Dressing changes

When would you change the dressing on a *new* PEG tube if there were no written or standing orders besides "remove sutures 7 days postop"? Would you change the dressing with or without an order or would you assess the dressing and if being clean, dry and intact wait until the 7th day to change it?

For my question, keep in mind there is no order written for a dressing change and there is no facility policy written for new PEG tube dressings. The only facility protocol is written for existing PEG sites and daily dressing changes.

Any input is appreciated.

I would call the physician and ask if he wanted dressing changes and how they would be done.

yep, call the physician for orders on dressing changes. Even if it's a new peg site if the facility protocal is with existing peg sites thats what it is now.

Call the doc.

Call and ask. I never do the first dressing change without a order.

i'm responsible for that patient. i change dsg to make sure things are status quo under there. i don't wait for orders .....ever:smokin:

I would change the drsg but the op's are probably right call and get the order.

how does one monitor for s/s of infection unless you change the dsg?

i would change the dsg within 24 hrs post procedure and get orders from doc.

leslie

I would change the dressing 24 hours post op to check healing. If it needed to be changed sooner, than I would do so. I would also expect to change the dressing q shift and prn until the area stops oozing. I'd use good ole soap and water. I'd wait until the doctor made rounds the next day and remind him/her we needed orders for dressing changes.

I would call the doctor and get the dressing change order. That doesn't take long and is legally what you should do if you don't have a PEG dressing protocol. If it's oozing a lot or saturating the dressing it would be something you want to notify the surgeon about, anyway.

It wouldn't be an issue where I work. The surgeons are in seeing the patient in less than 24 hours and always pull down their own dressings, either changing it themselves or giving instructions on how they wanted it changed. I wouldn't have to worry about the patient going over 24 hours without a dressing change.

Thank you all very much for the replies.

I'm still learning that all cases may be different for post op dressings, initially I thought how I learned... that you initially just observe the dressing and change when ordered and it's is usually after the Dr. performs the first change.

I need to go with the -when in doubt, ask/call - from now on, and get it in an order.

Am I wrong to think that some dressings wouldn't be changed, just observed and if there were to be drainage that would be reinforced or circled and monitored? If so, could you tell me which this may apply to?

Thanks again!! You all are always so helpful.

That is true, most post op dressings this would apply to. Usually the surgeon will want you to just re-inforce the dressing if it looks like it may bleed through. However, when in doubt, ask. I've have some surgeons who wanted me to take the dressing off due to bleeding, clean the site and reapply. So, best to ask.

Blessings

one of our docs wants nothing on his tubes after insertion. Nothing. Weird, but there it is...we just sop up the gunk when it presents itself....