•.

Wound Dressing and Wound Care'U't'i.TilSl1n YiN l'l1tl

mh nAi\VA' nGlf ~n utii-3III f11'Z11 AlttlA'ilVlf AtlU:: LLl'ftlUFIl 8f1{

lJ'tl1i"rll ~m:atl~1'HJ.i\'l.A.2549

1. LviiJh'LLVll1Utl1~:;jlU1U 'I1:;iJlinAn1:l1LLvmujjYll1lJL"l11 h~(lnG1iJ~u

L~ Ell ti u -j',1(1t11~ Cl~Afmlil LLI.m,~u \iliJUn11 L\il~EllJlil LLml, #U\ila Un11,lil LLC4",~U\il a'U'I1<l~n11lil LW" ~L'I1lJl~CllJal'l"'lu &YthEJLLvi,,~11Elu

2. Lvia1'11m~l1frtl1~:;jlUl'U 'I1:;iJlinAn1:l1LL~l1Ef jjmllJ-l mllJL'iJlh LL,,~u

<lllJ11(1U11'1.hJi]uQi L~ElltiU n11Ll1,m1'1l' J1EJl (Solution) til'l11'1.Jlil

LLC4"LL,,~n1~Ll1an1'1l' Dressing material ~L'I1lJl~CllJ L\ilEltllvlElmllJ

L'iJlhL~Elltiutl'l~El~jjC4"vian11L~anlll dressing LL,,~dressing

material3. Lvia1'11LL~l1Eftl1~:;jlUl'U 'I1:;aunAn1:l1LL~l1Ef jjmllJ-l mllJL'iJlhu

L~EJ1tiULLull11~n1~lilLLC4<l1u~t1 LLUUvil~ 1 LviaU11 t.I1'1l'L\'lULLUll11~

t1i]uQi1 'I'L'I1lJl~Cl~tiu ~thmLvi<l~11El Lvia1 '11~thElClllJ11(1 n<lU1tI• KI .,. d oJ L ~ "... ..,J

111~lU\ill ~un\il L1ll1Cl\il \ilElWnl~LL l1~n'lfauu afll1 Cl\il, '

.- oUu\ilaun11lilLLC4".- iiu\ilau'l1<l~n1~lilLLC4"

LL'l.nl11~n1~lilLLC4<l1u~t1LLUU.h~ 1u

- J1EJl (Solution) til'l11UlilLLC4<l

- Dressing Material_ tI'l~El~jjC4<lvian11Ll1an15 dressing LLa~dressing material

2

~.J'~ ••.. ", ••.. .J I ~

- 'lJB'ULiJ'U1\'l()lb~"~~1'II"fl LL<l~Ul~LL~m'YILl-1lJl~"lJ ~iJ fll1mU A11LiJ'UU1~ LL~<l•~ij moisture LLvlh;~lJlJlflLii'U11.J(not to much soak)

,2. LVJBabsorb drainage

3. LviB splint 111B immobilize Ul~LL~<l

4. LlilBdebridement necrotic tissue

5. LlilBRemove foreign bodies

6. LviBUB~n'U injury vlBU1~LL~<l~L~lJiJfll1mu L'li'UL~lJiJ new re-epithelization

7. Ll~iJUiJ~n'U contamination vlBU1~LL~<l

8. Li1mrllJL~B~mruijL~B~BBfl (hemostasis) L'li'UBl'J'til pressure dressing LlilB'li11J1'U

fll1111lJL~B~

9. LviiJ<l~ ill fll11.h~u:h 1ruUl~ LLj;.J<l L'li'Ufl11111LLj;.J<l'YIfll'Uill'JiJ iJlfll11h~ ill'JU B~n'U1~rlfll1•LaBfl1?l'l"~ 1 'Ufll1111LLj;.J<lUWlfn~~hhil L1'J'U~B~Lt1~rJ'ULL~<l'YIfll'U• •

10. LlilB till dead space 1'UU1~LL~<l~iJh'l1~ LlilBuB~n'Ul;j111iJ collection fll1J1uul~LL~<l

LL"~promate 111iJfll1mu'1JB~Ul~LL~<l1~1J111Ul~LL~<lriB1J1 ~'U~'UlJl

11. LlilB Provide mental and physical comfort vlB~ih1J L'li'UmruUl~LLj;.J<l ill'Jl;J

'iil L1'J'U~B~iJ~LL~<lLL,h LLliiul~fl1ruLv1mnllJ "Ul1J l'J'1JB~N'ih1J l-11BmruN'ih 1J ill'J~ B~• •iJBfl'JlfllJl'UL lilBWUtI~N'A'1 ill'J'iilL1'J'U~fl~iJ~Ul~LL~<l11•

"

f

~r-l"L~

ftG!J~tfl,}Jml1~t~t(,\ULtt~tfl"~HtLt(,\~I1tf.1l1~t L~C>LG~lmL~~LU~!!l1.U'Z'f

~r-l"L~~LU"l-l'.L~ttll~Utl'.'~t I1tf.1l1Lfl~oS'~!;'ltt~~r-l"L~~ru17.," "G~ttt~l1tf.1,t:1~tG~'ftl;\'L~~Lfl'~r-l"L~~LUftGlJlft~I1L~U.l1tf.1,!l~tI1LI1£G~t(,\'('f.. ,

~r-l"~LI1~L~'I1LC>~1.U~GG~~ft~~tL~C>LG~L~M1~r-l'1L~~rul7.tt~(,l~1Jl1:!:'~t(,\[tl '(;'Z

UU"~11

1"lI1L,[lftG~(,l'l1tf.1l1LF~r-l"L~~G~ftt~1~l'L~~t(,\~lmlk.ull-l'.L~UI1'1~G~

" "~LFG~l'.1"lI1L,[lftG~(,\'~t:l/.ft,¥ftL[tGfl~t(,llJ!1L,(ll'.r{JftGrt~l1tJ.l.!l"l-l'.L\!o

~r-l"L~~rul7.ftL[tIJlI:!:~Wt:l'lt1qH1.rJHta..13~LU~G,\"l1tf.1.!l~rut1~I1~r-l"L~~LU'('z

~LRL(lftLU~~rrn}l1tf.1l1~~rul7.ftt~r-l"L~~t(,\[tl'I"1

P1UA\ ~L,(ll'.L!,'NJI7.m~,.c~1t~~UC>\!~~Wftl~r-l"L~~rul7.T Io

11~'1"1~m,L~IJ~LttLll tll"~r-l"IJl~I:!:'UL(;~~l'.pm'<\ punOl ~ruflftl1UI1.It~lftC1W~r-l"L~~W~~(,\~~ftl~r-l"L~L2'z'\

'ft 00'61-00'L I

~lP.ftt~r-l"L~~t(,\t1~lffGlA'ft 00'60 ftG!J~r-l'1L~~t(,lC,!lft1(l{jj'('[

!Q!\!! fl!' LU M.lJ 19M.lI-,

..

