Turtle in scrubs 6,280 Views
Joined: Mar 8, '07;
Posts: 217 (43% Liked)
; Likes: 218
10 year(s) of experience
I find most physicians don't really know what a traditional wet to dry is, or it's consequences. Most don't know what else to order. I don't really see "true" wet to dry dressings done intentionally anymore. I only see them done when dressings are left on by accident too long. The only thing that separates a wed to dry dressing from a NS moist dressing is time and saturation. Generally I see NS moist dressings done (even when the order is for a wet to dry), where the dressing that comes out of the wound is still slightly moist, and therefore not as traumatic to the wound bed.
If the wound is dirty, meaning it has necrotic tissue, than a traumatic dressing removal is not such a bad thing. However there are better, less painful ways. And if the wound bed had any part of it with a clean wound bed, especially with granulating tissue, a wet to dry dressing is harmful. Placing a contact layer such as vaseline gauze is an excellent idea.
This is where knowing what the wound needs, and clarifying the intentions of the MD are helpful.
For skin protection (before tape application), I like Cavilon No Sting Barrier Spray. I would recommend using this (or another skin barrier) to clean, dry skin before applying tape.
If skin is impaired and it is a sacral injury you could also skip the tape by securing dressing with underwear. In acute care setting if you have access to mesh/disposable panties, those work nicely.
But I can't help wondering why the patient needs dressing changes 3 times a day. It is highly exudative? Is it a wet to dry dressing?
Yes, using foam dressing for cover dressing. Her skin is way too fragile to be left uncovered while it heals. And it was pretty exudative in the beginning. I've had her shower twice now with her dressing off, about a week between each dressing change, and it is going well. The flap I placed back was approx 70% viable and the other 30% went necrotic and is clearing away with cleaning. I didn't have much hope with the flap being viable in the beginning because it was so bruised, but I thought it was worth trying to save, and turns out it was a good choice. Interestingly, after her shower the triad was still on. It is a thin, scattered, layer, but still there. Of course she was instructed not to scrub it, only gently let warm soapy water flow over and sort of rub it in the direction the flap was going. So, I've stayed the course with the Triad, having her reapply another layer and cover with mepilex. I've not used Triad much, and never with a skin tear before, but so far I'm happy with it. I wanted something that I could dress and leave undisturbed for several days between dressing changes. The only drawback is wanting to completely clean the Triad off and not being able to. It just made it a bit tricky to assess the wound.
Thanks. I haven't tried mineral oil, but I haven't really tried very hard to get it off either. I was more comfortable leaving a thin layer in the wound after cleansing than I was risking causing any more trauma to the wound. I think next I will have her shower with the dressing off, just letting soapy water run over it.
I have a pt with a pretty bad skin tear. I was able to place flap over approx 70% of wound although its long term viability is questionable. I had smothered the whole wound with Coloplast triad. 1 week later the flap is adhered but looking rather dark. But she bruises easily and is on anticoagulants. I cleaned the wound gently as to not mess up the flap. Much of the triad stayed in the wound. For those who have worked much with triad, how do you clean the wound without causing trauma to the wound bed? If the wound bed were necrotic I wouldn't mind getting a bit rough, but I don't want to disrupt the flap, or any granulation tissue. Is it alright to leave the triad that remains after gentle cleaning, and just apply new layer? Any thoughts?
Separate bedrooms. If he doesn't respect you enough to try and address the issue, respect yourself enough to do what you need to do to get some sleep.
The hot water in a washing machine is not hot even to sanitize clothing, not even close.......
Reference to washing clothes can be found here CDC - MRSA and the Workplace - NIOSH Workplace Safety and Health Topic
I'm curious to see if anyone has, or knows of, any research out there on safe practices for washing scrubs at home. I've read through posts here on allnurses of what people do and think should be done, but I'd love to see some research data if there is any out there.
I'm tired of going through scrubs so fast because I wash them in hot water if it really doesn't make a difference (i.e. mechanical washing and hot dryer kill of organisms anyway), but I don't want to be the fool who spreads nosocomial infections to my patients, or infect my family.
From my experience WOCN's are in demand (in the couple of States I've lived in). I am not familiar with a DWC. It may be popular in different areas of the country however. I think the question is, 'are there jobs out there that require this certification'? Have you seen postings for jobs that require a DWC? Or, do you work for an employer who will hire you in a new role, or pay you more money if you have this certification? If the answer is 'No' to these, I would steer clear of going that route.
Whatever route you take, I would recommend researching the job demand in your area first. If you are in an OP clinic I'm guessing you have vendors stop by. Talk to them! They have their finger on the pulse of the area, and will often be able to tell you who is looking for a WOCN, etc. Some places will hire a nurse without a WOCN, and pay for them to go to school if they will commit to working at their facility for a couple of years. It's always worth asking! Visit local hospitals and clinics and just ask questions. Check out Indeed and see what jobs are listed for WOCN's and DWC's.
I'm a Director of nursing at a SNF and the wound care director. This is an absolute breech of confidentially. Even texting an MD for orders is a HIPPA violation. If I found out that anyone of my staff nurses did this, they would be terminated on the spot. Imagine if that was your family member!! Come on people... Be an advocate for your patients
No, I've not heard of this. Without knowing the wound, generally if it needs moisture added then an alginate is not appropriate, as it is utilized to absorb exudate.
Hi everyone. I'm looking for some recommendations of a good moisturizer for regular to dry legs to be used under compression wraps, and total contact casts. I'm looking to moisturize while avoiding maceration. Any ideas?
Definitely check to see what your hospital policy is. This may clear things up one way or the other. If there's a hospital policy against something you're doing then you can either cut your hair, or respectively challenge the hospital policy. If there's not a hospital policy then there's your support to challenge her.
Wondering if anyone has gotten an RN license through Endorsement from another State recently. Specifically I'm wondering how long after they specified that it was "In Review" did it take? They have all my info, fingerprints, and I've passed the JP Exam.
Any recent experience?
Thanks HouTx! I'm pretty open at this point. There are no jobs with CSR posted at this time in my field. I have sent over my resume in case something comes up. This past weekend I was in town and stopped by the CSR at the Medical center and it had a good feel to it. Really I'm just snooping around trying to gain any information I can from a far before moving to the area.
Meditech seems to be a pretty archaic system from what I've heard. I saw the system pulled up at one of the Methodist hospitals and it was like the old DOS black and white screen and they were using F keys! Not that this would make or break a job, but it sure can make it nice when you have a system that is user friendly. I currently use Cerner and although it has its quirks I think it is pretty good for information retrieval. Epic seems to be very well liked as far as EMR's go.
Really, I'm just looking around. Any thoughts you can share are most welcome.
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