Steps of a wet to dry dressing - page 3

Hi, I need to write a plan of care for a wet to dry dressing, lots of steps and I'm not sure when the sterile gloves go on. Could you help? Here is the scenerio I've come up with: position... Read More

  1. Visit  Hollibeth profile page
    0
    Hi bebop1,
    You could try suggesting packing the wounds with something like aquacel and covering it with an absorbant dressing like a foam or reinforced hydrocolloid such as combiderm (or smith and nephew have a great product called "allevyn cavity sacrum" that's highly absorptive and is self adhesive). The foam will be the most absorbant, but something like combiderm has a hydrocolloid self adhesive surrounding that will make it easier to keep the dressing in place. The packing I suggested is highly absorbant and turns into a gel when it comes into contact with exudate so removal is much less painful than the removal of wet-dry gauze dressings. You could argue that it will not be that expensive because there would be less need for dressing changes (can be left in place for up to 7 days if not saturated). Of course, if you wanted to speed healing the method would have to be wound-vac. I suppose that could be argued as being more humane because it would fill the wound in a much quicker time (I've seen wound vacs regranulate stage IV pressure ulcers in less than a month). You'll have to check with your account manager and see what wound care product company you have a contract with, but all of the companies have products like these (even 3M) and usually have representatives that you can call that can suggest the best dressings in their line to manage these wounds.
  2. Visit  HeartsOpenWide profile page
    0
    We do not do wet to dry dressings anymore; it goes against evidenced based practice
  3. Visit  moliverlpn profile page
    0
    As a wound nurse I utilize w/d when wound conditions permit. Wetting the dsg for ease of removal is contraindicated as the purpose is light debridement of slough and such.
  4. Visit  lsyorke profile page
    1
    Quote from moliverlpn
    As a wound nurse I utilize w/d when wound conditions permit. Wetting the dsg for ease of removal is contraindicated as the purpose is light debridement of slough and such.
    Removing a "wet to dry" dressing dry is removing good tissue along with bad. That defeats the purpose of wound care. In wound care we don't use wet to dry, ever.
    apocatastasis likes this.
  5. Visit  BelcherADN2010 profile page
    0
    It is 2009 now ( I see this was posted in 2006) and we are still being taught wet to dry sterile dressing changes.
  6. Visit  mard688 profile page
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    Thanks for the info guys! we just learned this in lab, makes more sense now
  7. Visit  gettingupthere profile page
    1
    Non of those were wet to dry! wet to dry is not done 3 times a day. The reason for wet to dry is to debride a wound. If it's done 3 times a day, there isn't enough time to allow the gauze to dry. That being said, this is cruel! Think of it, it's meant to debride. The dressing is left in place until it drys out, then the nurse comes along and pulls this dry dressing out, supposedly debriding as it comes out, causing bleeding and further tissue damage! Would ANYONE want this done to them?????
    If the dressings are too wet, then there is maceration! This treatment is archaic!(sp) sorry for such a miserable response, but that type of dressing makes my knees weak!!!!
    woundnurse7 likes this.
  8. Visit  BelcherADN2010 profile page
    0
    We are being told that these dressing are being changed once a day and that if the gauze is sticking to the wound that we should wetten it with saline, allow it to loosen, and then remove the dressing.
  9. Visit  starletRN profile page
    0
    What is the purpose of that oil-based dressing (can't think of the name of it) for wound debridement? I had a patient with it on his toe and no matter how much NS I soaked it with it would not loosen from the wound.
  10. Visit  cory39 profile page
    0
    Quote from nowhappywoundnurse
    NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO
    NO more wet to dries. Research has proclaimed wet to dries to be harmful. Leave fibers in wound, non-selective debridment- removes granulation and epithelial tissue! Good article out there called hanging wet to dries out to dry. If you work in a LTC facility- beware- you will get flagged for this!!

    I'm just wondering if your going to tell a doctor "NO NO NO NO" when he writes an order for a wet to dry dressing change? My suggestion is do not believe everything you read or see, lol
  11. Visit  woundnurse7 profile page
    1
    Well believe this, it is a quote from a law suit in regard to fraudulent billing 'Hogue E, 2003': "Physicians orders to apply betadine on a routine basis to a patients pressure ulcer may provide an excellent example of this type fraud. the application of betadine to patients pressure ulcer is clearly outside standards of care for the treatment of pressure ulcers. Thus, if agency staff members render care ordered by the physician and submit a claim for payment for this care. the claim is false even though every thing on the claim form is true because the services provided were not reasonable, necessary, and appropriate." Like wise, the NPUAP Clinical Practice Guidelines dictate (pg. 84) to avoid gauze dressings, and these are the standards that you will be held accountable to in a court of law. Believe that!!!
    Last edit by woundnurse7 on Mar 4, '10 : Reason: misspelled word
    Bklyn_RN likes this.
  12. Visit  lalaxton profile page
    2
    Quote from cory39
    I'm just wondering if your going to tell a doctor "NO NO NO NO" when he writes an order for a wet to dry dressing change? My suggestion is do not believe everything you read or see, lol
    If a doctor writes an order to give a medication that you know is clearly going to harm your patient, are you going to give it? You are responsible for your own practice, regardless of what a physician orders. Contrary to popular belief, physicians can learn from nurses. Let's help those who are still using these outdated practices to learn better wound care technique. There is a wealth of information out there about not using wet to dry dressings. Simply Google the term.
    apocatastasis and Bklyn_RN like this.
  13. Visit  Hoosiernurse profile page
    0
    Quote from InIt4Life
    Yes it is still being taught and this is 2007. I am really interested in learning more. Please email with more info if possible. Thanks
    It's now 2010, and I worked for two months at our hospital's wound care clinic. I was instructed to do a w/d dressing for a patient, and this clinic is being run by a prominent independent wound care company who sends their physicians and nurses to special training to be certified to work in the clinic. Is it possible that it still has use in certain kinds of wounds? It wasn't something we did often at the clinic.


    HoosierNurse

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