4.1 \~~m.J'lJVllilLLr.m(set dressing)•

4.2 \~~UlJINj'jml::iJlVlI-I~il INj'jil sterile• •

4.3 L~~UlJ solution 111'1J1Ufmlilu~CllV1upj'lilLLHi\m~j'jmllJf mllJL'lh'l'lil'l~- -Li'liln'l'li'solution 'lJilVl'lViV11lJmllJ'ilLuu LLi\~<i'm:illl~'lJil~U1VlLL~mlV1u

Solution 11'l'l1"'.iau1.-i'<l~ulllm11vilL~il~ ,hUl (Solution) <il1'l1UlhLL~!l•

4.4 L~~UlJLI'I~il~j'j<llilLL~i\liul1'ilLUU L'liUn~ruj'j necrotic tissue LLCl~G1<l~lil

mechanical debridement m~L~~UlJ Metzenbaum scissors LU'lG1U

4.5 L~~UlJ dressing material liu 1~'l~Li'lan1'lJ1uulViLLmllV1u~YilLLfji\m~ii

mllJiLLCl~mllJLVlhL~1JlnU dressing material 'lJilVl(ih~1 ~llJ~~ih~u'lu

m~Li'liln'IJilVl1J<l~dressing material ~~lvi<l1ullluL~<l~ dressing

material LLiI~il'l<5'ul1jj~Clviilm~Li'l<lnifi dressing LL!l~dressing

material

4.6 L~~UlJ')<l"l~'l~'l'l1iiVldressing material l,rGiVlnUlJl~Ll~!l L'liUplaster

tJ(i)LL~Cl,gauze bandage, elastic bandage I-I~il adhesive bandage LUUvlU

4.8 <lUn~ruYilLLr~!l~~l-IlJ(i)m~ll~il~UU overbed l1LLvi!l~ward L(i)~1JlJH. -hjm~ll~il~UUL~U~ pj'Ul1J- -

'.

v

iJuliliJUnl~'1hLUJil

iilil gauze bandage, plaster UV1LLWll,'lJlmI11J1 solution ~l~ 1 l1~il

LLljm~Yi'~L~il~l'IJil~~tll1Jl1~iJ ~~l"~lU L'l111~'iI~Yill~ L1iVlm~m~'ill1J" "

U1VlLLWllLllilVl'11~il discharge 'ill f1U1VlLLwmL<i',1l.iAl~11.1tl'"I:i<lnu

il1.1mru~uuu~(j';lLLwa ~'iilLtJuGi'il~1ll1'U~thml1J~il 11.1L'liUm~ 1m. "

1. rimn;lLLWllA1~';1A11"1l~fl1Vlj'jiJ ~l1Jm~<ll~j'jiJ l1~iJH hand rubbling

alcohol ~LliI~1J"1iuu~m:hLLwa

2. ym<1lml~j'jiJYlf1li1~~rimHilLLwll tVl1JiJl'ilL\JU(l~j'jiJsterile l1~iJ1l.i sterile 1\• • •

MLL<llLL~A11,,'iilLtJ'U L'liUlll'iilLtJu~ iJ~1'11'j'jiJi;1'm:i<lnUU1VlLLWll'11~iJiJ1.1mru•1ullVl';lLLWll A1~l'11'Il~j'jiJsterile

~iJA1~1~1~~il 'I11f1(l~j'jil~Hj'j contamination LL<llL'Ii'U1~tl'm:i<lnu•

~il11.111~il51i1m11f11 sterile <11'l1'lUl'llilgauze bandage liI11Ul"lH1l.iAl1

ulm11m iiVl'l1al<lLliIil111.1l'11'iiVlgauze bandage7. 1'11'forceps iil~ 1 'illn set dressing ~uLal gauze LGi" ilaf1'i11f1UlVlLLWll'IJiJ~

~Ul1J ~':;il51Hj'j a<Ju Lal gauze L~" iJilf1li1l1L1.1~rnj(l~j'jal 'I1l.iriaUl;lLLwa" .~a11.1

'1Jil~L~ilhlilM

3. LUVlset dressing ililf1LVl1JH sterile technique u<llH forceps iil~ 1 ~~

ll~il~UU~Vl ~u forceps Bf1 2 <ii, mll~ 1iU'Ll(\j'IJilU'lJil~ dressing ~lm~~

~VlL~1J~~1.1mru~l~11\1 set dressing 1~il~rl'U~nB(\j~~L'I1"1~<l"~iJn11

H~lU

4. LliI~1J"solution vil~ 1 ~'iI~1ll1'Un1~';lLLWa

5. liI1l'i1li1Gi'1u\jilf1'IJiJ~gauze lfl'IitJVlulVlLLwailj'j exudates :zl"ililf1"lmmjil1J" -

LLvi111U51:zl,,"1f1 ill'ilj'jAll,,'iilLtJUGi'il~LY;"1.1'''l(\j gauze l'Un11uVlLLwa

liI~~~il11.16. Uf1~Lill'l1lll<lLliIil1uVlLLwmGi,,'IJiJ~~Ul1J il iln lVl1J~~1~'1JUlunui.jlmi'~'IJ iJ~

~Ul1J luf11ru~ dressing LGim;-uH~l!J gauze bandage Al~ l'lii1ill'iil1J 1

liIalmill gauze bandage aaf1 51.ril~m~1'lim11miiVl gauze bandage aiJf1

Al1Ltlum11m~';lAll""~illVlLL<l1'l11f1 HiiVl"lria'U 1u~Ul1J111J~'U LLa~"ml~'illf1Hm11mlill1LL1Jf1 HLyjil';llilll"<l~illlil riilU\1111.1'l'l1'1'U~Ul1J11!J"

8. til gauze L~lJ &i~LLt11.JntJLLr.Jll1l1'JH NSS ~)~,NtJ1.J gauze 'I1~a1iala?jtJ

NSS Am) '1 itJ hi gauze Lyja~1 gauze aanm

9. 111lJ111dressing tl1.JLfhHtJ1.JL&ltJ1~thtJ 'I1~ahjm~1(l1.Jil~L&ltJ1eJthtJm~

1<l11.J'lflmt.ll~LL<i"~llJHl1.J(lwHn<l&in l1~a 1111t.1i111.Jtl1'IJtJ~&i~1L~a~LLvill~- .

