putting vaseline gauze under wet gauze

[NurseCard, ADN]

Okay, so my floor currently has two patients with wet to dry dressings ordered.

While I understand that wet to dry dressings are no longer the standard,

they are still ordered and still done. I work in a small hospital with

limited resources and limited types of dressings, so... our surgeon

orders them.

A couple of nurses on my floor have decided that they should put

Vaseline gauze between the wounds of these patients, and the

wet gauze, in order to minimize pain and bleeding by minimizing

pulling on the wound.

Doesn't that defeat the purpose of the wet to dry? Isn't the main

purpose to debride the wound by pulling off dead tissue and slough?

I did my patient's dressing tonight and noticed more slough than

the night before, perhaps because the day shift nurse had used

the Vaseline gauze.

Or am I wrong?

[angeloublue22, BSN, RN]

You are correct. I used to do the same thing until I was told the rationale. Even though it is kinder to the patient, that is not a wet to dry dressing.

[NurseCard, ADN]

Yes I'm sure it is painful, the wet to dry. We generally give pain

medication in preparation for it, but that doesn't mean it works enough.

[Turtle in scrubs]

I find most physicians don't really know what a traditional wet to dry is, or it's consequences. Most don't know what else to order. I don't really see "true" wet to dry dressings done intentionally anymore. I only see them done when dressings are left on by accident too long. The only thing that separates a wed to dry dressing from a NS moist dressing is time and saturation. Generally I see NS moist dressings done (even when the order is for a wet to dry), where the dressing that comes out of the wound is still slightly moist, and therefore not as traumatic to the wound bed.

If the wound is dirty, meaning it has necrotic tissue, than a traumatic dressing removal is not such a bad thing. However there are better, less painful ways. And if the wound bed had any part of it with a clean wound bed, especially with granulating tissue, a wet to dry dressing is harmful. Placing a contact layer such as vaseline gauze is an excellent idea.

This is where knowing what the wound needs, and clarifying the intentions of the MD are helpful.