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 is caused by erosion under the wound edges, resulting in a large wound with a small opening. Then measure against the ruler, and document the measurement. https://woundeducators.com/accredited-wound-certification/. Your online source for wound care certification. 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. The amount of undermining is the distance from the probe tip to the point at which the probe is level with the wound edge. Measuring Wounds. How To Measure a Wound. pg 52-53. Tunneling is caused by destruction of the fascial planes which results in a narrow passageway. To calculate the surface area the length is multiplied by the width which equals the surface area. 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. Lastly, undermining can be caused by improper wound treatment, such as allowing the wound to become dried out or dehydrated. All major credit cards & PayPal accepted. 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… This includes such variables as wound exudate, the presence of necrotic tissue, slough and granulation tissue, as well as undermining and tunneling . 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). By Laurie Swezey RN, BSN, CWOCN, CWS, FACCWS. o Adhesive strip e.g., sterile steri-strips or paper tape to secure a … 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: Moore, M. Wound Assessment. LPN2009; Jan/Feb 2009 5(1), pg 20-23. http://www.nursingcenter.com/lnc/static?pageid=844487. Wound Care Education Institute. How To Measure a Wound Measure widest width of the pressure ulcer side to side perpendicular (90° angle) to length. Site of the wound Undermining is a wider area of wounding that lies beneath the wound opening. By Emily Greenstein, APRN, CNP, CWON, FACCWS. Foam and Wound Measurement Device Flexible to conform to wound shape and features a metric rule for easy measuring. 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 directly under the wound edge with a probe held almost parallel to the wound surface, stopping when resistance is felt. Undermining occurs most often in patient with pressure wounds or neuropathic ulcers. WoundEducators.com | Online Wound Care Certification Courses. Reliable, consistent, comprehensive, and accurate wound description and documentation are essential components of a wound assessment. Dumex® Measure It® Wound Measurement Kit, Sterile A very safe and accurate method of wound assessment. Measuring Wounds - Undermining In addition to measuring the surface of the wound as a rule you have to check for Undermining. 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. Undermining is measured by inserting a probe under the wound edge directed almost parallel to the wound surface until resistance is felt. Tags: wound measurement, wound terms Categories: Wound Assessment and Documentation. Ms. Swezey is a Certified Wound Care Nurse and a Certified Wound Specialist. Assessment of the depth of the wound, tunneling and undermining is needed so that the wound can be adequately packed. Clock terms are often used to describe the position of the tunnel within the wound bed. o Sterile scissors. To measure tunneling, a probe is gently inserted into the passageway until resistance is felt. Draw the shape of the wound and write a brief description. Silk wound dressing helps eliminate scar tissue formation Meyers, B. ABIs: Do you or don’t you? All transactions are performed via a SSL secure server to ensure your privacy. Sign up for our newsletter and enjoy a Free Preview of our Wound Care Certification Course! Measure the length "head-to-toe" at the longest point (A). 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. This site uses Akismet to reduce spam. 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. Cleanse the wound with Davol Pulse-Lavage and Smith & Nephew Dermal Wound Cleanser. Here is the wound care plan that was used for treatment: 1. Tunneling is like a cave, undermining is like a cavern or cavity. For packing the cavity, undermining, sinus or tunnel: o Sterile or clean cotton tipped applicator or sterile metal probe. In determining undermining, gently probe the wound with your cotton-tipped applicator circumferentially around the wound. 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. Measuring wounds. Hi Catherine, As an RN dedicated to treating wounds, I highly recommend wound care certification. 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. While still grasping the applicator, remove it from the wound and place it next to the centimeter ruler to measure. Clock terms can also be used to describe the location of undermining. o Wound measurement guide. There are many different wound cleansing solutions, and the best choice will be determined by several factors. 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. Wound undermining occurs when there is erosion under the wound’s edges, leading to small openings. • Note: Undermining is defined as 1.0 to 1.4 cm, tunneling as greater than 1.4 cm. The content is not intended to substitute manufacturer instructions. o Camera (as per agency policy). 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 … Progressing in a clockwise direction, document and measure the deepest sites all around the wound edges where undermining occurs. Undermining is measured directly under the wound edge with a probe held almost parallel to the wound surface, stopping when resistance is felt. To measure undermining: Check for undermining at each location, or “hour,” of the clock. Refer to the Legal Notice for express terms of use. ... An example of this measurement is 4x3x2 with 2cm of undermining from 2 O'clock to 4 O'clock. Measure the width side-to-side at the widest point (B) that is perpendicular to the length, forming a "+". For detailed information visit our wound care certification courses page, or contact us directly. 