Facebook Twitter RSS Reset

Wound dressing- definition, purposes, principles, types, procedure

Definition

Wound

An injury to living tissue caused by a cut, blow, or other impact, typically one in which the skin is cut or broken.

Surgical or Wound dressing

Sterile dressing covering applied to a wound or incision using aseptic technique with or without medication.

Purposes

  • To promote wound granulation and healing
  • To prevent undue contamination of wound
  • To decrease purulent wound drainage (dressing material absorbs the drainage)
  • To provide dry environment (moist environment facilities growth and multiplication of micro-organisms)
  • To immobilize and support the wound
  • To apply medication to the wound
  • To provide comfort
  • To promote aesthetic sense

Major principles for wound dressing

  1. Use Standard Precautions at all times.
  2. When using a swab or gauze to cleanse a wound, work from the clean area out toward the dirtier area. (Example: When cleaning a surgical incision, start over the incision line, and swab downward from top to bottom). Change the swab and proceed again on either side of the incision, using a new swab each time.
  3. When irrigating a wound, warm the solution to room temperature, preferably to body temperature, to prevent lowering of the tissue temperature. Be sure to allow the irrigant to flow from the cleanest area to the contaminated area to avoid spreading pathogens.

TYPES OF DRESSING

The types of dressing is as follows

  • Transparent adhesive films
  • Hydrocolloids
  • Collagens
  • Hydrogels
  • Exudate absorbers
  • Polyurethane foams
  • Lubricating sprays of emollients
  • Enzymatic debriders
  • Nonadherent dressings
  • Gauze dressings

Procedure

Preliminary Assessment

    • Level of consciousness and understanding of the patient
    • Vital signs
    • Allergy to tape or cleaning solutions
    • Bleeding tendencies
    • Doctor’s order
    • Bleeding or drainage from wound site
    • Condition of the wound

Preparation of the patient and ward

    • Ensure that sweeping and mopping of ward is completed
    • Explain procedure to the patient
    • All articles should be assemble at patient bed side
    • Proper lighting of the ward
    • Switch off fan
    • Provide privacy by using screens
    • Check the agency protocol about using cleaning solutions
    • Fix disposable plastic bags in holders on the trolley. Place within reach for disposal of soiled dressing.

Articles required

        1. Sterile dressing set containing the following
        • Dressing cup (1)
        • K-basin
        • Artery clamp
        • Non-toothed thumb forcep
        • Cotton balls
        • Gauze pieces
        • Pads

Other articles

      • Cleaning solution prescribed
      • Sterile saline
      • Prescribed solution for dressing wound
      • Adhesive or non-allergic tape
      • Scissors
      • Sterile gloves (1 pair)
      • Plastic bag for waste disposal
      • Pad drum with sterile dressing pads and gauze pieces
      • Towel or pad and mackintosh
      • Kidney tray
      • Sterile scissor (if needed)
      • Cheatle forceps
      • Ether

Procedure of wound/surgical dressing

      • Position the patient comfortably
      • Expose the dressing site
      • Instruct not to touch wound, equipment or dressing
      • Wash hands
      • Open dressing pack
      • Transfer extra cotton balls and gauze pieces into the dressing pack if the wound is large
      • Pour cleaning solution into the dressing cup
      • Cover the pack without contaminating the inner layer
      • Place dressing mackintosh and towel under the part and place clean K-basin over mackintosh
      • Remove outer dressing
      • Use ether to remove adherent adhesive
      • Leave the inner dressing if it does not come out with outer dressing
      • If wound drain is present, remove one layer at a time
      • Do surgical hand washing
      • Wear gloves if the wound is contaminated
      • Flip open the dressing pack cover by inserting fingers in the inner layer of the wrapper
      • Using thump forceps, pick up cotton ball and wet it in saline
      • Using artery clamp and thump forceps, soak adherent gauze squeezing the cotton ball over the gauze
      • Using the same artery clamp, remove the gauze and dispose in the plastic bag
      • Discard the artery clamp
      • Observe the character and amount of drain and assess the condition of the wound
      • Use only thump forceps to pick up cotton balls
      • Pick up cotton balls every time using only the thump forceps and soak in cleaning solution
      • Squeeze out excess solution from the cotton balls into the kidney basin (sterile)
      • Clean the wound (clean to dirty) with firm stroke using the artery clamp
      • Discard used cotton balls into the clean K-basin
      • Use only one cotton ball for each stroke
      • Ensure wound is thoroughly cleaned
      • Finally, clean the skin in proximity to the wound edge, with strokes away from the wound
      • Soak gauze piece in the dressing solution, squeeze out excess solution, spread it keeping it over the sterile field
      • Apply over the wound, fully covering the wound with medicated gauze pieces
      • Apply dry gauze pieces over the medicated gauze pieces
      • Apply pad if the wound is large or lot of exudates is present in the wound
      • Discard gloves if used
      • Discard the used artery clamp and thump forceps into the clean K-basin
      • Secure dressing with adhesive/bandage

After care of patient and articles

    • Make the patient comfortable
    • Replace equipments
    • Discard the disposable items
    • Wash hands
    • Document the type of dressing, condition of the wound, type of exudate and patient’s response
    • Report is any abnormality is observed