Steps of a wet to dry dressing - page 3
by oxyjen | 169,565 Views | 50 Comments
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 patient pad bed, emesis basin... Read More
- 3Aug 2, '07 by tvstimsonWet to dry dressing are very antiquated, inadequate, and ineffective when compared to the available alternatives.
Wet to dry dressings require frequent changing. This subjects / exposes a wound to more instances of possible infection.
When compared to other type of dressings the wet to dry often mistakenly is considered to be a more economic procedure. But considering the frequency of dressing changed; the nursing time required; and the over all extended healing time; it becomes apparent the cost is much greater.
Again, because the wet to dry process is so slow the wound has a far greater chance of becoming chronic and again more suceptable to infection.
Very often wet to dry dressings are very Painful. In many cases narcotics are given to counter act this pain. Is this a good justification when there are many more non-painful procedures.
Wet to dry dressings are Indiscriminate of what tissue it removes. Wet to dry can remove viable, newly healed, and intacted tissue.
The WET portion of wet to dry holds moisture in contact with the exterior epidermal tissue which needs a dry enviroment to maintain its integrety. Constant contact to moisture causes it to break down.
The DRY portion of wet to dry also removes body fluid and nutrients necessary to to repair tissue. It also creates an isotonic imbalance leaving the tissue more suseptable to further break down.
Wounds will heal despite the wet to dry treatment, not because of it!
Besides being a poor selection for debridement I believe there well could be some legal ramifications by this continued practice.
For more information please read the article "Hanging wet-to-dry dressings out to dry" by Ovington, Lisa at:
- 2Oct 23, '07 by sharlynnThey are not the same thing. Wet-to-dry was pulled off dry as a debridement technique. It was generally very painful and is now out of favor because it does more harm than other methods.
Wet-to-damp or wet-to-moist is a kinder method. It promotes a moist wound bed, which is the preferred treatment now. Although many dressings are better and promote faster healing, this is a cheap and effective dressing technique.
- 0Apr 3, '09 by HollibethBoy I really wish schools would quit teaching wet-dry techniques. I am currently in Home Health nursing and have had my fair share of pt's coming out of the hospital with dry necrotic wounds following wet-dry treatments. There are so many advanced wound care products on the market that are becoming so much more reasonably priced, I don't understand why the hospitals don't employ these methods. We currently use Convetec products which are superb, but I was also a Director of Nursing in a facility that used 3M and Smith and Nephew products. In that position I kept a keen eye on budget and found these products to be both beneficial and cost effective. There was a question a few posts back on what you should use if not wet-dry. It all depends on the wound, but the main goal of the therapy is to maintain an optimal moist wound environment. If it is sloughy, use an antimicrobial gel forming product like aquacel ag to fill and cover with a transparent dressing (if low exudate), hydrocolloid dressing (if mod exudate) or a foam dressing (if mod-copious exudate). This combination encourages autolytic debridement, a much less painful and effective method. Each of these products can remain in place for up to 7 days which means fewer dressing changes (lower cost) and less opportunity for contamination. Also, did you know that there was a study that showed that bacteria can penetrate through 60 layers of gauze! The advanced products have bariers that prevent bacteria contaminating the wound. This post comes from a place of love. It disappoints me that our medical environment neglects to offer sufficient training to the wonderful people that are joining our industry.
- 0Apr 18, '09 by bebop1I have a patient that has a huge stage IV on her sacral area. She is hospice, and we are using w/d on her, due to the doctor states, we do not intend it to heal, so keep the wound care products at a minimal. Which I understand, but....ya know! the patient does not eat, only drinks small amounts of water. we have to give her a lot of meds before the procedure. she also has wound to her heal, that pretty much is down to bone...that again is w/d.
what you ya all suggest is a..."more humane" treatment. This patient is very close to the end of her life, but we need to keep her comfortable. and this wound is getting so deep that soon it will prob open up into the rectum!
The sacral wound does not seem to 'hurt" her as much as her heel wound. What would you suggest that would not be as painful as w/d....but also cost effecient? since the doctor really doesn't want anything else? He wound has granulation tissue...and bone present...no slough.....and High exudate.
what is a better alternative?????/
thanks! I want to go to this doctor with some information to help with dressing changes to be less painful!
- 0Apr 19, '09 by HollibethHi 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.
- 1Apr 26, '09 by lsyorkeQuote from moliverlpnRemoving 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.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.