Changing wound dressing

Renata Vytejčková, Jana Heřmanová

Wound

• The impairment of integrity of the skin or mucous membranes

Wound classification

• Acute – surgical wounds

• Chronic – bedsore, leg ulcer

Phase of wound healingGranulating wound – red, well perfused wound, prone to injury

Epithelisation wound – red with white places, skin cells migrating to the middle

Wound healing

• Per primam – primary intention (no complications, as expected)

• Per secundam – secondary intention (complications, wound infection, dehiscence, evisceration)

Phase of wound healing infected wound - secretion, odor, redness around

Necrotic wound – dry or wet, black crust

Indication for dressing change

• Wound control• Sterile Dressing Application• Medicament application, ointments,

powders• remove the drain • suture removal• Wound cleaning

• Etc.

Preparing for the dressing change

• Analgetic application • Patient positioning

• Room preparing – treatment room, patient‘s room

• ensure private environment • Equipment preparing

Basic surgical instruments• Plain Forceps - without

teeth• Kocher – with teeth

• Surgical tweezers – teeth (tissue tweezers)

• Anatomic tweezers – without teeth (plain tweezers)

• Scissors

Dressing cart, table, trolley

• Upper surface – sterile equipment, solutions

• Lower surface – disinfection bath, glowes, The kidney bowl etc.

• Plastic basket for waste

Equipment

• Personal protective equipment (PPE)• Sterile or clean gloves• Face maskSterilization packaging• Paper with foil• metal container + Cylinder and sterile forceps

Procedure of dressing change

• Explain the procedure to the patient• Position the dressing set on the table• Wash your hands with antiseptic solution• Open the dressing set without touching the

contents• Loosen the tape on the patient's existing

dressing

• Patient position• Waterproof drape to protect the linen• The kidney bowel• Only the material that can be decontaminated can be

placed in bed

Procedure of dressing change

• Put on clean gloves• Remove the existing dressing sterile water, benzin• Remove the gloves

• Put on sterile gloves or work in clean gloves and with an instrument

• Don‘t touch clean surface of the dressing table

Wound disinfection

• Aerosol alcohol desinfection + sterile swab• Iodine disinfection (Betadine) + sterile swab• Sterile napkin with disinfecting solution

• Chlorhexidine, Peroxide

Equipment for wound cleaning

Instruments

Disinfection procedureLinear wound, puncture wound

Wound cleaning

Applying the new dressing• With sterile gloves• With sterile instrument• Grab the gauze around the corner • Do not touch the central area

• Secure with tapeor use adhesive dressing

Changing dressing of a wound with a tube drain

• Cut the gauze with sterile scissors• attach to both sides of the drain

Inadine dressing

• paraffin gauze with iodine between two sterile foils

• Cut over sterile surface • Use sterile scissors and forceps (tweezers)

•

Suture removal

• Sterile scissors and forceps (tweezers)• nothing should remain under the skin• Use gentle movements to release the suture

under the skin• Cut the stitch under the knot

• Using tweezers, remove the stitch

Finishing the dressing change

• remove gloves inside the room• Hand disinfection• adjust the position of the patient• Educate the patient about pain, secretion• Clean the equipment in

cleaning room