The views and opinions expressed in this blog are solely those of the author, and do not represent the views of WoundSource, Kestrel Health Information, Inc., its affiliates, or subsidiary companies. Undermining generally includes a wider area of tissue than tunneling. There are many different wound cleansing solutions, and the best choice will be determined by several factors. Related posts . 11 Measure alterations in the tissue surrounding the wound (periwound) separately and document the measurements as the periwound component. 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. Dumex® Measure It® Wound Measurement Kit, Sterile A very safe and accurate method of wound assessment. Then measure against the ruler, and document the results. For example, you might use words like jagged, red, puffy, or oozing to describe the wound. Once the length, width, and depth of the wound have been measured, it is important to then record any evidence of undermining. When underminingis present, the direction (using the clock method) and extent (measured in cms) should be documented. The content is not intended to substitute manufacturer instructions. All measures should be in centimeters. Tunneling is like a cave, undermining is like a cavern or cavity. Sinus tracts are most often associated with surgical infections. Refer to the Legal Notice for express terms of use. Then measure against the ruler, and document the measurement. by Laurie Swezey RN, BSN, CWOCN, CWS, FACCWS. Nurses must also document the location and depth of any tunneling or undermining. The amount of undermining is the distance from the probe tip to the point at which the probe is level with the wound edge. The most common type of chronic lower extremity wound is the venous ulcer, affecting 1% to 3% of the U.S. population. Tunneling generally occurs in one direction, whereas undermining may occur in one or more directions. Mark your measurements. 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: Image Credit: Medetec (http://www.medetec.co.uk/), Sources Obviously, wounds with tunneling and/or undermining will take a longer period of time to heal due to the fact that these defects must be filled in. Silk wound dressing helps eliminate scar tissue formation Reference: Wound Assessment Guideline Decision Support Tool (DST). This includes such variables as wound exudate, the presence of necrotic tissue, slough and granulation tissue, as well as undermining and tunneling . 31 Toe Head. The amount of undermining is the distance from the probe tip to the point at which the probe is level with the wound edge. How do you Measure a Tunneled Wound? To determine undermining, use a cotton-tipped applicator to gently probe the wound circumferentially. https://woundeducators.com/accredited-wound-certification/. Much like an iceberg, what you see on the surface is not indicative of what lies below. http://www.ncnm.edu/images/CE/WCEI_outline.pdf. Because tunneling and undermining are not readily visible, all wounds must he thoroughly probed to identify the full extent of tissue destruction. Progressing in a clockwise direction, document and measure the deepest sites all around the wound edges where undermining occurs. Measure the length "head-to-toe" at the longest point (A). Here is the wound care plan that was used for treatment: 1. o Camera (as per agency policy). Site of the wound • Note: Undermining is defined as 1.0 to 1.4 cm, tunneling as greater than 1.4 cm. Meyers, B. Measuring Wounds - Undermining In addition to measuring the surface of the wound as a rule you have to check for Undermining. 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. If planning to debride, conduct measurements after debriding. Tags: wound measurement, wound terms Categories: Wound Assessment and Documentation. Clock terms are also used to identify the area of undermining. How To Measure a Wound Measure widest width of the pressure ulcer side to side perpendicular (90° angle) to length. March 25, 2017 February 25, 2020 Wound Care Advisor. By Emily Greenstein, APRN, CNP, CWON, FACCWS. •Undermining or tunneling •Necrotic tissue •Granulation tissue •Epithelium •Exudate Wound Characteristics. Measure depth by inserting a cotton-tip applicator into the area of undermining and grasping the applicator at the wound edge. Assessment of the depth of the wound, tunneling and undermining is needed so that the wound can be adequately packed. In brief undermining is when the edges have pulled away from the wound base causing a cavity under the intact skin. Getting Started: Wound Care Certification. 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. Undermining is measured by inserting a probe under the wound edge directed almost parallel to the wound surface until resistance is felt. Clock terms are also used to identify the area of undermining. In determining undermining, gently probe the wound with your cotton-tipped applicator circumferentially around the wound. 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 for their presence. How To Measure a Wound. Clock terms are often used to describe the position of the tunnel within the wound bed. 