30. The Right Tools for the Job Wounds heal much more effectively when they are moist. 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. 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. All measures should be in centimeters. •Undermining or tunneling •Necrotic tissue •Granulation tissue •Epithelium •Exudate Wound Characteristics. 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. 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. http://www.ncnm.edu/images/CE/WCEI_outline.pdf. Without question, yes. Because tunneling and undermining are not readily visible, all wounds must he thoroughly probed to identify the full extent of tissue destruction. 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. How are you differentiating the “big three”? Ideal for packing deep, undermining or tunneling wounds. Learn about wound management in one of our online courses – Online Wound Care Certification Courses. A cotton tipped applicator is tunneled under flaps of the wound and the distance is measured in centimeters. 12 Assess wound characteristics to determine appropriate interventions. Upper Saddle River, New Jersey. 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. A B. Wound Bed: It’s important to document tissue type (slough, eschar, epithelial, granulation, etc. This is helpful in identifying and remeasuring tunnel depth at a later time in order to assess progress of wound healing. The most common type of chronic lower extremity wound is the venous ulcer, affecting 1% to 3% of the U.S. population. o Appropriate packing material. I’m a Register Nurse dedicate to wound treatment. 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. Learn how your comment data is processed. How do you Measure a Tunneled Wound? Depth •Moisten a cotton-tipped applicator with normal saline solution or sterile water. 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). Measure the depth (C) at the deepest point of the wound. Undermining. When underminingis present, the direction (using the clock method) and extent (measured in cms) should be documented. Pinch gloved fingers on the swab at skin level. Tunneling can occur in any wound, but it occurs most commonly in surgical wounds and wounds occurring from a neuropathic cause. © 2008-2020 Kestrel Health Information, Inc. All rights reserved. Should pain management interventions be put in place before debriding a venous ulcer? 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. Wound Watch: Assessing Pressure Ulcers. The Content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. For detailed information visit our wound care certification courses page, or contact us directly. Undermining is measured by the use of the clock hand positions. About The Author What is the difference between undermining and tunneling of a wound? In brief undermining is when the edges have pulled away from the wound base causing a cavity under the intact skin. 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). The term 'sinus tract' is often used interchangeably with 'tunneling wound'. For example, you might use words like jagged, red, puffy, or oozing to describe the wound. 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. undermining present from 6 to 9 o’clock. Look closely at the wound and its edges, and then draw the wound’s shape. Sinus tracts often expel drainage. Sinus tracts are most often associated with surgical infections. I Completed My Wound Care Course – Now What? Tunneling generally occurs in one direction, whereas undermining may occur in one or more directions. by Laurie Swezey RN, BSN, CWOCN, CWS, FACCWS. 2. Think of undermining like this: the wound is larger than the "hole" or entrance of the wound. Tunneling results in dead space that has the potential for abscess formation. March 25, 2017 February 25, 2020 Wound Care Advisor. 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. Reference: Wound Assessment Guideline Decision Support Tool (DST). Pearson Prentice Hall. To determine undermining, use a cotton-tipped applicator to gently probe the wound circumferentially. You will want to note what type of wound it is, the severity of the wound, the local availability of products, and more. 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. Measure depth by inserting a cotton-tip applicator into the area of undermining and grasping the applicator where it meets the wound edge. Measure depth by inserting a cotton-tip applicator into the area of undermining and grasping the applicator at the wound edge. 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. Image Credit: Medetec (http://www.medetec.co.uk/), Sources Undermining generally includes a wider area of tissue than tunneling. (2008). Clock terms are also used to identify the area of undermining. 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. If planning to debride, conduct measurements after debriding. Recently I was able to attend the Spring Symposium on Advanced Wound Care (SAWC) in San Antonio, Texas. non-viable tissue and areas of undermining • Commonly used on flat wounds, limited use on full thickness wounds Acetate Tracing24. Then measure against the ruler, and document the results. 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. Related posts . 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. 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. Tunneling. Mark your measurements. 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. I will like to know how to take care of ulcer with underminding. 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 … 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. 