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