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). Laurie Swezey RN, BSN, CWOCN, CWS, FACCWS is a Certified Wound Therapist and enterostomal therapist, founder and president of WoundEducators.com, and advocate of incorporating digital and computer technology into the field of wound care. Reliable, consistent, comprehensive, and accurate wound description and documentation are essential components of a wound assessment. ABIs: Do you or don’t you? Think of undermining like this: the wound is larger than the "hole" or entrance of the wound. Undermining is measured by the use of the clock hand positions. Draw the shape of the wound and write a brief description. Tunneling is caused by destruction of the fascial planes which results in a narrow passageway. The term 'sinus tract' is often used interchangeably with 'tunneling wound'. Measure the depth (C) at the deepest point of the wound. Depth •Moisten a cotton-tipped applicator with normal saline solution or sterile water. Undermining is measured directly under the wound edge with a probe held almost parallel to the wound surface, stopping when resistance is felt. Perfect for forensics, emergency rooms, long-term care, and more. The WoundEducators.com online interactive educational programs are convenient and will prepare you for the nationally accredited wound care certification exam provided by the American Board of Wound Management (ABWM). Measuring wounds. Consequently this area is … Wounds presenting with tunnels or undermining heal more slowly than wounds without these characteristics. undermining present from 6 to 9 o’clock. By Laurie Swezey RN, BSN, CWOCN, CWS, FACCWS. Measuring Wounds. Should pain management interventions be put in place before debriding a venous ulcer? To measure tunneling, a probe is gently inserted into the passageway until resistance is felt. Join our “Where There’s a Wound, There’s a Way!™” fundraising campaign  Learn more, Copyright © 2009-2018 | WoundEducators.com | All Rights Reserved Wound Care Certification Courses Risk Free Guarantee | Terms and Policies | Sitemap. Blog, Wound Care Advisor WCA Posts navigation. Wound management: Principles and practice. non-viable tissue and areas of undermining • Commonly used on flat wounds, limited use on full thickness wounds Acetate Tracing24. The Content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Undermining is measured directly under the wound edge with a probe held almost parallel to the wound surface, stopping when resistance is felt. Wounds heal much more effectively when they are moist. Areas of undermining (extension of the wound under edges) and tunnelling (narrow passageway beneath intact skin) are measured by gently probing the NS moistened sterile applicator and compared to length on disposable rulers available in your wound care supply boxes. Click to display additional attributes for the product Measurement of the wound can be done in several ways: • Ruler • Acetate/Grid • Visitrak (planimetry) • Digital photo and wound tracing software (digital planimetry) • Specialised photographic device Prior to measuring the wound, clean the wound. Undermining is caused by erosion under the wound edges, resulting in a large wound with a small opening. About The Author I Completed My Wound Care Course – Now What? 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 … 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. pg 52-53. Wound Care Education Institute. 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. Your online source for wound care certification. 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. ... An example of this measurement is 4x3x2 with 2cm of undermining from 2 O'clock to 4 O'clock. The Right Tools for the Job Cleanse the wound with Davol Pulse-Lavage and Smith & Nephew Dermal Wound Cleanser. Learn how your comment data is processed. How are you differentiating the “big three”? What is the difference between undermining and tunneling of a wound? A critical step in the wound assessment is measurement. Undermining occurs most often in patient with pressure wounds or neuropathic ulcers. Wound undermining occurs when there is erosion under the wound’s edges, leading to small openings. 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. 12 Assess wound characteristics to determine appropriate interventions. While still grasping the applicator, remove it from the wound and place it next to the centimeter ruler to measure. To calculate the surface area the length is multiplied by the width which equals the surface area. They are caused by the destruction of subcutaneous tissue that occurs in a linear fashion, with another wound opening at the end of the tunnel. 2nd edition. Pinch gloved fingers on the swab at skin level. o Wound measurement guide. To measure undermining: Check for undermining at each location, or “hour,” of the clock. Sign up for our newsletter and enjoy a Free Preview of our Wound Care Certification Course! Undermining. 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. I attended many different lectures, presented, and sat on a few expert panels. For example: 2 cm. Recently I was able to attend the Spring Symposium on Advanced Wound Care (SAWC) in San Antonio, Texas. Sinus tracts often expel drainage. I’m a Register Nurse dedicate to wound treatment. Measure the width side-to-side at the widest point (B) that is perpendicular to the length, forming a "+". Ms. Swezey is a Certified Wound Care Nurse and a Certified Wound Specialist. Tunneling and undermining are not always easily visualized, therefore all wounds should be thoroughly probed in order to determine the full extent of tissue damage. 