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