wound care

[sonstermonster]

question I am a new grad learning about wound care with my preceptor at the hospital. We had a patient that had a 7" incision- a portion dehisced, abd. area, and left a 5 cm tunnel. In terms of cleaning and packing. I asked her if it was appropriate to irrigate a wound in which we are unable to see the base of the wound. She of course said yes it was appropriate...and went through with irrigation and and packing. I felt very uncomfortable with this. I tried to find out the correct way of cleaning a deep wound, which is excreting large amts of serosang. drainage. I am wondering if this is the correct way...another nurse had shown me another technique. She confirmed my suspicion that we never irrigate a wound that we can not see the wound base.

She said since you cant irrigate you soak your ribbon gauze, ie. 1" in N/S then pack the wound, then remove this ribbon and repack with your ordered ribbon packing ie. mesalt ribbon packing. And then you place the external drsg. This seemed logical to me? However I just wanted to see if this is common practice?

[chihuahuaman]

The best thing to do is check with the wound care nurses if you have one or look up the policy. Where I work we do irrigate. I couldn't imagine packing, then pulling out, then packing a wound. So much pain for the client! After we irrigate tunneling wounds, we measure the length with sterile cotton swab, then pack with mesalt ribbon if ordered.

[czyja, MSN, RN]

Agree with the above poster. Talk to your wound care CNS.

I would only add that since this is a dehisced incision, the surgeons may want you to be doing something specific with it. What were the orders?

[sonstermonster]

Orders were to cleanse and pack with mesalt. The doc. had little experience with wound care. I spoke with our ET nurse, she said it is not best practice to irrigate a wound where you are unable to see the wound bed. Sounds logical to me. Also The packing is light packing, packing should NEVER be tight packing..so minimal to no pain should be felt, unless the tunnel is small, perhaps a pilonidal sinus, may be tender, since the entry site is so small. She said it is appropriate to soak N/S lightly pack, pull out and repack with dry mesalt..especially if the wound has a high amount exudate. Very informative experience for a new grad.

[xtxrn, ASN, RN]

With that much drainage, is the patient not a candidate for a wound vac?

[leslie :-D]

With that much drainage, is the patient not a candidate for a wound vac?

maybe.

from my experience, it might deliver too much neg pressure in such a fragile area...even if applied intermittently.

mesalt dsgs are wonderful...i've even combined them with calcium algate dsgs for extra absorption.

they're still researching various types of wounds, where npwt would be indicated.:)

how come no one can see the wound bed?

leslie

[alphabetsoup]

You need to check with the surgeon for specific wound care orders for a surgical wound. If the surgeon wants it irrigated then it should be irrigated. If the surgeon doesn't want it irrigated then it shouldn't be irrigated. It's that simple. Irrigating and cleansing are not always the same thing, especially if the wound is unexplored (ie you don't know what is at the "end of the tunnel") and has depth. You could introduce bacteria by forcibly instilling saline.