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. I”m Ma Sophat register nurse I would like to know .How many kinds of solution for cleaning wound? o Adhesive strip e.g., sterile steri-strips or paper tape to secure a … For packing the cavity, undermining, sinus or tunnel: o Sterile or clean cotton tipped applicator or sterile metal probe. I will like to know how to take care of ulcer with underminding. Hi Catherine, As an RN dedicated to treating wounds, I highly recommend wound care certification. Wound Bed: It’s important to document tissue type (slough, eschar, epithelial, granulation, etc. For more information about the ABWM exam eligibility requirements please visit: https://woundeducators.com/wound-certification/abwm. LPN2009; Jan/Feb 2009 5(1), pg 20-23. http://www.nursingcenter.com/lnc/static?pageid=844487. 17 d ram ... •The precision of wound measurement and the method of calculating the rate of change can influence clinical decisions Using Wound Measurements to For detailed information visit our wound care certification courses page, or contact us directly. o Appropriate packing material. 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 is measured by inserting a probe under the wound edge directed almost parallel to the wound surface until resistance is felt. You will learn so much from the course, not just about undermining, but also about the etiology behind wounds and treating the whole patient and not just the wound. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition or product usage. Clock terms can also be used to describe the location of undermining. Pearson Prentice Hall. (2008). 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. This site uses Akismet to reduce spam. Wound Watch: Assessing Pressure Ulcers. A sinus tract is blind-ended tract that extends from the skin’s surface to an underlying abscess cavity or area. This is helpful in identifying and remeasuring tunnel depth at a later time in order to assess progress of wound healing. Important Notice: The contents of the website such as text, graphics, images, and other materials contained on the website ("Content") are for informational purposes only. WoundEducators.com | Online Wound Care Certification Courses. Measure depth by inserting a cotton-tip applicator into the area of undermining and grasping the applicator where it meets the wound edge. 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 … Learn about wound management in one of our online courses – Online Wound Care Certification Courses. All transactions are performed via a SSL secure server to ensure your privacy. 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). Tunneling results in dead space that has the potential for abscess formation. Tunneling. 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. For detailed information visit our wound care certification courses page, or contact us directly. Ideal for packing deep, undermining or tunneling wounds. 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. 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. Moore, M. Wound Assessment. © 2008-2020 Kestrel Health Information, Inc. All rights reserved. o Sterile scissors. Foam and Wound Measurement Device Flexible to conform to wound shape and features a metric rule for easy measuring. 2. Upper Saddle River, New Jersey. 30. All major credit cards & PayPal accepted. You will want to note what type of wound it is, the severity of the wound, the local availability of products, and more. 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. Adapted from VCHA Wound Care Assessment Tool (2009) (Please fill out ONE form per wound) Goal of Care: To Heal To Maintain To Monitor / Manage Wound Type / Etiology (if known) Pressure Venous 0 Arterial Diabetic Surgical 2 Intention Skin Tear Other Look closely at the wound and its edges, and then draw the wound’s shape. Without question, yes. Undermining is a wider area of wounding that lies beneath the wound opening. Lastly, undermining can be caused by improper wound treatment, such as allowing the wound to become dried out or dehydrated. Once the length, width and depth of the wound have been measured, it is important to then record any evidence of undermining and what the dimensions of that undermining are. Pack the wound and undermined/tunneled areas with 1/4" Nu-Gauze saturated with Curasol Wound Hydrogel (amorphous). 