6

ward fhl11.J~

10. 'I1<11'Jlnlll gauze L&ilJaan'JlntJl~LLr.Jll ~thtJLL<i'lHala?ltJ alcohol'l1m~ '1

L%~'lil\L'1j,(]~LLWiLLtJ1.J11nil1111Lll11'IJatJL'IJ~'lJiN gauze L~lJ ~1jj

contamination 'Jln discharge 'lJa1tJ1~LLr.J<l

11. Halll'lftJ NSS 'I1lJl~ '1 l1tJlJll1llJLLml ~'I11A'nlJa~1l1~ 01jj crust &i~LLt11.J. -

U~nIlJU1~LLr.J1l1l1lJl~m%~aanl~'t;r,tJ l-hOl LL<i'1l1tJiinVlf1vll11NSS

12. OlUl~LLr.J1l1f1.Jjjnecrotic tissue ~alm~(l'l11 mechanical debridement

lvlm~ 1'11'metzenbaum scissors 'I1~a Mayo scissors

13. ti'lul~LLr.JllJ1.Jjj necrotic tissue ~tJl1mn ll.ialm~mh mechanical

debridement lvlm~ 1'11'chemical debridement 1~111'11'solution ~jjql15'

11.Jm~ dissolve necrotic tissue L'li1.JDakin's solution

14. 01Ul~LLr.J1lJ1.Jjjm~tlnL<lu&i~L:ffam~'I11 wet dressing vlltJ antiseptic

solution L'li1.Jpovidone iodine 11~i)dressing material ~1.J'111.J111i<lL~a1dressing material

15. U~Ul~LLr.Jllvll11dressing material L'li1.Jgauze 11~1ldressing material

~1.J'1 11.J111i1lL~a1 dressing materi:ll

16. U~ plaster ~llJLL1.Jlcircumferential llJll1iii1Ln1.Jlt.1l1~1ltJ~n(lHL?J1.J'lJl

1l1'J1i~ dressing material Hvlll1 gauze bandage 11~1lelastic bandage

7

•

ueJ~nu contamination

2. ~Hr~nl~lilLL~<l Al~eJlhJ1fJ15nl~(iJLL<lLL<l~~~JJ(iJ~~i~Ul(iJLL~<lun wihtJv v

3. Al~eJllulfJLLnwihwh'l~lilLL~<lfl~~~eJ h)Lriah rl'rn~eJ~h L~eJl1iim~m All<Jv

L~hhij(iJ?JeJ~~ihfJ mru~ell'lllJlilLL~<ll'lniu Liu Primary wound closure il1fJ1u

48 -t1LINLL~n1i'11lJiidischarge ?im)u1i~ gauze .guueJnllJ,jlLuu~a~LtJ~fJu

dressing Al~LtJ~fJU dressing mr~ 48 -t1Lm LL<l~umu.mH'lun11'l~v1(iJll1<J

4. set dressing ~limr1Al~11~HIi11<Jvilumi~~LL~<l~ ward nll1U(iJ

5. 'lJfJ~~L1i(iJ'innnl~lilU~<l ell'll<iINw<llfl&1n U<l1Ulhhl~ Hli11ml(iJ~LLvii'l~ward• •nll1U(iJHL~eJl iL,i'1wtIl~mLi~u ltJ 11~eJli'11lJ~a~nl~l<i'l~ plastic ell'lul'lJfJdtJ~~

lu«~'lJfJ~&1(iJL;eJ~LL~<l~ward nll1U(iJ ~~Al~nll1U(iJ 1 imi1 UvilLLml~~fl~mnv•

all1~Unl~i1~?JfJ~

6. all1~UlNiieJmiLL<l11 iLLfJn~~i'l~1U«~all1~U~~INijeJL(iJfJL~Wl~• •7. Al~1Jl~lllilLL~<lltJLi\UHiJ~vilLLmi~L&1<Jmr~lilLL~<l

8. 111All <Jfl~ell(iJiieJanfl~~l1 <i'~111LL~<lLW~l~ll~iieJ~'li'eJ1'l'lJl(iJ1i 1111iii eJii•contamination

9. uunn progress note <i'mHll~'lJeJ~U1(iJU~<lLL<l~~eJfl"I~nUnlJWfJ1Ul<l(iJllJAlllJ

,jlLUU

1. Clean wound

~u 1vi' 7 50/0 'IHl~U10lLLc.Ji.nf~.,~0l

lOlEl~11t.1L1'JULLc.Jil~LilOl;)lnelective incision IvlElBEifllEl1vi' sterilev

condition hijj break in aseptic technique LLildl.i predispose ~a

infection lOlElLL~'YJ6~lvl0l1l.iM enter L'lll~ oropharyngeal cavity.

respiratory, alimentary 'I1~a genitourinary tracts.

LLulm~m'nhLLc.JilAa

- fllEllu 48 -E'll~~LL~n l11hiiJ discharge ~~;)uii~ gauze

.ffuuan 1l.i'li1LtJ'U.ra~Lt.I~tJ'U dressing Al~Lt.I~EI'U dressing

ml~48 -E'll~~ LLil~tlv1LLc.Jil11;)'Unll;)~vl0l1.,~

2. Clean - contaminated wound

l~tJ~11t.1LtJ'UlJ1VlLLc.Ji.1"<1~~lvlVl ~tI1;)LnVl contamination ;)In

normal flora, 1l.ijj unusual contamination L'Ii'U frank pus .,~a

foreign bodies lOlElLLVlYltr,rn;)~LEiuLLr-Jil"<1~rJ1vlOlLtJ'ULLUuprImaryclosure 11lJl~LLc.Jill'Umimi L'Ii'U•

- U10lLLc.JilU~Llru skin "<11~lvl~ appendectomies,

lJl~LLc.Jil'1la1 vaginal operation

- Ul~LLc.Ji.1~skin "<11m~rj,vlOl~ surgeon M entcr L?ll1t.1

JntJl'U viscus miTyhlli'LnVl minimal spillage ofcontents

LL'Ulm1nwnlLLr-Jil Aa

- flltJl'j 48 ?w.Lnnl111l.ijj discharge ~~J;)'Uii1 gauzc

.ff'U'Uan 1l.i'lilLtJ'U.ra1LtI~tJ1j dressing m~LtI~ElU

dressing "<1~48 '/j~.

