Deep partial thickness burn--dressing ?

skeeterRN · May 20, 2010

Hi. Im an ICU burn nurse. my suggestion would be to keep the would covered. Letting it "breathe" is not best practice. It allows for bacteria and infection to set into wound bed. If the wound has any big blisters, they should be deroofed (using a sterile scissors cut the blister "roof" and let the fluid drain). Trim the roof rissue to the border of the blister. After deroofing, place the wound in SSD (silvadene). Put SSD ONLY on burned skin, as it will break down healthy skin. Place a gauze dressing over the SSD and secure the dressing with a loose kerlex wrap or spandage. The idea is for the SSD to provide a bacteriostaic environment and to stop the burning process. It will cause the burned skin to macerate and lift- which is the goal. Keeping badly burned skin intact is a breeding ground for infection. The wound must be cleaned and redressed everyday.

agentarjuna · May 20, 2010

Not a burn nurse, but a burn survivor here! I had full thickness burns to both hands when I was 17, and it was repeatedly emphasized NOT to allow the wound to breathe. They did perform "deroofing" as described above, and slathered me in Silvadene & did some really creative kerlex wrapping (I had to have each finger wrapped individually; all 10 fingers!) Letting it breathe is pretty much inviting bacteria in.

Now, that said, a nurse at the burn unit at Arkansas Children's told me they don't use Silvadene there anymore. I cannot remember what she told me they used instead. Anyone know?

anon456, BSN, RN · May 20, 2010

I just wanted to chime in from personal experience with a recent scalding burn on a family member. The burn was dressed with petroleum soaked dressing and the person was instructed to change that dressing daily for 3-4 days and be sure to keep it covered. The person was sent from ER with more of the petroleum dressings for home use. They were told that if it was left uncovered it would have a greater chance of scarring.

mamamerlee, LPN · May 20, 2010

If this is a patient, where are the ORDERS for the wound care? Why is it up to the individual nurses? Can you get a consult from a wound care nurse or the patient's doctor?

.MediKATE. · May 20, 2010

I would have to say the nurse was in the wrong here. They should not have let it "breathe". This allowed for bacteria to get in and also the healing tissue to dry out. It should be kept moist and covered.

SunnyAndrsn · May 20, 2010

Many of my patients want their wounds left uncovered and do not understand the concepts behind a moist healing environment.

In TCU and LTC, we have some latitude with wounds, as the MDs are not there on a day to day basis to provide regular wound orders...although we have standing orders, and are expected to regularly update the MD to wound progress, etc. Usually once a week unless there are s/s of infection.

As the wound changes, we will change the treatment, update the MD as to why, but in the meantime, use an appropriate dressing based on the changes that occurred in the wound.

Nurses working with burns or other wounds should know that leavinga dressing off to let the wound breath is counterproductive. The silvadene cream, petroleum gauze or xeroform gauze is most often what I have seen used on burns or abrasions.

Long before I was a nurse, I took care of a little boy (I was his foster mom) who had been burned. Long story as to how he ended up in our care, but he had some open areas when he came to us. We were using either xeroform gause or pieces of Una, depending on the depth. The deeper areas we used xeroform, the shallow open area we used the una.