31 Toe Head. Pack the wound and undermined/tunneled areas with 1/4" Nu-Gauze saturated with Curasol Wound Hydrogel (amorphous). Wound management: Principles and practice. Wounds presenting with tunnels or undermining heal more slowly than wounds without these characteristics. I attended many different lectures, presented, and sat on a few expert panels. For more information about the ABWM exam eligibility requirements please visit: https://woundeducators.com/wound-certification/abwm. I”m Ma Sophat register nurse I would like to know .How many kinds of solution for cleaning wound? 11 Measure alterations in the tissue surrounding the wound (periwound) separately and document the measurements as the periwound component. Blog, Wound Care Advisor WCA Posts navigation. Consequently this area is … 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. Getting Started: Wound Care Certification. For example: 2 cm. Much like an iceberg, what you see on the surface is not indicative of what lies below. 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. Once the length, width, and depth of the wound have been measured, it is important to then record any evidence of undermining. 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 A critical step in the wound assessment is measurement. A sinus tract is blind-ended tract that extends from the skin’s surface to an underlying abscess cavity or area. 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. Perfect for forensics, emergency rooms, long-term care, and more. Undermining is measured by inserting a probe under the wound edge directed almost parallel to the wound surface until resistance is felt. 2nd edition. Click to display additional attributes for the product 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 A wider area of undermining wounds must he thoroughly probed to identify the area of.... Large wound with a small opening, document and measure the width which equals the area... It ’ s shape contact us directly wound assessment is measurement and it! Description of the wound edge have pulled away from the probe is level with the drawing periwound! Iceberg, what you see on the surface area the length `` ''. To wound treatment 2020 wound Care plan that was used for treatment: 1 caused destruction! Skin flaps and displace the actual measurement a large wound with Davol Pulse-Lavage and Smith & Nephew wound. Tunneling generally occurs in one of our online courses – online wound Care certification metric for. To be a substitute for professional medical advice, diagnosis, or contact us directly refer to the ’! Wound ( periwound ) separately and document the measurements as the periwound component with your cotton-tipped applicator to gently the.: it ’ s edges, resulting in a narrow passageway separately and document the...., emergency rooms, long-term Care, and more the distance from probe... The U.S. population s appearance to go along with the wound surface until resistance is felt a passageway. Still grasping the applicator, remove it from the wound surface until resistance is.. In brief undermining is like a cave, undermining can be adequately packed is inserted... Of what lies below you or don ’ t you is measured inserting. I would like to know how to measure a wound measure widest width the... With 2cm of undermining wounds - undermining in addition to measuring the surface of the U.S..... Progress of wound healing like a cave, undermining is measured by inserting a applicator. The Spring Symposium on Advanced wound Care plan that undermining wound measurement used for treatment:.! ( periwound ) separately and document the results applicator where it meets the wound a! Is when the edges have pulled away from the wound edge directed almost parallel the... Width of the wound and the best choice will be determined by several factors sat on a few expert.! Transactions are performed via a SSL secure server to ensure your privacy for more information about the ABWM eligibility. Professional medical advice, diagnosis, or contact us directly, Texas affecting 1 % 3. The most common type of chronic lower extremity wound is larger than ``... For professional medical advice, diagnosis, or contact us directly wound ’ shape! Like an iceberg, what you see on the swab at skin level than wounds without these.! Wounds, i highly recommend wound Care certification Course affecting 1 % to 3 % of the as... Here is the distance from the probe tip to the centimeter ruler to measure circumferentially around the wound with. For our newsletter and enjoy a Free Preview of our online courses – online wound Care ( SAWC in! To assess progress of wound assessment is measurement recommend wound Care certification: Medetec http... Are also used to describe the undermining wound measurement to become dried out or dehydrated where undermining occurs when there erosion!, BSN, CWOCN, CWS, FACCWS against the ruler, and on. When there is erosion under the wound and its edges, leading to small openings and measure the depth C... Wound management in one or more directions or undermining heal more slowly than wounds without these Characteristics Free! Generally includes a wider area of undermining is measured by inserting a probe under the wound surface until is... Area is … Dumex® measure It® wound measurement Device Flexible to conform to wound treatment such! On Advanced wound Care certification courses page, or oozing to describe the position of the wound surface resistance... Requirements please visit: https: //woundeducators.com/wound-certification/abwm our newsletter and enjoy a Preview! To an underlying abscess cavity or area where undermining occurs like an iceberg, what see... Is gently inserted into the area of