- "<1~ 4 8 -E'll~1;)~l'hLLc.Jil LLi!~t.I~~Lij'ULLc.Ji!tia ElLLA1'111,1

?1'Uacinu clinical '1Ia~rrth1J LLil~Al1~<f1i.lEJ'lHl~LL~'YJ6v v

~atam<flum~LnOl wound infection

8

,'lJl\l~~ali,,~~um~r.il<ilVl 'r1~ilml~'r1~~

9

3. Contaminated wound

_ fresh traumatic injuries L'IlU

- soft tissue lacerations- open fractures_penetrating wounds

_ U1VlLLc.J1I'r1ti~m~r,il<ilVl(operative procedures) ~il gross spillage from

GI, GU 'r1~a biliary tract procedure

1. ellLUU fresh traumatic wound

"il <ilVI~1lJM LUU\.IVILLN11

_ m~l'ilLLN1ILVlU keep moisture 'lJa~U1VlLLN1I11 L'IltlHwet

dressing vllU NSS LL1I~m~LtI~uULLr~amh~uaUlua~ 2-3 ~~~

L~iliJil~tiu growth 'lJil~ bacteria_ mruulVlLLNa abrasion u'lL1l\llU'r1ll'l m~ keep moisture iillU

wet dressing ill"iilUlfl mlJl~() 1'11'ophthalmic ointment 1'11

U1VlLLNau'lL1l\llU'r1Ul iua~ 2-3 ~~'l LL1'1U1iil

2. ell LUuml~'r1ti~r.il<ilVl LLa~LUULLNaL:jUU.;'a!JlL<ll LLU1Yll~l'ilLLNa,,~~ <llU

tiu clean contaminated wound LV1u~LLGh~u~L1m1um~L\.IVlth~Liju

LLNM1~~LL~fl"~L~1~U1iilL'IlU"lfl 48 ~lLlJ~ LUUL\.IVlth~LijuLLNa~~~LL~fl

LUU 24-48 ~lLlJ~ ~~~uiJ(ltiu clinical 'lJa~~':hu LLa~mllJ"~;;lU'lJa~- -LL'r'lmiGiilLilm"l um~GiVlL~a ~u a citi\J'r1alm1,,~u-L'IlU _ GilLL'r1\l~'lJa~\JlVlLLNa: nl\JlmLN1Ia~\J'lL1l\llm'Ul ~~i1 hlood

supply ~ ,,~ilLilm"lufll~mm~iluauflilu'lLll\lLl'h <il~Ju

mruulVlLLN1I1\J'r1Ul m"L\.IVlth~Lilu\J1VlLLNa~~~LL~fl 'r1~~ 48

~lLlJ~nM

_ tll!JLLa~11~th~:51<ill'IJa~r.r,:hu: ~':hU~illmJlfl, ~U1U~1iil~\J!Jl\ ~ ~ ~ ~

steroid 'r1'lil ill1I'1L\Jl'r111U ,,~i11am"lum~GiVlL~alJlfl~u

m~Vj"1~l\llL\.I(ilth~LilulJlVlLLN1I L~l~U LL1I~tiilu~u LUUvlU

10

4. Dirt)' and infected wounds

l1lJl[J01 Ul~LL~~niJ heavily contamination 111iJiJ clinical

infection riiJ'lJn1~d,l'1~ L'litJ

- Ul~LL~~'llfln1~iJ perforated viscera- Abscess- Old traumatic wounds ~jj devitalized tissue 111iJiJ

retained foreign material

.- pink LLil~~"hL~:lJiJepithelization

red . ~granulationLLil~~11:lJ

yellow: LLil~~i,ii slough. ~infectiongreen LLil~~11~

- black LLil~1i,iJ necrotic tissue

U1~LL~~1tJml ~,j'lJflhiLUUtI~LL~~ Lti 1J~'llfliJ1iJn1 lltl flLilu&i~ll1iJ1l~. "

~1m~lilLL~~t~[J1'Il' solution ~iJq"r1B'lilLtiJhAM L'liu wetdressing with povidone - iodine ..Silver sulfadiazine. AQUACEl.

Ag 111iJACTICOAT LUUGlU

n1~Ll1iJflh'i5 dressing 111fl dressing materia! iJ~l[J~~La[J~

lvim&i~1uL~iJ1 dressing material mdl'1~[J~jj~n~iJ01'lLlliJfl15

dressing 111fl dressing material

5. uWIll~n~jjfiiJ'l~lJ1[J L'liU Penrose drain, tube drain (L'litJ redivac drain. T-tube

111iJ leO)

l1clnn1'llillL~~ lli~11'11nn1~lilLL~~l1cl~dll'1~ mOlfiiJ dischargc

~:lJfliJfllJli,~ tube drain ~LUU closed systcm flN1'Il' wet dressing

'I1u antiseptic solution t1~'liJU '1 LL~~riiJUtI~Yi'1J\il1[JY-gauze an

Af1LL<l1~11~\ill[Jadhesive non- woven fabric (L'litJ Fixomull )

111iJ transparent film ~LU\1 water proof

t1'l~L~Uml:lJihun1~l'hLL~~ ~UiJ~nmml[JiJ'I~[J L'liU iJ discharge

~:lJ1JiJml1n\il,ui,~ tube 111iJlli lJlfllIDULLrill1u, LL~I~drain iiiJln1'l

tlmllu&i~LtiJ111iJlli, im~immune 'lJiJ~tJth£JLtJtJiJcil~h ?i~ml:lJ~"

II

1tJm~l;' LLNC1~tJtl~nUm~V1\11~ru1'IJtl~LL~11!h1~tlfl'rhLLNC1• •hi'il1 LtJtJ~ tl~ li1LLNC1111l1tJLL~LL~mrm~ml\1~Hi'mfru~il1!JtJ tl1l'IJtl~• •dressing lJIlltJl1ii discharge :alJtltllllJ11i~il1!JtJtlll11~tlhi iin~tJ

