Wound Packing P&P

SionainnRN · Oct 16, 2014

Is this for homework?

firstinfamily, RN · Oct 17, 2014

The only time I had to account for wound packing and number of pieces used was when a wound-vac was used for the wound. Usually OR surgical interventions have a sponge count at the beginning and end of the surgery to make sure nothing was left inside the patient that should not be. Also, the number of gauze etc might indicate the level of wound care involved and is a way of reimbursement for that care. As a med/surg nurse, I have never documented how many gauze was used in a packing, however, in LTC we did for reimbursement purposes.

Paperchasr · Oct 21, 2014

Lol, no, I wish. Patient received multiple outpatient wound repacks through our facility and was discharged from daily wound packs when they no longer appeared necessary. Patient began having problems at the wound site a few months later and after multiple explorations, a retained piece of packing gauze was found. We don't want that to happen again and are revising our policy but want to make sure our approach is evidence based, thus the need for references.

Paperchasr · Oct 21, 2014

Yes, that is what I am finding in the literature and research as well. However, since wound packing is sometimes used in tunneled wounds, one would think there would be literature supporting the notion that if you use more than one piece of packing, document it so that the next care provider knows how many pieces they are looking for.

Here.I.Stand, BSN, RN · Oct 21, 2014

No P&P, although it's a good idea. If it's tunneled, we use enough packing tape/roll to extend to the surface...that's just common sense. If it's 4 cm deep, clearly it's a bad idea to put one piece deep into the area and another piece into the more superficial part of the area.

And then we need to actually explore the area to make sure all gauze is out when we're changing the packing. Again, common sense. Once we admitted this pt to the LTACH I was working in at the time. He'd been in the ICU with Fournier's gangrene, and was still septic and on the ventilator when he came to the LTACH. He was febrile, the wound was red, and he acted like he was in horrible pain. Well one end of the incision was open, and the other end still had sutures in there that were embedded into the skin. The WOCN decided to clip and remove them, and when she did that we found a fist-size ball of Kerlix that looked and smelled like it had been in there for weeks. :barf02:

So yeah I do think it's good practice to document how many pieces of packing are in there...although any RNs could have found this one if they had simply looked west of the sutures. The skin was sutured, but clearly the wound was open so what did they think was under there?

tyvin, BSN, RN · Oct 22, 2014

I worked at a posh LTC facililty at one time where a cheerful, ambulatory, older female was admitted for long term stay as she didn't want to bother her family anymore and was in need of cohorts her own age. An accident happened the second day she was there and her hip was broken.

She went and had the hip replaced. Some days later days post op we were changing the drsg of the wound and sarosanguineous fluid started to appear. I said that she needed to go out and be evaluated by the surgeon and have an x-ray. Due to egos and a failed system the women wasn't sent out until day 30 post op, even though it continued to get worse. The only reason she was sent out is because I called the surgeon myself and described the situation.

She was brought back with very little explanation but she had some type of surgical procedure. I called my friend who worked over where the women was sent...I can still remember her exact words "Don't tell anyone, but she had a sponge from the surgery tucked in her wound and the surgeon took it out."

I was told point blank to keep my mouth shut when I was dragged into a room with the DON, HR, the administrator, and a few others I didn't recognize. It was everything short of an interrogation.

The women ended up never walking again. I was so young and so wrong. I should have went to that family and told them but I didn't. It wasn't about the money because all the residents at this place were very wealthy. It was about a cover up which, I have found out, happens often in medicine. I was right in the middle of it, and I wasn't sure what that little power group would do to incriminate me; I did not trust them, and I was afraid.

You can rationalize anything to fit your needs but sometimes it's the truth that needs to be told. I think of that women often and just can't seem to forgive myself; so I tell the story as often as this type of subject comes up that others may be prepared to do what's right if confronted with a similar situation.

How did the surgical team miss the sponge...no policy in place, miscount, human error, etc..it happens a lot more than people think.

Tenebrae, BSN, RN · Oct 22, 2014

What type of wound?

If I am doing a Vac or renasys change using sponge I will count the sponge as I put it in. AMD gauze seems to be popular for these dressings, simply because it comes in a large roll and is easier to use in undermining wounds. In those instances it goes in in one piece. If the wound is granulating quickly and there is the risk of the wound bed granulating into the gauze I will also put a layer of cuticerin to aid removal of gauze next time.

I always document what goes into the wound, so the next nurse comes along they know exactly should be there when the dressing is taken down.

For non complex cavities such as abcesses, pilonidal sinus, perianal abcess. When we are packing these types of wounds, we generally use a ribbon which goes in one piece

We dont tend to have a specific P&P for packing of wounds.