WET to Dry

[EJSRN, BSN, RN]

Does anyone know what the deal is with a wet to dry drsg?? It just seems to me that it is NOT very effective. I had a pt. who had a gangrenous wound to her coccyx area and it was debrided. Now the treatment is wet to dry bid, and the wound still smells gangrenous and it looks terrible. Anyone care to explain? Thanks!

[bethchpn]

It is very unusual to see wet to dry unless you have an order from an older doctor who is not up on wound care. There are many products out there now that can keep a wound moist without changing as freq as wet to dry. It has to be changed often to keep wet and when you remove gauze it can stick in the wound or tear the new epithileal tissue that is granulating.It occas is done the first couple days after surg . We Have had great luck with wound vacs on the type of wound you are describing. There are very good wound care workshops you might want to attend.

[iluvivt, BSN, RN]

Agree with the above. Also get a wound care nurse consult. The theory behind wet to dry is that wounds heal in a moist environment and then when the wet gauze drys and you peel or pick it off you debride it somewhat. There are so many advances in wound care you do not see these orders any more...they go right to the wound vac

[lpnflorida]

Wound vacs are a wonderful, however they are not able to be used on all areas of the body. Occasionally we still do wet to dry drsg orders, they can be effective when done correctly. Hate when they are not done correctly and then you start to see the maceration which occurs outside of the wound bed on what was the healthier tissue. There are so many different ointments , treatments available. Love that we have wound care docs that we refer to .

[BGgirl]

I find that while we use wound vacs when possible, we also do a lot of wet to dry dressings on my unit.

[SuesquatchRN, BSN, RN]

Wet-to-dry is no longer considered to be the most effective method for the reasons stated above.

Alginates are more often used now.

[highlandlass1592, BSN, RN]

Wet-to-dry is no longer considered to be the most effective method for the reasons stated above.

Alginates are more often used now.

Gotta disagree with ya...some wounds still take wet to dry and changes maybe bid or tid. I do love the wound vacs though till they start leaking.

[SuesquatchRN, BSN, RN]

Gotta disagree with ya...some wounds still take wet to dry and changes maybe bid or tid. I do love the wound vacs though till they start leaking.

I didn't say that it's never used, but we have seen better improvement with other methods.

[HeartsOpenWide, RN]

Our wound care center taught us that they do not do wet to dry anymore because it can remove good healthy tissue. I am sure there are some areas that still do this, but in my are they are very against it.

[mama_d, BSN, RN]

I do have to say that I love wound vacs and feel that (in my facility at least) they are under-utilized. I think it's b/c although the staff has inservices on them once or twice a year, no one seems comfortable with them. I'm one of the few nurses with a lot of experience with them, thanks to my time in pediatric ALTC and spinal rehab. It seems like the only nurses I know who really like them are those with a lot of hands-on experience with them. Although I do admit that on huge coccyx/sacral wounds they can be a pain in the patoot.

We have moved away from wet-to-dry; even when they are appropriate, the MD/DO's order damp-to-dry now. We have a great wound care nurse who we can have come in and assess and order treatments on our patients; it's supposed to be just with a doc's order but they usually bow to our expertise in dealing with wounds and I have never had one object to a TO being written in their name for the consult.

I think one of the key things to our facility having near optimal compliance with wound care is that we have several protocols in place which are fairly easy to understand and cover everything from fungal rashes to stage IV's, along with which special bed is appropriate to order depending on skin issues/risk for breakdown. We also have protocols in place for ordering rectal tubes when appropriate, which can be a HUGE help, especially on our bed-bound, nutrition impaired, skinny little c-diff/VRE patients. This is also the one area in which the bigwigs have no problem expending a little extra initially to prevent issues further down the line. This is on ongoing process which I have seen greatly refined over the five years I've been at my facility.

[oncnursemsn]

We just had the WOCN nurse at our institution do an inservice for the faculty- and I agree with much of previously posted. She advises "moist to dry" if used at all- the purpose being to debreide the tissue that needs to be removed- it hurts! If more than 25% of the wound is granulated she said- stop the packing and go to a different type of dressing- but the vac rules. She wished she had invested in stock in KCI about 8 years ago! (I do too!) Their wound vac is a huge $$ saver in time, supplies and hospitilization.

Just my