Joint Replacement Post-op Dressing Changes

[NurseSabrina]

Hi all! Need your help! I have worked on the Joint Center for GHS for over 5 years now. We have always used gauze and Tegaderm dressings starting PostOp day 2 on Knee and Hip Arthroplasties. We are about to have our annual retreat and want to ensure that we are up to date on our practices.

What type of post-op dressing do you apply and when?? Thanks in advance for all your help!!:)

[Mike Huster]

Sounds good! But if there is alot of drainage it could be a problem. We typically apply an ABD pad over the site on post op day two, when we remo0ve the surgical dressing. I usully check it alot to make sure we are not "leaking" all over the bed. Then I change the dressing at least daily.

[RheatherN, ASN, RN, EMT-P]

agreed with above post, we remove and put on ABD with burn netting over if needed, other than that, nada.

-H-RN

[november17, ASN, RN]

For knees: We use 4x4s and ABDs often secured with TED hose or just the netting. It depends on the surgeon.

For hips: ABDs and medipore or paper tape. Again, depends on the surgeon.

For shoulders: Either 4x4s or ABDs torn in half secured with medipore.

We don't use tegaderm except on IVs

[P_RN, ADN, RN]

With a teaching program and over 40 different ortho docs, I'd hesitate to offer much hope there could be a standard. It varied from no dressing if no drainage to full sterile field using xeroform gauze, 4x4s and fully occlusive paper tape. The teaching program tended to use a large bandaid or airstrip.

[november17, ASN, RN]

It seems like you'd want a nice dry dressing over the incision site. I don't see the logic of having any type of wet or air occlusive dressing over an approximated orthopedic type incision. Is anyone familiar with current research or what the academy/association of orthopaedic surgeons recommends?

[CoolKell10]

For TKRs we normally just use 4x4s and wrap the knee with an ace wrap. Most of our total hips are covered with telfa and tegaderm. I'm sure every hospital is different though and it depends a lot on the doctor's preference.

[natkat2816]

All our docs like just 4x4's and medipore tape to secure. Of course if it's draining we would reinforce with an ABD.

[luckijillno1]

My experience has been the patient comes to the floor with gauze, tegaderm, and tightly wrapped with acewrap. With an order we change the dressing to a primapore dressing, which is a tegaderm with a pad in the middle, then we leave the wrap off.

[mama_d, BSN, RN]

We use primapores at my facility.

[khirbz]

In our facility we usually use sterile gauze for moderate ooze wound especially for the first 2 days post op. Then just a padded tegaderm afterwards...

[alngela2]

We have a "Joint Camp" here at our hospital. The standard is mesh/4x4s for knees. Mesh 4x4s/abd for hips. We make the first dressing change post op morning 1.