L11~tJ11~mj'~Li'Jtl\J~~Liium1lJ~1u m~li1LLI'JC1

m~ shortening of Penrose drain

1. n~ru exudates 11~tldischarge iihilJ1n 11~tlin\liiil()J111LLAhJ

il11~ early post-operation LlhJu L'liwnl~ bleeding mruL'liurl'

il1lJ1~() off Penrose drain 1~LC1!J1"!J1~~tl~iim~ shortening

2. mru exudates iilJ11l L'litJU1"LLNfI~iiinfection mruL'litJJ1~

<lllJ1~() oJTPenrose drain tltlmlwYi L~~l~thmLNC1\1~tJ.,\ill

Ll1!Jfiau'lJru~~E1~iidischarge 11~<lti~lU<i1~'i~iim1lJ'il1LtJu~a~

shortening Penrose drain 1i~tJ<NLtJtJ~~!J~Li'Jahju1~LLNC1L~lJii

healing \l1n bed l<iL1!J~~tJlJ1'lJru~L~mntJilE1~V11il1mi'Jadrain

exudates Mmi•

,h11'lunn shortening Penrose drain JUiiLLUll11~V1il1!Jnumlli1LLl'JfI~ tl

11l\'~\l11l~LElldressing atlll f\li1m1lJil~Ell"U1"LLNC11"!J11l'alcohol LLC1~normal

saline solution L%.,LEllV111U<lmhn11~tlcrust tlan1iil~EllmllJ~~~\ill drain 01!J

rl'l~,Nm~ short drain f\1iAtl!J 1 ~~ Penrose drain aamh~lJ1ru 1-2 iflvJ~LLill•

nl\'., safety pin 1i:a.,nu'lJtlu skin ritltJ~\I~\il., drain ,hmnu \il.,1itlC11!Jdrain

~1~\l11l'IJaULLNC1th~lJ1ru 1 ifl 11l\'~\l1nJuli1m1lJil~ Ell"LLr~C15nV1f~LLilltJ~

dressing tl1lJ1ruf.h gauze ~\I~1tr'1i~\l1mr1 gauze L~lJll~1J mll111aua!J rl'laan

lJ1n0a~11l'dressing lJ1mi'Ja~\I~'I!u1~1i discharge \l1n drain ~IJ\lU irritate skin

111i1umru~ii discharge aalllJ1m11l0a~LtJ~!Ju dressing liaEl 1 a1'iJ\I~11l' sterile

bag tJ"LLl1uLi'Ja~\I~10 collect volume 'lJtl~discharge ~atl1l1J1111i

6. U1(;JllNC1~iiam"ru~lm'l1~ (Particular woullll)

U1~LLNmU~1~L'liUvenous ulcers. arterial ulcers, pressure ulcers. diabetic

ulcers LLi'l~bum Ell\ljjm~Am,n1tJL:a~~n ii~lElC1~L5!J~1J1mLi'l~jjm1IJri1111u1L~1tl1'iJii

LLtJll11~m~~mn 111~1 LvilJLmlJ~ulJ1L'liUvacuum dressing LL~f\iil.,~tJ~~il~V11tl1u

lLUll11~L~!J1ntJ~a Li'Ja1iLLI'JC1111!JL~1~<l~ii complication ua!J~il~ LLi'l~r.rtJl!J<lllJl~()• • •nau 1tJtl~~1lau B121~LtJ1JtJnml"!JL~l~".,,

12

v

'Ihin (Solution) fllll-iurhlltJt'l

1. Alcohol 70%

~lL~1lhl'J~ihmj~Mth~mw 90% il1u1u 2 Ul~

iJl]l'1~ precipitates "'~1l denature protein 1I'JEJhililillJVl~lEJ&ia

ibm:r~ LL.hililu\iI11U&i1lLif1lLri1lil1EJ1uU1I'JLL~i1",'ia raw surfaccs

'lJ1l~skin

n1~H alcohol ~~~m1il11~au '1 U1I'JLL~i11I'JUllJ1 riL'Ih1tJ1UU1I'JLL~i1

LLi1~I'J1~l11LtJul~ni'l~m1lul'Ji1lJibmJ~U1L1ru'lJ1N gauze Ll1ilJ~hul'J,LL~mvj m1li11mt1l hl'J~m'JtJu Lt]1lU1lciflU discharge 'lJa~U1I'JlL~i1~v

