Wound Care

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Specializes in ER (new), Respitory/Med Surg floor.

Hey everyone! I work on a respiratory/med surg floor and do not get a lot of wound care patients. I was just wondering how wound care should be completed in regaurds to being sterile. I had one cute little lady who fell on some pavement, injured her calves, didn't go to the doctor, the wound became necrotic and ultimately huge chunks were debrided. Anyway I remember even as a nursing student having to do a dsd on just some staples and my instructor teaching me to use sterile gloves. I would not do that now! Just don't touch the inside of the gauze and place on with reg gloves.

No my thing is when can you use reg gloves and when not. I would think any open area and especially if your packing you should use sterile gloves. However, one nurse told me unless it was a surgical sterile wound you can use reg gloves. Now the little lady I mentioned above the debrided areas were now huge chunks of skin missing. What I have to do is get someone to hold her legs up for me after I remove the dressings and set up on a table about 4-6 wet and dry saline gauze 4X4s and 6 wet saline 2x2s. After removing the dressings I foam then put on sterile gloves take the 2x2s apart and pack them into the wound put on the 4x4s then cling. On both calves. What happens is it takes me 30 min to do this. Am I being too technical? The charge nurse tonight told me if we all did it the way I did it there would be no nasocomial infections in the hospital. So while I did it correct and safe for the patient how can I do the job and do it realistically? That's when the charge nurse mentioned she may not have used sterile gloves only if it's a surgical sterile open wound.

I'm not being lazy it's just I actually HAD TIME the last few days to do this (pt census a little low FINALLY) and if we get back to full beds and short staff there is no way I'll get out on time. PLUS don't forget the other staff member also holding her legs up for 30min with me NO WAY i'd get that help if it was full or very busy. So how do you all do your wound care. When to use sterile gloves. I really get the impression people do not use sterile equipment or am I 100% wrong? I'm going to purchase a wound care book but would appreciate realistic practice among other nurses! Thanks a bunch!

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Sounds thorough, I've wondered the samething. I'm guessing alot of it has to due to time contraints like you were discussing the low census. I agree with the charge nurse that if the wound is surgically opened it should be sterile and if it is something like an environmental wound the clean technique will work. I guess it would not hurt to do the "sterile technique". I do like you when im changing a wound and try not to handle the gauze and use cotton tipped swabs to pack a tunneling wound. Maybe you can answer a question for me, what is the theory behind the wet to dry dressing? does the moisture aid in granulated tissue formation? I was asking a nurse this the other day and we both had no idea. Thanks.

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Specializes in Med-Surg.

I'm not sure what the answer is.

I always use sterile technique for packing wounds, and am particularly maticulous about the dressings directly on top of the open wounds even if there isn't packing. I'd rather take a few minutes longer using sterile technique. But that's me.

Even if you didn't use sterile technique and used clean, how many minutes would you actually save?

Those wounds can get a staph infection or a necretizing infection and delay healing.

Again, I don't know 100% for sure as I'm not the wound care expert. I only know what I do, and what I teach those I precept to do.

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Specializes in Med-Surg.
Sounds thorough, I've wondered the samething. I'm guessing alot of it has to due to time contraints like you were discussing the low census. I agree with the charge nurse that if the wound is surgically opened it should be sterile and if it is something like an environmental wound the clean technique will work. I guess it would not hurt to do the "sterile technique". I do like you when im changing a wound and try not to handle the gauze and use cotton tipped swabs to pack a tunneling wound. Maybe you can answer a question for me, what is the theory behind the wet to dry dressing? does the moisture aid in granulated tissue formation? I was asking a nurse this the other day and we both had no idea. Thanks.

I think the wet does provide the moist environment needed for healing. But also as the dry dressing wicks out the wet it also takes with it debris from the wound, helping to keep it clean.

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I think the wet does provide the moist environment needed for healing. But also as the dry dressing wicks out the wet it also takes with it debris from the wound, helping to keep it clean.

Exactly!!:) And prevents further tissue damage in the wound bed when the moist layers are removed. Since they are not adhered. The dry layers are to very slowly, dry out and gently slough the wound.

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Specializes in ER (new), Respitory/Med Surg floor.
Exactly!!:) And prevents further tissue damage in the wound bed when the moist layers are removed. Since they are not adhered. The dry layers are to very slowly, dry out and gently slough the wound.

Thanks for the advice but now I have another question. I understand for wet to dry dressings the dressing dries and debrides the wound. However, is that just while the dressing is on for 24 or 12 hours? What I mean is when I remove the dressing sometimes it dries onto the wound am I to just remove the dressing even if it's pulling out skin and causing bleeding and lots of pain to the pt even when they are given pain medicine prior? I told one nurse I'd help her with the wound care today and she just ripped it out. Ok i'm exagerating a little but really rough. I'm allways concerned I'm being to cautious and want to make sure I get the job done. Also she packed it very heavily to the point it pushed the skin out a little. What I did was put saline to the dressing before I removed it. Am I defeating the entire purpose of the dressing? And the dressing I'm sorry was wet to moist also. I'm so confused!

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Thanks for the advice but now I have another question. I understand for wet to dry dressings the dressing dries and debrides the wound. However, is that just while the dressing is on for 24 or 12 hours? What I mean is when I remove the dressing sometimes it dries onto the wound am I to just remove the dressing even if it's pulling out skin and causing bleeding and lots of pain to the pt even when they are given pain medicine prior? I told one nurse I'd help her with the wound care today and she just ripped it out. Ok i'm exagerating a little but really rough. I'm allways concerned I'm being to cautious and want to make sure I get the job done. Also she packed it very heavily to the point it pushed the skin out a little. What I did was put saline to the dressing before I removed it. Am I defeating the entire purpose of the dressing? And the dressing I'm sorry was wet to moist also. I'm so confused!

The nurse that ripped it out is brutal even if she did premedicate. You were right(and humane) to pour some sterile saline into the wound to soften it before removal. The nurse you were helping not only caused the pt pain but more than likely caused a lot more tissue damage. Overpacking a wound will prolong healing time weaken the heathly surrounding tissue the last thing it needs is added pressure. You did not defeat the purpose. Your nursing judgement was sound. :)

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Specializes in ER (new), Respitory/Med Surg floor.
The nurse that ripped it out is brutal even if she did premedicate. You were right(and humane) to pour some sterile saline into the wound to soften it before removal. The nurse you were helping not only caused the pt pain but more than likely caused a lot more tissue damage. Overpacking a wound will prolong healing time weaken the heathly surrounding tissue the last thing it needs is added pressure. You did not defeat the purpose. Your nursing judgement was sound. :)

Thanks a bunch! Ok I'm not loosing my head here! I'm going to get a nice book on it all just to have for my library of nursing books. It's the only aspect of my schooling I wish we had more on. But yeah this nurse is very nice but too much at times. She's the one that will hold back on morphine if they are in resp distress b/c she does not want to depress the respiratory status. I mean yes we don't want to do that but these orders I'm talking about WAS to give specifically for RESPITORY distress. I don't think of her as cruel she's very nice and caring. But I'm there helping her with the wound care and the cute little old lady is having a difficulty time and she tells her oh that's suppose to do that it's debriding the wound she put NO saline on it at all and that's exactly my thinking wouldn't that break new skin with it. Debridment you usually just get the dead skin. Ok I'm on tract thanks!

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