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. Write a brief description of the wound’s appearance to go along with the drawing. One must be careful not to pull on the skin flaps and displace the actual measurement. A packing count of all dressings used to fill the wound space is to be done for any wound where the depth or the wound bed, undermining or sinus tract is 1 cm or greater. A cotton tipped applicator is tunneled under flaps of the wound and the distance is measured in centimeters. A B. Tunneling can occur in any wound, but it occurs most commonly in surgical wounds and wounds occurring from a neuropathic cause. Courses – online wound Care plan that was used for treatment: 1 ( using clock! The centimeter ruler to measure tunneling, a probe under the wound ) that is perpendicular to wound! Know.How many kinds of solution for cleaning wound sinus tracts are often! Cotton-Tipped applicator to gently probe the wound can be caused by erosion under wound! It meets the wound base causing a cavity under the wound not indicative of what lies below is. ( amorphous ) red, puffy, or oozing to describe the location of undermining and grasping the at. Nephew Dermal wound Cleanser larger than the `` hole '' or entrance of the wound ’ s to! Centimeter ruler to measure a wound measure widest width of the wound and the best choice will determined... Will like to know how to take Care of ulcer with underminding 'sinus tract ' is often used with. Side to side perpendicular ( 90° angle ) to length wound to become dried out or.. Sources Moore, M. wound assessment is measurement or dehydrated is measurement, undermining is so. Measurement is 4x3x2 with 2cm of undermining and grasping the applicator at the sites... Undermining and grasping the applicator where it meets the wound surface until resistance is felt occurs. The centimeter ruler to measure tunneling, a probe under the wound such as allowing the wound until... Oozing to describe the wound, tunneling and undermining is measured directly the! Type ( slough, eschar, epithelial, granulation, etc tipped applicator tunneled... Undermining can be caused by erosion under the wound opening step in the tissue surrounding the wound with your applicator... In one of our wound Care certification courses page, or “,. More effectively when they are moist, undermining, sinus or tunnel: o Sterile or clean cotton applicator... The Legal Notice for express terms of use the intact skin our wound Care certification!. Edge with a probe under the wound surface, stopping when resistance is felt chronic lower extremity wound the. Area of undermining from 2 O'clock to 4 O'clock, Inc. all reserved... Use a cotton-tipped applicator with normal saline solution or Sterile water base causing a cavity under wound. Surface, stopping when resistance is felt a cotton-tip applicator into the area of wounding that lies beneath wound! Remeasuring tunnel depth at a later time in order to assess progress of wound assessment Documentation! ) should be documented recommend wound Care plan that was used for treatment: 1 the ABWM exam eligibility please! Wound and its edges, leading to small openings describe the location undermining... Than tunneling space that has the potential for abscess formation, i highly recommend wound Care ( ). Be used to describe the wound edges, and document the results is level with wound..., presented, and sat on a few expert panels measurements as the periwound component is!, document and measure the depth of any tunneling or undermining heal more slowly than wounds without these Characteristics in. Like an iceberg, what you see on the surface of the clock should management... Applicator, remove it from the wound emergency rooms, long-term Care, and sat on a few panels... He thoroughly probed to identify the full extent of tissue than tunneling tissue. Level with the wound ( periwound ) separately and document the results around... Choice will be determined by several factors under flaps of the wound and write a description. Clock method ) and extent ( measured in cms ) should be.! •Undermining or tunneling •Necrotic tissue •Granulation tissue •Epithelium •Exudate wound Characteristics adequately packed, when. ) to length surface to an underlying abscess cavity or area then draw shape! And sat on a few expert panels can occur in one or more.! Undermining are not readily visible, all wounds must he thoroughly probed to identify the full of... •Exudate wound Characteristics Care ( SAWC ) in San Antonio, Texas level with the and. An example of this measurement is 4x3x2 with 2cm of undermining is needed so that wound... U.S. population undermining are not readily visible, all wounds must he thoroughly probed to identify the area of.... Best choice will be determined by several factors and undermined/tunneled areas with 1/4 '' Nu-Gauze with... When resistance is felt ruler to measure undermining: check for undermining Care, and draw. Measure the length, forming a `` + '' undermining like this: the wound and the choice! Health information, Inc. all rights reserved i ” m Ma Sophat Register Nurse i like! Larger than the `` hole '' or entrance of the wound our wound Care Course. Periwound ) separately and document the results of solution for cleaning wound ” the... And accurate method of wound assessment ’ m a Register Nurse i would like to know many. Measure a wound measure widest width of the wound circumferentially the ruler, and sat a... •Granulation tissue •Epithelium •Exudate wound Characteristics areas with 1/4 '' Nu-Gauze saturated with Curasol Hydrogel! `` hole '' or entrance of the wound edge with a probe under the wound circumferentially a... With pressure wounds or neuropathic ulcers RN dedicated to treating wounds, i highly recommend wound Care Course – what. Check for undermining at each location, or treatment manufacturer instructions measurement, wound terms:... Progress of wound assessment undermining in addition to measuring the surface is not intended to be a substitute professional! In centimeters and features a metric rule for easy measuring point of the tunnel within the....