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!

[Hollibeth]

Boy I really wish schools would quit teaching wet-dry techniques. I am currently in Home Health nursing and have had my fair share of pt's coming out of the hospital with dry necrotic wounds following wet-dry treatments. There are so many advanced wound care products on the market that are becoming so much more reasonably priced, I don't understand why the hospitals don't employ these methods. We currently use Convetec products which are superb, but I was also a Director of Nursing in a facility that used 3M and Smith and Nephew products. In that position I kept a keen eye on budget and found these products to be both beneficial and cost effective. There was a question a few posts back on what you should use if not wet-dry. It all depends on the wound, but the main goal of the therapy is to maintain an optimal moist wound environment. If it is sloughy, use an antimicrobial gel forming product like aquacel ag to fill and cover with a transparent dressing (if low exudate), hydrocolloid dressing (if mod exudate) or a foam dressing (if mod-copious exudate). This combination encourages autolytic debridement, a much less painful and effective method. Each of these products can remain in place for up to 7 days which means fewer dressing changes (lower cost) and less opportunity for contamination. Also, did you know that there was a study that showed that bacteria can penetrate through 60 layers of gauze! The advanced products have bariers that prevent bacteria contaminating the wound. This post comes from a place of love. It disappoints me that our medical environment neglects to offer sufficient training to the wonderful people that are joining our industry.

[bebop1]

I have a patient that has a huge stage IV on her sacral area. She is hospice, and we are using w/d on her, due to the doctor states, we do not intend it to heal, so keep the wound care products at a minimal. Which I understand, but....ya know! the patient does not eat, only drinks small amounts of water. we have to give her a lot of meds before the procedure. she also has wound to her heal, that pretty much is down to bone...that again is w/d.

what you ya all suggest is a..."more humane" treatment. This patient is very close to the end of her life, but we need to keep her comfortable. and this wound is getting so deep that soon it will prob open up into the rectum!

The sacral wound does not seem to 'hurt" her as much as her heel wound. What would you suggest that would not be as painful as w/d....but also cost effecient? since the doctor really doesn't want anything else? He wound has granulation tissue...and bone present...no slough.....and High exudate.

what is a better alternative?????/

thanks! I want to go to this doctor with some information to help with dressing changes to be less painful!

[Hollibeth]

Hi bebop1,

You could try suggesting packing the wounds with something like aquacel and covering it with an absorbant dressing like a foam or reinforced hydrocolloid such as combiderm (or smith and nephew have a great product called "allevyn cavity sacrum" that's highly absorptive and is self adhesive). The foam will be the most absorbant, but something like combiderm has a hydrocolloid self adhesive surrounding that will make it easier to keep the dressing in place. The packing I suggested is highly absorbant and turns into a gel when it comes into contact with exudate so removal is much less painful than the removal of wet-dry gauze dressings. You could argue that it will not be that expensive because there would be less need for dressing changes (can be left in place for up to 7 days if not saturated). Of course, if you wanted to speed healing the method would have to be wound-vac. I suppose that could be argued as being more humane because it would fill the wound in a much quicker time (I've seen wound vacs regranulate stage IV pressure ulcers in less than a month). You'll have to check with your account manager and see what wound care product company you have a contract with, but all of the companies have products like these (even 3M) and usually have representatives that you can call that can suggest the best dressings in their line to manage these wounds.

[HeartsOpenWide, RN]

We do not do wet to dry dressings anymore; it goes against evidenced based practice

[moliverlpn]

As a wound nurse I utilize w/d when wound conditions permit. Wetting the dsg for ease of removal is contraindicated as the purpose is light debridement of slough and such.

[lsyorke, RN]

As a wound nurse I utilize w/d when wound conditions permit. Wetting the dsg for ease of removal is contraindicated as the purpose is light debridement of slough and such.

Removing a "wet to dry" dressing dry is removing good tissue along with bad. That defeats the purpose of wound care. In wound care we don't use wet to dry, ever.

[BelcherADN2010]

It is 2009 now ( I see this was posted in 2006) and we are still being taught wet to dry sterile dressing changes.

[mard688]

Thanks for the info guys! we just learned this in lab, makes more sense now :)

[gettingupthere]

Non of those were wet to dry! wet to dry is not done 3 times a day. The reason for wet to dry is to debride a wound. If it's done 3 times a day, there isn't enough time to allow the gauze to dry. That being said, this is cruel! Think of it, it's meant to debride. The dressing is left in place until it drys out, then the nurse comes along and pulls this dry dressing out, supposedly debriding as it comes out, causing bleeding and further tissue damage! Would ANYONE want this done to them?????

If the dressings are too wet, then there is maceration! This treatment is archaic!(sp) sorry for such a miserable response, but that type of dressing makes my knees weak!!!!

[BelcherADN2010]

We are being told that these dressing are being changed once a day and that if the gauze is sticking to the wound that we should wetten it with saline, allow it to loosen, and then remove the dressing.

[starletRN]

What is the purpose of that oil-based dressing (can't think of the name of it) for wound debridement? I had a patient with it on his toe and no matter how much NS I soaked it with it would not loosen from the wound.

[cory39]

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!!

I'm just wondering if your going to tell a doctor "NO NO NO NO" when he writes an order for a wet to dry dressing change? My suggestion is do not believe everything you read or see, lol