Wet-to-dry dressings

[James_Adam]

I've been told that wet-to-dry dressings are now "outdated practice" and they have been removed from our wound care protocol altogether (I've been a nurse for 6 mos and i work in a nursing home). Is this true? i have a feeling it's because the owner of our company also owns a pharmacy and he orders our wound care supplies from convatec. so I don't know if it's all a money racket or they really are outdated. any opinions?

[Lovely_RN, MSN]

I've been taught that wet to dry dressings are not good for two reasons. 1. They do not always provide the moist environment that is needed for wound healing. 2. They are not very good at debridement because you usually have to wet them before you can take the gauze off. Wound gels like solosite are good and hydrogel does an excellent job of keeping wounds moist. For debriding we use a lot of Accuzyme and Collagenase.

[James_Adam]

well, i've only been a nurse for 6 months, but i have a lot of experience in wound care, and it seems to me like wet-to-dry dressings are a godsend for debridement. From my limited experience, they are second only to surgical debridement which i've done a lot as well.

[Lovely_RN, MSN]

If your wetting the dressing before you take it off then you can't have much debridment going on. If you aren't then isn't that terribly painful for the patient? Wouldn't a enzymatic debriding agent be a more humane choice?

[James_Adam]

they don't seem to cause any pain to my residents at all. of course i do make sure they've had their pain medication before i remove the dressings. and if you do it nice and easy, i've always found that it cause minor discomfort, but nothing along the lines of, say, starting an IV or giving rocephin injections. my main question being, are they really outdated practice, or do you as nurses still see them ordered quite often?

[KyPinkRN]

I've been taught that wet to dry dressings are not good for two reasons. 1. They do not always provide the moist environment that is needed for wound healing. 2. They are not very good at debridement because you usually have to wet them before you can take the gauze off. Wound gels like solosite are good and hydrogel does an excellent job of keeping wounds moist. For debriding we use a lot of Accuzyme and Collagenase.

I work on a wound care floor in a hospital... we see a lot of use of the debriding agents and not so much wet to dry. Used to use a lot of accuzyme but I am pretty sure its been taken off the market a couple of months ago. Most of the time however if we are seeing the patient in the hospital its so they can have some sort of surgical debridement, and then they get a VAC.

[jmgrn65, RN]

We still use it occasionally but once the wound care nurse gets involved they usually change it to use a debriding agent.

[Lovely_RN, MSN]

You know what? You're right I am seeing less accuzyme on my treatment cart. What I have seems to be left overs and we are using more Collagenase.

I work on a wound care floor in a hospital... we see a lot of use of the debriding agents and not so much wet to dry. Used to use a lot of accuzyme but I am pretty sure its been taken off the market a couple of months ago. Most of the time however if we are seeing the patient in the hospital its so they can have some sort of surgical debridement, and then they get a VAC.

[Ginger's Mom, MSN, RN]

It depends on resources, in home care there were lots of wet to dry dressings since the ointments are very expensive.

[homeman]

My research and consulting with a wound care nurse indicates wet-to dry dressings are not the standard of care and contraindicated for several reasons. We have been at battle with a surgeon who insists on Rx'ing and we don't want to follow these because they are not the standard and patients do so much better with other treatments with less frequency. Really frustrating!!!

[Diaper, RN]

Well I'm working in the step down ICU floor. Recently, my patient had colon resection and the physician ordered the wet-to-dry dressing to cover the suture. The wet-to-dry dressing seems to be a common practice in my unit.

[homeman]

True, but is it the standard of care? I just read an article that indicated evidence based practice indicates not the standard but that surgeons still use this treatment and are reluctant to change, especially because the request is coming from nurses! My question is we have a license to protect, how can we knowingly provide something that is not the standard of care simply because it is ordered?