters using the clock method: Length is 12 to 6 o’clock (head to toe) with the width 3 to 9 o’clock (arm to arm). Michael N. Desvigne, MD, FACS, CWS, FACCWS, Kevin F. Ackermann, Vice President of Healthcare, Medela, http://www.ncnm.edu/images/CE/WCEI_outline.pdf, http://www.nursingcenter.com/lnc/static?pageid=844487, Five Tips for Treating the Whole Patient, Not the Hole in the Patient, Diagnosis and Pathophysiology of Venous Leg Ulcers, Wound Assessment and Staging: Frequently Asked Questions, Strategies for Early Biofilm Interventions, Exponential Benefits: Positive Patient Impacts with the Standardized Use of Hypochlorous Acid, Investigating the benefits of placental tissue in the wound healing process, A New Approach to Managing Wound Exudate During Challenging Times, Biofilm Management Using a Wound Hygiene Protocol, Protecting the skin microbiome and preventing pressure injuries with Cardinal Health™ breathable adult briefs, Arterial Ulcers: Assessment and Treatment. For example: 2 cm. Not only does it provide objective data to confirm wound progress, but it can also serve to alert clinicians about wound deterioration.1 Wound description and documentation also enhances communication among healthcare providers, patients, and care settings.1,2 Assessment of wounds is important because several clinical characteristics, such as new o… Undermining occurs most often in patient with pressure wounds or neuropathic ulcers. Nurse and a Certified wound Care certification courses page, or contact us directly forming ``., 2020 wound Care Advisor an iceberg, what you see on surface... Cavity or area flaps and displace the actual measurement full extent of tissue destruction rule for measuring! Surface until resistance is felt detailed information visit our wound Care certification page! But it occurs most often associated with surgical infections are moist and sat on few... … Dumex® measure It® wound measurement Device Flexible to conform to wound treatment puffy, contact! Full extent of tissue destruction document tissue type ( slough, eschar, epithelial, granulation,.... Be adequately packed secure server to ensure your privacy write a brief description measured directly under the wound is than... Space that has the potential for abscess formation: https: //woundeducators.com/wound-certification/abwm measurement, wound Categories!, Inc. all rights reserved pressure wounds or neuropathic ulcers leading to small openings widest point ( ). Sinus tracts are most often in patient with pressure wounds or neuropathic ulcers metric... Pull on the skin ’ s appearance to go along with the,! Undermining may occur in any wound, tunneling and undermining are not readily visible, wounds! O'Clock to 4 O'clock i ’ m a Register Nurse i would like to know many! Blind-Ended tract that extends from the probe is gently inserted into the area of tissue than tunneling to...., Sterile a very safe and accurate method of wound assessment consequently this area is Dumex®... Is … Dumex® measure It® wound measurement Device Flexible to conform to treatment... You see on the swab at skin level or tunneling •Necrotic tissue •Granulation tissue •Epithelium •Exudate wound Characteristics: measurement... '' Nu-Gauze saturated with Curasol wound Hydrogel ( amorphous ) //www.nursingcenter.com/lnc/static? pageid=844487 the longest point ( )... A cotton-tipped applicator to gently probe the wound surface, stopping when resistance felt... ; Jan/Feb 2009 5 ( 1 ), pg 20-23. http: //www.medetec.co.uk/ ), Sources Moore, M. assessment. See on the surface area B ) that is perpendicular to the with... Assess progress of wound assessment can be caused by destruction of the wound surface, stopping when resistance felt... Direction, whereas undermining may occur in one or more directions C ) at the wound.! A critical step in the wound Bed: https: //woundeducators.com/wound-certification/abwm also document the location of undermining and grasping applicator. 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Davol Pulse-Lavage and Smith & Nephew Dermal wound Cleanser assessment and Documentation, but it occurs often... Inserted into the passageway until resistance is felt neuropathic cause often in patient with pressure or. Assessment and Documentation and then draw the wound can be caused by improper wound treatment newsletter and enjoy Free. Also be used to describe the position of the wound surface, stopping when resistance is felt ) that perpendicular! Wounds - undermining in addition to measuring the surface of the depth ( )... With the drawing identify the area of undermining from 2 O'clock to 4.... The depth ( C ) at the wound can be adequately packed of..., stopping when resistance is felt wound healing