Dressing change

joe17 · Feb 16, 2012

i am studying for my nclex on dressing change. can someone give me a cliffnote version fo dressing change and the purpose for it.
1. wet to damp
2. wet to dry
is there anything else? please help a former nursing student in need.

wet to dry wound care dressing

1. go wash your hands, put on clean gloves, gather your supplies.

always use aseptic technique regardless of what type of wound you are dealing with. one of the ways i like is to use my sterile gloves as a field and dump onto that all the supplies i will be using...lucky you if you get your 4x4 guzes in a "boat" otherwise use your opened gloves as your tray so to speak. always use aseptic technique and thanks to coolhubs for reminding me of this fact!! nurses get too hurried and we leave out the obvious sometimes! handwashing and gloving and changing gloves whenever you should...which is often so pile those gloves on top of everything as well!

2. normal saline, 0.9 % (watch expiration dates), gauze (4 x 4 and 3 x 3), tape, sterile applicators, gloves and plastic bag (walmart bags work well).

3. lay out your cover (this is the opened sterile glove pack i talked about above) on a clean work surface, wax paper is fine, then start opening supplies. i like to set up two sets, one will be moistened with normal saline and the other will be the dry top and the tape layer.

4. remember! wet to dry never goes in really wet…it means it goes in just damp enough that it will be 100 % dry by the next dressing change. the purpose of wet to dry is to pull off all bad (dead) tissue every time you remove the old dressing.

5. with the smaller of the gauzes, take each one when it is dry and unfold it, play with it, fluff it…much easier to do it now rather than when the saline is on it. just be careful and don’t touch anything that is not on your wax paper…keep it all as clean as you can.

6. moisten the fluffed gauzes and the two unfolded small gauzes with saline. unfold but do not fluff the top four or five 4 x 4 gauzes that make the top layer, this just makes it easier to place it over the moistened gauze in one piece instead of trying to place each gauze separately.

7. cut your tape.

8. go wash your hands, put on clean gloves.

9. remove old dressing slowly, carefully, put one finger of left hand on the skin and stretch the tape up and away from the skin at the same time with your right hand, moving along the edges until top portion is off. repeat with each side or piece of the old tape

10. remove the inner packing, count the gauzes as they come out, you will count them going in as well. nurses, remember to document hw many pieces of guazes were used coming and ging! discard old dressing into plastic bag by rolling the old dressing into one glove and pulling the other glove on top of it so you thrw it away like a big ball and the soiled dressing is insde it.

11. go wash your hands, put on new sterile gloves. you are almost done!

12. ok, now, clean until the wound bed looks better and or smells better, be sure to hold up anatomical structures (buttocks, leg, arm or wherever the wound is so you can see inside as much as possible. that’s done, that’s the hardest part and you did it!!) and remember, wound bed is used as a general term, it can be small and superfical or may be larger, the point is to observe it carefully every time. if there is anything different from day to day, call your nurse!that's what she's there for! the nurse may be your physicians nurse (get to know her by name) or your home health nurse (hopefully she's so good you will love her and depend on her because she is your number one backup!)

and just as hand washing is the best way to prevent the spread of any infection and you are washing your hands like crazy with every step...be alert and watch for signs of it anyway!!

signs of infection are: pain, redness swelling, warmth, change in color of wound bed or drainage, change in odor,change in consistency of drainage; but first and foremost pain is the number one sign of complication or infection!

13. pat the surrounding skin dry, use the skin prep or sureprep ,or whatever skin barrier you have, on the edges and let it dry a little. now go...you guessed it! wash your hands and put on new gloves :) are you remembering to sing the abc song or happy birthday? they both take 15 to 20 seconds to sing and thats the exact amount of time needed to kill the bacteria on your hands!!!

part two

14. pick up the bundle of fluffed small gauzes and one at a time, slow and carefully fill the wound bed. you do this one fluffed gauze at a time, q tip in one hand, pointed edge of gauze in the other and slowly place one end of gauze in one end of the wound bed as far as you can go and work yourself back to the top of the wound bed. you can do this!!! just go slow, do not pack it hard, do not force the gauze, just waffle it back and forth. i use the terms bottom to the bed and top of the bed just as example, jut do not take the fluffed gauze and plop it in there and be done, take your time, it will be more comfortable and will do the job better. also try to use the cotton part of the qtip/dont use the stick part..dont hurt the new tissue that is growing anymore than need be.

15. go wash your hands and put on new clean gloves.

16. now see if you can pick up the bundle of dry gauze and lay it all in one piece on top of the moistened gauze. ta da!!

now one piece at a time, lay down the pieces of tape you've had ready until all parts of the gauze are covered. do this around all four sides.

17 guess what? ta-da ta-da!!!!!!! you did it!! great job!!!

diana2520 · Feb 16, 2012

Joe17, you are a life saver, all your time and and your tips..plus plus is very much appreciated :)..had to say this

hotnurse408 · Feb 16, 2012

Thank you so much Joe17!!!

Is it true that wet to damp promotes healing? or is it wet to dry.

I was told that wet to dry also prevents bacteria from infecting the wound or something. This information is a blur in my head