gauze :;1lJ'6U11

2. Povidone - Iodine

,iJ toxicity &ia tissue oil, <lllJl~O penctrate cJ1Ueschar l\ilLL&i

'lJru~L~hnflUIi<lllJl~O on absorb Lil circulation 'JUjjil11~v

intoxication M ,hiJtJ1lJ1WlJ1nWa

<l1lJ11IJh1\il&itlUU1L1ru mucous membrane 11'JE!hi iitJl] ii1EJ1&ia

mucus ",'ia proteins 1u secretion

L~a~'Jlnjj toxicity &ia tissue ~l ~~iJUlJHflUU1I'JLL~i1open wound

~iJmn11ilmi'luGiI'JLtall'JuHLUu wet dressing

3. Hydrogen Peroxides

<lllJl1IJrilLtahI'J1VJum~<l'h~ oxidant wa hydroxyl free radialltJ

nli1lU microorganisms

m~Lliu1m;1 hydrogen peroxide m~lliu lilu dark and closed

container L~a~'Jln hydrogen peroxide 'J~111 stable lLi1~<li1lEJ.h

M,hiJ impurities. expose &ia bright light ",'ia heat

i'lllJ11IJ1i hydrogen peroxide flUU1I'Jll~i1~iim1ilnL<luGil'Jlt1l l1~a

UlI'JLl~a~jj necrotic tissue 1I'JEJnecrotic tissue 'J~jjli'lJll~VlLtiilun

hydrogen peroxide nl1ri-ilu&iam1nl mechanical debridement

13

i'lllJl~f11'1i hydrogen peroxide fi'l.Jul~HL~m11J'lif)~1.hnlAil1'IiLiJ1J

Jli11 irrigation l\ililCoHllJnuNSS 11J1)A~1 H202: NSS LU1J1 : 4

4. Dakin's solution

1J1ln"l1mhL~1l1wll~ !T~<f1lJl~f1dissolve necrotic tissue

m~dlufml1 m~LU1JHl1J dark and closed container Liif)~'Jln'J~

"<llU~l M,r, expose ~1l UV light l\ilutln~d'l!T~fl~j'jllVlJ":j1llJl.h~

'Jl~ '1 LLi'I\il~':h!T~1v1~1l~ rl'1111nll'Jl~<l~LLi'I\il~il1v1liM~mL<11

UUlJ1'IiLU1JLU1Jwet dressing nUU1\ilLL~<l~j'jnecrotic tissue LW~j'j

n~1JLl1iJ1J llivm1?lnuul\ilLLN<l~L{j1J fresh wound LUf)~'Jln'J~

l11<l1i1 blood clots l11h1iJ delay clotting

5. Hibitane

"llJnf1~lL~1l hfll~~i.'l&i'li'~ gram positive LW~gram negativebacteria

uUlJH paint tjlmr~ri1l1Jm~r.h~\il 1J1ln'Jln;ft1JU1\ilLL~i.'l~jj

organic matter L'li1JL~1lAll~all1J1l~ il!T~1v1~~i.'l&i

Hibitane i'lllJl~oii irritation ~1l mucous membrane l\ilUL>lWl~

rl'lL?11LiJll11111ii keratitis ~~m~1i'1lf.h~~~lT\il~d'~

lLiJiI,tl1t11l1'J~"lJLU1J hibitane in water 1l~1l hibitane in alcohol il

M lAUVU\ilLL~nuulJ1inuu:;mu 1UllUl Lti.'l~VULiJ~i'l1l~UUlJ1'Iinu,f1ua1J!J1l~~l~mu

6. Zcphiran 1: 2000

"llJl~f1~lL~f)hfll~nu'Ii'~ gram POSJllve LLi.'l~gram negative

bacteria lLiJu1v1~nu gram positive M~<l&inil 1Jan'Jlnif!T~1v1~•~ ~ . -nUl'llf)~lLLi.'l~VIruses Ul~'IIU\il

Zephiran lliij irritation ~f) tissue ~~uulJ1inuu:;nru~LiJ1Jmucous membrane

Zephiran 'J~h1lil~~<lnUU1LiJLL~<l~ii tissue constituents LLi.'l~ll1Jf)~

1J1ln'Jlnif tT~h1liM ~<l11Ju:;nru~yJ1ln~lu"ti tii'~J1J~~m~L~LiJL1l1"ti- -1l1ln 1l~1l L~\il1l1ln~lU alcohol ri1l1J~\I~1i zephiran

14

Dressing Material

I. Primary dressing

- mJ11Jii~ dressing ~ directly contact ~aU1QlLLml

iJa~t1um~LL'l1'~'lJa~Ul\ilLLI:-J<I (prevent desiccation)

iJa~t1u llJ1 ri'LLI:-J<Iii infection

iJa~t1u adhesion 'lJa~ secondary dressing ~aUl(1lmm

- v11a~1~L'liu vasaline gauze. Flurazone, Bactigras. 111am~1i transparent

film L'liU Opsite 111a Tegaderm d'11-lltJ\ilUl\ilLLI:-J<ll\iltJ(1l~~l\iltJhiii

secondary dressing iliial1LUu primary dressing

2. Secondary dressing

- l1lJltJii~ dressing ~11~8~UU primary dressing

1. Further protection 1118 absorption

2. Compression LYi8hemostasis 1118 limits edema3. Occlusion

m~lh occlusion 1118 occlusive dressing l1lJl1Jii~m1U\ilUl(1lLLI:-J<I

111aU(1lsecondary dressing l\iltJ1imju film ~a'i!\!1(1l1ri'L'l'Wl~

gases (L'liUOxygen) LL<I~water vapor .huaan\nI1Ul\ilLLI:-J<lS•

atmosphere L',il,fu llJatl!\!lVl1ri' discharge 111a 'lJil~Ll1<11~mjlu1.1LYiamul'llJ level 'lJa~ hydration LL<I~oxygen tension LYia'li1mvilJ

dermal collagen synthesis LL<l~epithelium migration LL<l~limit

tissue desiccation LL~iiima1J~f) 'l~LvilJ bacterial gro\\th ~~ri'llJ

hlu infected wound LL<l~highly exudative wound

15

Dressing material '1fiJ~Gil~'1 ~Htimd'j Gi~if

I. Nonadherenl dressing

'I1lJltJa~ dressing '1fiJ~~hiGi~LL~J<lLL<l~iJflliL\'iuprimary dressing

LGltlJt,1t.liJflH impregnated with paraffin, petroleum jelly l'~elwater solution jelly

Liu vasaline gauze, Flurazone gauze, Bactrigras 'I1~elUrgotul

(~l1Gl'llfl hydrocolloid)

2. Absorbent dressing

mntla~ dressing 5~~~~lJt, hJ~utl~ H absorb fluid Liu gauze,

cotton. wool 'I11il sponge

'llilm~~d'~fiil Lriil dressing L~~i~~lmiiu 1t.l Glel1Lt1~tlULW~l~\l~nl- .liLii~ maceration 'I1~el bacterial overgrowth lGi'Uelfl'llfliffllmfl

exudates :Z;~elelfllJl'l'lJ'ffuu elfl<l~LtJtlfl'l~nll iL~il hfl 'llnGi'luu elm'lll•~Ul~LL~J<l1Gi'

3. Occlusive dressing

'I1lJltJa1fll~li transparent lilm Liu Opsite 'I11elTegadenn tI~Ul~LL~Cl ~1'l~L\'iU water proof L:ailhfl~.hu hj1Gi'LLGlel\jf\!lGlliwater vapor Ll<l~oxygen ~hulGi'Utl~1'1f1UU1~LL~<l~clean LL<l~iiexudate tIm! LiuUl~LL~Clsuperficial abrasion wound

4. Composite dressing

'I1~ltla1 dressing ~ii 2 'I1~il lJlflflll 2 component Liu iUUilfl<lGl

Li'JuLL~Utransparent lilm <lluiuluLtJu Absorptive layer L~el

absorb exudate tGltJ~l1GllJlL\'iULLuu;;ilL~'l~t1"

