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Simple Wound Care Instructions Step by Step
Wet to Dry Dressings
Wet to dry dressing changes can be a very effective form of autolytic debridement for wounds with over 50 % slough and soft tissue that is pulling from the healthy tissue. However, although it is an old form of debridement there are still professionals who use it incorrectly and use it without the criticial thinking skills behind it.
Always use aseptic technique regardless of what type of wound you are dealing with. One of the ways I use aseptic technique is to use the paper from the opened pair of sterile gloves as a field and dump onto that all the supplies I will be using...lucky you if you get your 4x4 gauzes in a "boat" otherwise use your opened gloves as your tray so to speak. Always use aseptic technique and thanks to coolhubs for reminding me of this fact!! Nurses get too hurried and we leave out the obvious sometimes!
This article will affect:
- Your time, it is very precious.
- Your pocketbook, as no one I know is really rich.
- Your nerves, as no matter how long you have nursing, or how much patient care you have done, or how many scraped knees you've bandaged, wound care can get gnarly.
- Your memory as everything you do must be set up before you even start.
So, lets get to it then, shall we?
Wet to Dry Wound Care Dressing
1. First things first! Wash your hands, put on clean gloves, gather your supplies.
2. Normal Saline, 0.9 % (watch expiration date), gauze (4 x 4 and 3 x 3), tape, sterile applicators, gloves and plastic bag (plastic grocery bags work well).
3. Lay out your cover (This is the opened sterile glove pack I talked about) on a clean work surface, such as wax paper , then start opening supplies. I like to set up two sets, one will be moistened with normal saline and the other will be the dry top and the tape layer.
4. REMEMBER! Wet to dry never goes in really wet…it means it goes in just damp enough that it will be 100 % DRY by the next dressing change. The purpose of wet to dry is to pull off all bad (dead and or necrotic) tissue every time you remove the old dressing.
5. For the sterile 4x4 gauze, take each one and unfold it, play with it, fluff it…much easier to do it now rather than when the saline is on it. Just be careful and don’t touch anything that is not on your wax paper…keep it all as clean as you can.
6. Moisten the fluffed gauzes with your normal saline and the two unfolded small gauzes with saline. Unfold but do not fluff or moisten with saline the top four or five 4 x 4 gauzes that make the top layer, this just makes it easier to place it over the moistened gauze in one piece instead of trying to place each gauze separately.
7. Cut your tape.
8. Go wash your hands, put on clean gloves.
9. Remove old dressing slowly, carefully, put one finger of left hand on the patients skin just above the dressing and stretch the tape up and away from the skin at the same time with your right hand, moving along the edges until top portion is off. Repeat with each side or piece of the old tape
10. Remove the inner packing, count the gauzes as they come out, you will count them going in as well. Nurses, remember to document hw many pieces of guazes were used coming and ging! Discard old dressing into plastic bag by rolling the old dressing into one glove and pulling the other glove on top of it so you thrw it away like a big ball and the soiled dressing is insde it.
11. Go wash your hands, put on new gloves. You are almost DONE!
12. OK, now, Clean until the wound bed looks better and or smells better, be sure to hold up anatomical structures (buttocks, leg, arm or wherever the wound is so you can see inside as much as possible. That’s done, that’s the hardest part and you did it!!) And remember, wound bed is used as a general term, it can be small and superfical or may be larger, the point is to observe it carefully every time. If there is anything different from day to day, call your nurse!that's what she's there for! The nurse may be your physicians nurse (get to know her by name) or your home health nurse (hopefully she's so good you will love her and depend on her because she is your number one backup!)
13.You know hand washing is the best way to prevent the spread of any infection and you are washing your hands like crazy with every step but...BE ALERT AND WATCH FOR SIGNS OF INFECTION AT ALL TIMES!
Signs of infection are: pain, redness swelling, warmth, change in color of wound bed or drainage, change in odor or consistency of drainage; but first and foremost PAIN is the number one sign of complication or infection!
13. Pat the surrounding skin dry, use the skin prep or sureprep, or whatever skin barrier you have, on the edges and let it dry a little. Now go...you guessed it! Wash your hands and put on new gloves! Are you remembering to sing the ABC song or Happy Birthday? These songs usually take 15 to 20 seconds to sing and that's the exact amount of time needed to kill the bacteria on your hands! Are you remembering to tell your patient about hand washing as well? If the patient has small children or grandchildren in their life using the song is a good way to present the teaching in a fun and non condescending format.
14. Pick up the bundle of fluffed small gauzes and one at a time, slow and carefully fill the wound bed. You do this one fluffed gauze at a time, Q tip in one hand, pointed edge of gauze in the other and slowly place one end of gauze in one end of the wound bed as far as you can go and work yourself back to the top of the wound bed. You CAN DO THIS!!! Just go slow, do NOT pack it hard, do not force the gauze, just waffle it back and forth. I use the terms bottom to the bed and top of the bed just as example, jut do not take the fluffed gauze and plop it in there and be done, take your time, it will be more comfortable for your patient and may increase the healing process. Also try to use the cotton part of the Qtip/don't use the stick part..don't hurt the new tissue that is growing anymore than need be.
15. Wash your hands and put on new, clean gloves.
16. Now pick up the bundle of dry gauze and lay it all in one piece on top of the moistened gauze. TA DA!!
One piece at a time, lay down the pieces of tape you cut ahead of time until all parts of the gauze are covered. Do this around all four sides.
17 Guess what? TA-DA TA-DA!!!!!!! You Did It!! Great Job!!!
What is written here does not now nor does it ever take the place of your physician’s advice and services of your physician.
Consult your physician every time for all things medically related and of course, if you feel you have any of the signs or symptoms of what has been written in this hub, please contact your physician for a consultation as soon as possible.