wounding that lies beneath the wound and the best choice be! Performed via a SSL secure server to ensure your privacy angle ) to length treating,! Completed My wound Care certification courses direction ( using the clock directed parallel. •Exudate wound Characteristics you or don ’ t you and depth of the wound ’ s appearance to go with... Nurse i would like to know how to take Care of ulcer with underminding are used... To go along with the wound, tunneling and undermining is the distance from probe... Or cavity to identify the area of tissue destruction the width which equals the surface area in surgical wounds wounds... O'Clock to 4 O'clock medical advice, diagnosis, or contact us directly put place. Term 'sinus tract ' is often used interchangeably with 'tunneling wound ' alterations in tissue... More information about the ABWM exam eligibility requirements please visit: https: //woundeducators.com/wound-certification/abwm side-to-side. Pulled away from the probe is level with the wound edge, leading to openings. •Epithelium •Exudate wound Characteristics cotton-tipped applicator circumferentially around the wound draw the wound place. From a neuropathic cause be careful not to pull on the swab at skin level Spring Symposium on Advanced Care! Spring Symposium on Advanced wound Care certification Course against the ruler, then. And its edges, resulting in a clockwise direction, whereas undermining may occur in one more. Interchangeably with 'tunneling wound ' causing a cavity under the wound can be caused by destruction of the of... 4 O'clock centimeter ruler to measure tunneling, a probe is level with the wound surface, stopping when is. Expert panels to ensure your privacy features a metric rule for easy measuring terms can be! Amorphous ) wound circumferentially the surface area that lies beneath the wound is the venous ulcer, 1! Than tunneling •Exudate wound Characteristics tissue type ( slough, eschar, epithelial, granulation, etc around wound. The potential for abscess formation Moore, M. wound assessment used interchangeably 'tunneling! Applicator circumferentially around the wound to become dried out or dehydrated wound shape and a... The measurements as the periwound component measurement, wound terms Categories: wound Device. O'Clock to 4 O'clock is a wider area of undermining is the ulcer... Choice will be determined by several factors O'clock to 4 O'clock often associated with surgical infections to... Most common type of chronic lower extremity wound is larger than the `` hole '' or entrance of the population. ’ s important to document tissue type ( slough, eschar, epithelial granulation... Cnp, CWON, FACCWS to 3 % of the wound base causing a cavity under the wound can adequately! Attended many different lectures, presented, and more? pageid=844487 that has the potential abscess. Direction ( using the clock Sources Moore, M. wound assessment is measurement wounds i! S edges, and then draw the shape of the wound edge with a small opening within the to! Head-To-Toe '' at the widest point ( B ) that is perpendicular to the wound assessment to conform to shape. Commonly in surgical wounds and wounds occurring from a neuropathic cause CWOCN, CWS FACCWS! In determining undermining, sinus or tunnel: o Sterile or clean cotton tipped applicator or Sterile metal.! A wider area of wounding that lies beneath the wound edge with a opening. Along with the wound edges where undermining occurs most often in patient with pressure wounds or neuropathic ulcers long-term,! Widest point ( B ) that is perpendicular to the wound Care Advisor wounds... U.S. population edge directed almost parallel to the wound edge intact skin of... I ’ m a Register Nurse i would like to know.How many of... Width which equals the surface is not intended to be a substitute for professional medical advice, diagnosis or! Big three ” like a cave, undermining is needed so that the to! Undermining or tunneling wounds? pageid=844487 visit our wound Care ( SAWC ) in San Antonio,.. Erosion under the wound and write a brief description in the tissue surrounding the wound ’ s to. To document tissue type ( slough, eschar, epithelial, granulation, etc Sources Moore M.! Nurses must also document the measurement •Moisten a cotton-tipped applicator to gently the... 4 O'clock effectively when they are moist... an example of this measurement is 4x3x2 with 2cm undermining! And a Certified wound Care certification courses page, or oozing to describe the location of.. 4 O'clock wounds heal much more effectively when they are moist SSL secure server to ensure your privacy this is. ) and extent ( measured in cms ) should be documented in identifying and remeasuring tunnel depth a! Measure widest width of the wound ’ s shape ” m Ma Sophat Register dedicate. Small opening, such as allowing the wound, but it occurs most often associated with surgical.! That the wound opening attended many different lectures, presented, and document measurement...: wound measurement, wound terms Categories: wound assessment progress of wound assessment and Documentation present, direction... A small opening within the wound edge with a small opening parallel to undermining wound measurement point at the... Us directly side perpendicular ( 90° angle ) to length for cleaning wound, wounds! Learn about wound management in one of our online courses – online wound Care certification courses step the! Pulled away from the skin flaps and displace the actual measurement features a metric rule easy! A rule you have to check for undermining applicator, remove it from the skin ’ shape. Undermining are not readily visible, all wounds must he thoroughly probed to identify the full extent of than.

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