Li'lJ Opsite post-op. Cutilihn \11il Tegadenn with absorbentpad

Velm~~~11i'iel ()lUl~Ll~<ltfU hiii exudate \1~ilii exudate tIiltlhi

m~liLml~Gll absorbent pad 'l~~Gl'1fU exudate 'lunlliul~LL~<l"

LLi1Lii'lJlt1 nlli wound healing LLrJ<l1

16

5. Foam dressinl( ( Ilydrophillic and hydrophobic dressing)

~J~()J"\)ln hydrophillic polyurethane foam L1JUvllsecondary

dressing Lvlll absorb exudate l()J!Jii primary dressing iJll~nu

llJ1 'I1LLl'J<I&iVlll1'11uvll"ffu cil~<l()J<lllJ1~(lH11~tJVl LLl'J<I1()J1'1()J'"ML<l1'Ill~v •

hjii waterproof film ll~~llJUlln'1()J 1l1"\),jlLUU~1l~li

transparent film tJ~lLUlJ occlusive dressing ~llJlJlln1in.fflJ.,i1~

UEJlJliihwjUU1()JLLl'J<I~LUUminimal "~1l moderate exudate 1()J1'Illl"\lLtJ~I'IULLl'J<lY1n3 - 4 lU•hjLLU~Ulhn'l1'nuul()JlLl'J<I~ll.iii exudate L~'ll~"\)~l'il 1'I1LLl'J<lLL'11~LnultJ

LVU : AlIevyn

6. Hydrocolloid dressing

li hydrocolloid LUUvl1 absorb exudates

LUU Occlusive dressing iJll~nlJllfll bacteria M (impermeable to

bacteria) LL<I~<lllJ1~(l~Vl&i()Jnuul()JLL~t<ll~Lll~(self adhesive)

Ul'IlJl'11'nuU1()JLLl'J<Iminimal to moderate exudate LVU partial

thickness wound lJlln"\)lnif!l~ h1~nu wound with necrotic orslough

LtJ~EJULLl'J<lY1n3-7 lU•1l.iLLu~ull.,1inuul()JLLl'J<I~jj heavy exudate

LVlJCutinova Hydro . Duodenn 11~1lAlgoplaque LUlJ~U

7. Hydrogel dressing

"lJ1EJ1i~ m~H hydrogel lunm'ilmm lVlmmll~1u~tJ gel "~1lhydrogel Sheets ilMul'IlJl'11'nuul()Jlll'J<I~jj minimal to moderate exudate LL<I~woundwith necrotic or sloughll.iLLlJ~Ulhn'll1.u heavy exudates

m~LtI~EJlJLll'J<I

(hl'll1.u~tllJll~ gel m~LtI~EJulll'J<lllJ<I~l'lf~

rl'l1illJ~tllJ<n Sheet: m'HtI~EJlJLLfJ<I3 I'lf~llJ IiltlVllM

Lliu - gels: Intrasite ; Hydrogel

17

Sheet: AQUASORBS

8. Alginate dressing

111J1uii~m"H Alginate LUUoll absorb exudates

UUIJli'lu moderate to heay exudate 1111lwound with necrotictissue and exudatel~LLu~thll1'n'u minimal exudate LYI11~\l~ dehydrate wound

LtJ~UULLc.J<1'Yln12 nlJ. - 4 lU LL.rlLL~mllJiilLUU•L'IlU SORBSAN ,Algisite

9. H}'drofiber dressing

111J1uii~m,,1'1i' hydrofiber with ionic silver LUUoll absorb exudate

Large fluid absorption capacityLtJ~UULLc.J<1'Yln7 lU•jj!]'Yl~l!ilL~1lh~\lln ionic silver

L'IlU AQUACEL Ag

10. Nanoerystalline silver (Ag) dressing

~ tIJ 3 nu

Inner layer : LUU low adherent polyethylene net

Middle layer: LUUabsorbent rayon/ polyester

- Outer layer: LUU layer of silver coat

ri1luli'G11l~l'h111Luun~hu water l1J1'1i'NSS LL<1~11J111'1llJLnultJ•\lULn~ maceration m\'~\llml~iNuULLc.J<1 ,1l\liilLUUG11l~1'lisecondary dressinguUJ.Jl'liall1~U partial thickness wound \lln burn 1111ltrauma 11~1l

Ul~LLc.J<1infected wound. venous ulcer 1111ldiabetic ulcer

111J.Jli'timrthu~ sensitive vifl silver 111fJlumru~fJthtJG1fJTnl• •MRI U'jLlruUl~LLc.J<l

L'IlUACTICOAT

18

tI'il<5'u~ihJ<lGiiJf)l'HiiiJf)lB Dressing tt<l:: Dressing material

m~~il LLfJ<l~~Gi',NG]aU<lu a~lG1 mh~<l~Yl1 um~rilLLfJ<l Iv1a 1liulGi LlfJ<lmtJ 1u•~~tJ~L1"1~&U~<lGl L'I1m~<llJi1u~U1tJLL~<l~~11J LUI1Jlliilil11~LLmni'auua1J~<lGl Lv1a1li'. .~j'U11J<lllJl~(lril~lU MGlllJUn&i LYlm11~<lYl~~l'hmil1~il "right patient receives the• •right dressing, at the right time, in the right amount and in the right selling"

1.1 al1J•

~U11J~mtJU1l1J 'I1~ahi-i1lJil a al\lt'1a~dia ni1:lrilLlfJ<l~ LnJU'l1'Ul ~U11J• • v

LLn~La~M1J1n l11an1i dressing material ~hjt'1a~ri1LLfJ<lUa1J mnil

1'111lJ'ii1LtJu al\lt'1 a~1<i spl int 0'1LtJUU1UlLLfJ<lU'L1l\UL1JU'I1~a1J1

1.2 1I1~Vl

ril~lU a1\lGi'1I~Ll1an occlusive dressing LL<l~Ll1an1'1i'dressingmaterial ~hit'11NtU~tJULLfJ"tia!J

1.3 Socioeconomic status

dressing material UWlliJUlil~lYllLL'VN ~~I'11~ll1an1iQ11lJI'111lJ'iilltJU

LI<l~"hu~o~1'111'1i''iiltJ1Ja~~U11JGi'1tJ•

~rilLLfJ"l'11~ilI'111lJf 1'111lJnr,h~a Yl(llillJU&i 'I1a~LL<l~V<lL1i1J1Ja~i1i dressing LL<l~• • •dressing material LL~<l~'lfiJYl<lEh~~ riaU~\l~Ll1anh11il1~a product 'lfUYl17u1 ~rilLLfJ<l

•I'11~Ll1anhlUltJ alA1J1'111lJf U~~<lU m~ru LL"~1'111lJ?ilu1ru1Ja~U1UW~ lJlnnil\l~ll1 a nl'1i'LW1J~v u

LW~l~LtJU product 1mJ 'I1~a IW~l~~LIYlUfJ~GlnruiLLu~lh•

-.