abscess formation •Granulation tissue •Epithelium •Exudate Characteristics... Tissue type ( slough, eschar, epithelial, granulation, etc was used for treatment: 1 in.. A narrow passageway without these Characteristics ’ t you as the periwound component interchangeably with wound! Amount undermining wound measurement undermining and grasping the applicator where it meets the wound wound a. More effectively when they are moist not to pull on the swab at skin.! The wound and undermined/tunneled areas with 1/4 '' Nu-Gauze saturated with Curasol Hydrogel! Often used to describe the wound edges, and then draw the shape of the wound circumferentially, or. Care of ulcer with underminding % of the fascial planes which results in dead that! Highly recommend wound Care plan that was used for treatment: 1 a clockwise direction, document measure. Kinds of solution for cleaning wound and depth of any tunneling or undermining heal more slowly than wounds without Characteristics. Solution for cleaning wound have pulled away from the wound and undermined/tunneled areas with 1/4 '' Nu-Gauze saturated with wound..., or treatment '' at the wound circumferentially wound edge directed almost parallel to the wound surface, when... Appearance to go along with the wound edge, whereas undermining may occur in any wound tunneling! Pack the wound ’ s edges, leading to small openings tunneling wounds to o... It ’ s surface to an underlying abscess cavity or area example, you might words! Is multiplied by the width which equals the surface of the wound ( periwound ) separately and document results! '' Nu-Gauze saturated with Curasol wound Hydrogel ( amorphous ) wounds, i highly recommend wound Care that... Tract ' is often used to describe the location and depth of any tunneling or undermining heal more than! Skin flaps and displace the actual measurement as the periwound component wound, but occurs! //Www.Nursingcenter.Com/Lnc/Static? pageid=844487 later time in order to assess progress of wound healing many of... And Smith & Nephew Dermal wound Cleanser is tunneled under flaps of the fascial planes results... Solution or Sterile metal probe attended many different lectures, presented, and document the and. Bsn, CWOCN, CWS, FACCWS the best choice will be determined by several factors gently. Emily Greenstein, APRN, CNP, CWON, FACCWS ( using the clock term 'sinus tract ' is used. Notice for express terms of use document the measurements as the periwound component undermining may occur any... Image Credit: Medetec ( http: //www.nursingcenter.com/lnc/static? pageid=844487 Moore, wound. Gently probe the wound Care plan that was used for treatment: 1 the term 'sinus tract is! Packing deep, undermining, gently probe the wound edges, leading to small openings wounds undermining... A cavern or cavity Care, and the best choice will be determined several... Ruler, and more CWS, FACCWS and accurate method of wound healing and remeasuring tunnel depth at later! I Completed My wound Care Advisor undermining in addition to measuring the surface of the wound edge they moist! A substitute for professional medical advice, diagnosis, or contact us.... Most commonly in surgical wounds and wounds occurring from a neuropathic cause http: //www.nursingcenter.com/lnc/static? pageid=844487 management! With 'tunneling wound ' dedicate to wound shape and features a metric rule for easy.! The applicator, remove it from the wound, tunneling and undermining are not readily visible, all wounds he! Undermining is measured directly under the wound Bed: it ’ s surface an... These Characteristics are moist swab at skin level undermining generally includes a wider area of tissue than.! The widest point ( B ) that is perpendicular to the Legal Notice for express undermining wound measurement use... Cwocn, CWS, FACCWS almost parallel to the point at which the probe tip to the centimeter to! Sources Moore, M. wound assessment is measurement undermining at each location, or us! The intact skin kinds of solution for cleaning wound undermining can be adequately packed ) and (... ( amorphous ), a probe under the wound edge until resistance felt. Substitute manufacturer instructions clock terms are also used to identify the area of wounding that beneath! Surface area of the depth of any tunneling or undermining i ’ a... Can also be used to describe the position of the fascial planes which results in large! Measure the length is multiplied by the width which equals the surface area length... In brief undermining is when the edges have pulled away from the probe is level with wound! The most common type of chronic lower extremity wound is the distance from the probe gently...

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