wound care dressing skills... help!

[yawn]

I would like any help or info about the steps used to change a dressing... (how to open a sterile package... when to wear/change gloves??? and what type of gloves? sterile or clean?... do we have gloves on to open the garbage bag from the package? which step do we take off the old dressing? and clean the wound? etc)...

Also, I would like more explanation on the 1 and 1/2 inch border of the sterile field... When we open the sterile package, can we leave the end of our forcep on the 1 and 1/2 inch border, so that we can later just pick it up? or is nothing allowed at the border?? if so, how do we get the forcep without contaminating the field? Oh and why is there two forceps? There's one when we halfway open the sterile package, and the other one inside the tray... Which one is used to clean the wound? We are using the no touch technique... we clean with the forcep... But Im confuse... Thanks in advance! I will obviously have to go practice when the labs are open.

[Daytonite, BSN, RN]

you need to keep in mind the principles of sterile technique. sterile to sterile is always ok. once you have sterile gloves on, you can only touch sterile items with the gloves. so, think about this. . .you need to open any non-sterile packages before donning sterile gloves. however, everything inside a sterile kit will be sterile. if your garbage bag is part of a sterile kit then it is sterile and you will be able to open it with sterile gloves on. if it is not in the sterile kit then you must open it and have it ready outside what will be your sterile field before you put your sterile gloves on. old dressings can be removed with either clean or sterile gloves. however, you should change to a new pair of sterile gloves as soon as i started the wound cleaning. i have difficulty understanding what it is you want to know about the forceps. from what you've written i'm assuming that one pair is sterile and one pair is not. there are many times that i have done dressings where i have only kept one hand gloved with a sterile glove and my other hand ungloved in order to handle unsterile items. it's been a long time since i've had to worry about the edges of a surgical field and the principles involving sterile fields. however, but i think that you are supposed to consider any objects in the field that land in them as contaminated and not to be touched again with your sterile gloved hands.

http://teach.lanecc.edu/nursingskills/wound/drydrynodrain.htm - the sterile dressing change procedure with pictures from lane community college in eugene, oregon. this site clearly tells you to remove the gloves you remove the old dressing with and to put on new, sterile gloves to perform the new dressing.

http://www.cotc.edu/professional/streaming/archive/nursing.htm - this site has several videos that pertain to sterile dressings and sterile fields. click on the videos that interest you. you need a real player to see the videos.

http://www2.ncn.com/~bln/skills/nur108/nur108_dressingchange02.htm - applying a sterile dressing, a pictorial

http://www.surgeryencyclopedia.com/a-ce/aseptic-technique.html - a discussion about aseptic technique