New nurse wound care question: I think I really messed up a wound care dressing

[namaB, ADN]

So, I am a brand new night nurse just off orientation. I had an order to perform wound care on a pt with a healing stage 4 as wound care does not come in on the weekends, and the order was as follows: cleanse wound with sterile saline, apply vashe moistened gauze to woundbed, spray periwound with 3m barrier spray, and cover with mepilex.

B/c I am new and have never dealt with a stage 4 I asked 2 other nurses with more experience for help/ input as I understood the order to mean we need to repack the wound with vashe moistened gauze. There were two other nurses in the room when wound care was done and I was not the one who did it, though I was the one who documented it (the third nurse wanted to see the wound and the process as she was also inexperienced with this kind of care). The wound bed looked healthy with no tunneling.

Now that I have the benefit of a day of sleep I am 100% sure we did it wrong and I feel like am going to throw up. In hindsight, I think what the order meant was for vashe moistened gauze to be placed on top of wound packing and for the existing packing to be left in place as I think it was a special packing that only wound care uses (some kind of alginat?).  Anybody have any input here? 

[Candogal]

I think you did fine, the old alginate just like any dressing should not be left in the wound for too long. Whoever wrote the order should have specified to re-pack the wound and then filled the remainder of the cavity with the vashe moistened gauze.

[Kittypower]

You did it exactly right. Never leave the old packing in unless the order specifically states to. Leaving it in creates a nice place for bacteria to grow and cause an infection. Also, you cannot adequately clean a wound with the old packing still in. You did great!

[dommagaoning]

I don't know why you think you did wrong. I think you did what you are supposed to do. Although the order didn't mention removing the old dressing, it is logical to remove the old dressing and apply the new dressing. Leave the old dressing there and cover it with the new dressing basically harbour the bacteria growth. Plus, how could you irrigate the wound without removing whatever covered it. NO worry, you did a good job.