I posted this in the Wound Care forum, but I'm not getting any replies, so I thought I'd post it here.
Recently I worked with a nurse who placed a wet to dry dressing over a closed, non-draining skin abscess. She stated that the abscess was an open wound, due to the presence of three small tracts about the size of large pores where it had previously drained about a week prior. I did not observe any drainage, yet she stated that the wound was currently draining, but it had dried out due to the lack of a proper moist dressing. Her rationale was that the saline moistened gauze would draw out pus.
She moistened two gauze 4x4s with sterile saline solution, folded them in half, placed them on the reddened, non-indurated dome, and covered it with Tegaderm.
I was more than a little puzzled at this approach. First, I disagreed with the assessment that this was an open, draining wound, and second, I didn't think a wet to dry dressing was indicated. Third, her dressing wasn't really a "wet to dry" as I understand it. If she really was intending to place a wet to dry, her technique was incorrect.
As I understand it, an appropriate dressing for a skin abscess would be a nonstick absorbent pad secured with some roller gauze or a medipore square, with warm compresses applied 3-4 times daily.
I am willing to admit that there is a lot I don't know, and that maybe I'm wrong. She does have 20 years' experience, and seemed very confident in her assessment and judgment.
Also, she had advised the patient to shave around the abscess so that the Tegaderm would stick better. I was concerned that shaving so close to the abscess might create microabrasions that could lead to further infection/cellulitis. She said that since the patient was already on abx, that it would be okay. My contention is that since not every bacteria is susceptible to every abx, the patient would still be at risk.
I suggested washing with Hibiclens and covering with a Telfa, but she didn't take my suggestion.
No doctor order for any specific kind of dressing, just a verbal to "keep it covered", hence my thinking that just a nonstick pad secured somehow would suffice.
I really respect this nurse's experience, which was why I had to question my assumptions.
Last edit by Anna Flaxis on Jun 21, '12