Steps of a wet to dry dressing

[oxyjen]

Hi, I need to write a plan of care for a wet to dry dressing, lots of steps and I'm not sure when the sterile gloves go on. Could you help?

Here is the scenerio I've come up with:

position patient pad bed, emesis basin handy for later irrigation

open and arrange supplies

nonsterile gloves

remove old dressing

measure wound with cotton applicator tip

irrigate wound with NS and Toomey stringe

apply sterile gloves

pack wound with 4x4's

dry skin which is wet with irrigant

apply ABD pad and tape

Please rearrange these if they aren't in the right order. Add your rational so I'll understand better. Thank You!

[suzanne4, RN]

Irrigating a wound is not a wet to dry dressing. That is a separate step and needs a physician order especially for that.

A wet to dry dressing is one where either 0.9% NS or a medicated soln such as Dakin's soln are poured over the dressing, just enough to wet them while they are in their opened package, and it can also be a kerlix roll. You then wring it out, with your sterile gloves on, and place it in the wound. Then cover with an ABD.

Wounds do not get measured with every dressing change, most times get measured every few days or once a week. Depends on your facilities policies and procedures.

And if it is one that is getting done three times er day, you want to use Montgomery Straps so that you are not removing tape each time.

[CoffeeRTC, BSN, RN]

I had to google a Toomy syringe.

Are you irrigating it to flush the wound or clean it?

We don't need an order it cleanse with NSS.

As far as measuring...we do it once a week.

Why does this have to be in a care plan? Couldn't you just say...wet to dry dressing per protocol?

[oxyjen]

Hi and thanks for the comments. Well, the order is to irrigate the wound, I guess it is to both flush and clean it both? I need to make this care plan for students who need step by step instructions?

Order is irrigate with normal saline and pack wet to dry. Routine measuring is twice a week. So on the days of measuring they would add that step.

So am I saying to put on the sterile gloves at the right time? Would you put them on after flushing or irrigating with normal saline?

Sorry, I am old school, maybe toomy is an old term for catheter tip syringe, or maybe I am wrong about what a Toomy is? :imbar

Thank you!

[AnnemRN]

Hi, I need to write a plan of care for a wet to dry dressing, lots of steps and I'm not sure when the sterile gloves go on. Could you help?

Here is the scenerio I've come up with:

position patient pad bed, emesis basin handy for later irrigation

open and arrange supplies

nonsterile gloves

remove old dressing

measure wound with cotton applicator tip

irrigate wound with NS and Toomey stringe

apply sterile gloves

pack wound with 4x4's

dry skin which is wet with irrigant

apply ABD pad and tape

Please rearrange these if they aren't in the right order. Add your rational so I'll understand better. Thank You!

Dressing Changes: Sterile Technique

Wash Hands then:

1. Explain the procedure to the patient/caregiver

2. Assemble the supplies at a convenient work area

3. Assist the patient to a comfortable position to expose the wound. Place a plastic sheet under the patient to prevent soiling the linen. Drape the patient for privacy.

4. Place a clean towel underneath the working area to minimize contamination.

5.Open the sterile dressings, the irrigation and cleaning solution, and the instrument set to provide a sterile field.

6. Wear a protective apron when caring for a patient with a draining wound. Don nonsterile gloves.

7. Gently remove and discard the old tape and soiled dressing in a plastic trash bag. If the dressing sticks to the wound to the wound, moisten with sterile nss and then remove.

8. remove and discard nonsterile gloves. Don sterile gloves.

9. Cleanse and irrigate the wound as prescribed by the physician. Clean from the least contaminated area to the most contaminated area.

10. Inspect the wound, and evaluate it for healing versus signs of infection.

11. Apply a (moist) dressing,(gently feed moist gauze into the wound with cotton-tip applicators if packing is required)Place dry gauze over wet gauze. Then cover with a gauze dressing,or ABD pad and secure it with hypoallergenic tape,Montgomery ties or a binder.

12. Provide patient comfort measures.

13. Clean and replace the equipment. Discard disposable items in a plastic trash bag, and secure.

These steps are from "Handbook of Home Health Nursing Procedures" by Robin Rice.

[oxyjen]

AnnemnRN, bless your heart for going to the trouble to help me with my little problem! I really, really appreciate it very much!

[AnnemRN]

You are very welcome--I thought you would find it helpful!! :)

[nowhappywoundnurse]

NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO

NO more wet to dries. Research has proclaimed wet to dries to be harmful. Leave fibers in wound, non-selective debridment- removes granulation and epithelial tissue! Good article out there called hanging wet to dries out to dry. If you work in a LTC facility- beware- you will get flagged for this!!

[JeanettePNP, MSN, RN, NP]

Very interesting. I found the article over here:

http://www.findarticles.com/p/articles/mi_qa3977/is_200203/ai_n9080467

Can experienced wound care nurses please comment? Are you still using wet-to-dry gauze? Are student nurses still being trained in this method or are they being taught advanced wound care methods?

[crb613, BSN, RN]

We are still being taught w/d dsg. changes. I did one past this week.

[sharlynn]

Doctors may still order wet to dry dressings, but they also order betadine and hydrogen peroxide, too. All are no longer frecommended for wound care. My biggest problem since becoming certified is educating doctors!

[InIt4Life]

Yes it is still being taught and this is 2007. I am really interested in learning more. Please email with more info if possible. Thanks