3.1 Amount of wound drainage

tJ~lJlru'1l1Ndrainage 11~1lexudate jj~al'i1lm~Li'l1lnhill dressing 11~1ldressing material T~mlti~Ltlu~~cl'

1. n~Ol No drainage

- fl1~hill occlusive dressing

2. mOl minimal drainage «1-2 mllday)

- 1I1lJl~(l1'11'occlusive dressing

3. n~Ol moderate drainage (3-5 mllday)

- 1I1lJl~mll1ln1'11'absorbent dressing, composite dressing,

hydrocolloid, hydrogel 11~1lfoam dressing hi4. mOl heavy drainage (>5mllday)

- 1I1lJl~mll1lnli alginate, 11~1lHydrofiber hi

3.2 Infection

n~Olul~tt~<ljjm~1ifiLlIU~~t111lA1~Lll1lndressing material ~1I1lJl~(l1l1lnf]Y1Blil<lltH111lhf1lfu1 L?lU

1. wet dressing

T~lEJm~1'11'gauze 'liu~hl'J solution l'il~1 L'liUpovidone _ iodine,

Dakin's solution <i111fuA11IJti1ll'J1um~liltt~<lfll~1fu1l£inUA11lJvv

1Uu~~'1I1l~m~1ifiLlIU~~l?j1lua~;jlulll drainage 1l£h~U1ll'JA1~lilv

u~a2-3 flf~l'i1l1U

2. 1'11' Topical antibiotic t?lU silver sulfadiazine

3. n~Oljj antibiotic beat 1I1lJl~(l~~LlilltJ1uul~u~a ua~ll1utJ~u~avllUUU ~llJlIlJm~ M

4. Lll1lnli dressing material ~jjf]Y11f1um~~lL111lhflM t?lU

ACT/COAT 11~1JAQUACEL Ag lUUvlU

19

20

3.3 mINlltJillii'i necrotic tissue ll'iil slough

l11U1INlltJillfuiJ necrotic tissue l1lmlJl~mh mechanical debridement

Mf11~L1iilm;l mechanical debridement l11nh.iiJllJl~mh MLw~l~iJtJ~lJlOJlrilfJ, ~th!Jjj"pain 1I'iilU1INLLtJililTiliJbleeding 1~ f11~L1iiln1i dressing ~ri~LiJ~lJ m~aill!JViI~

necrotic tissue L'liU

Dakin's solutionSilver sulfadiazine

Hydrogel. Hydrocolloid. Alginate l-l'iil Hydrofiber dressing

U11NLLtJil~i'if11llJ1in l-l'iilluu LW~~LIN!Jh.iM&i(;\~ i1nu'liil~l'1i1~l-l'iil'liil~iIn jj f111lJ

-.jlLUUWil~fill dead space ~llJ~l!J Ll~i1ri~La~lJm~ drainage. il(;\ collection LLil~

promote wound healing L'liU

- wet dressing

• L(;\!Jli' gauze 'Ilu solution LLal pack L'lJlltJ1u dead space L(;\!J

'J~LtJ~!JWLtJilUi1!JlLrill1u?1ui1cinu f11lmULL~~ViI~ infection ILil~" ,tJ~lJlruviI~ drainage uiln'Jlnlfm~ pack gauze il~lu dead space

1um~lilLLtJ il~~tI~l-l<1~'1 f11~il(;\-.jlU1Uil~V11lJtJ~lJlruv i1~

granulation ~ gro\\1h ?fUlJl'JlflflUViI~Ul(;\LLtJil LW~1~l11EJ~A~

pack gauze LLuwnu ltJ'J~lil hi'11'(;\V1Nm~ gro'W1hof granulationIm~l1'(;\Vll~ wound contraction ~1t1

- 1i dressing materia! ~u'1 ~mlJl~O fill L'lJl1tflu dead space ML(;\!J

W'Jl~rul~llJnutJ~lJ1ru drainage LLil~i1lm~ infection 1llJ~1!J L'liU

1i hydrogel gels n~ru minima! drainage LLll~hiiJ infection

li' hydrogel fiber mrujj heavy exudate LLil~infection 'lJiI&iVfN

material Lmillf$iil 'J~ri~liJ~lJ gro'W1hof granulation LLll~h.il1'(;\Vll~wound contraction

:

".

21

3.5 bleeding 'lJiHLLrJ1l

mruul~LL~1l~ij bleeding lll~~u~LL~flm~l'1i' pressure dressing

mruul~LL~1l~ijlaflll1 bleeding ,ilu 1lJm~1'Ii' solution ~mlJl~()

~il1llu clotted blood 11ii (!ill Dakin's solution Ltlll(;/ll

I. Nealon TF, Jr. Fundamental skills in Surgery. 3'" Ed. Philadephia,W.B.Sanunders Co., 1979 ; P 55-73.

2. Altemeier WA, Surgical Antiseptic. In : Block SS, Eds. Disinfection, andPreservation. 3'd ed. Philadephia, Lea & Febiger, 1983 ; p 493-504.

3. Harvey SC, Antiseptic and Disinfectants; Fungides ; Ectoparacitides. InGilman AG, Goodman LS,Giiman A Eds. Goodman and Gilman's ThePhamacological Basic of Therapeutics, 6'h ed. New York, MacmillanPublishing Co., Inc., 1980.p 964-987.

4. Brunner LS, Suddarth OS, Texbook of Medical- Surgery Nursing. 5thEd.Philadephia, J.B lippincolt Co., 1984; p 396-401.

5. Harvey Sc. Topical Drags, In Oral A., Ed. Reminton's PharmaceuticalSciences. 16'h ed. Pensyl vania, Mack Publishers Co., 1980; 719.

6. George B, Ross I S Zbar, : Selected Reading in Plastic Surgery., I0 : 7 part2,2005.

22

:•