SURGICAL DRESSING

SURGICAL DRESSING – Purpose, Type of Dressing, General Instructions, Procedure, Cleaning the Surgical Wound, Dressing the Wound and After Care (Follow-up Care)

Surgical dressing is a sterile technique used to promote wound healing. It is a protective covering placed on the wound.

Factors Influences in Surgical Dressing

  • Patient acceptance
  • Ease of application/removal
  • Bleeding control
  • Exudate control
  • Pain management
  • Prevent allergic reaction/blistering
  • Conformable
  • Comfortable
  • Cost effective

PURPOSE

  • To protect the wound from mechanical injury
  • To splint or immobilize the wound
  • To absorbs drainage
  • To prevent contamination from bodily discharges (feces, urine)
  • To debride the wound by combining capillary action and the end wining of necrotic tissue and in its mesh
  • To inhibit or kill microorganism by using dressings with antiseptics, antimicrobial properties
  • To provide a physiologic environment conductive to healing
  • To provide mental and physical comfort for the patient

TYPE OF DRESSING

Dry-to-dry Dressing

  • It is used primarily for wounds closing by 1 degree intention
  • Offers good wound protection, absorption of drainage and esthetics, e.g. patient provides pressure for homeostasis
  • Disadvantage – they adhere to wound surface when drainage dries, removal can cause pain and disruption of granulation tissue

Wet-to-dry Dressing

  • They are particularly useful for untidy or infected wounds that must be debride and closed by 2-degree intension
  • Gauze saturated with sterile saline or an antimicrobial solution in packed into the wound, eliminating dead space
  • The wet dressings are then covered by dry dressings
  • As drying occurs, wound debris and necrotic tissue are absorbed into the gauze dressing by capillary action
  • The dressing is charged when it became dry

Wet-to-wet Dressings

  • Used on clean open wounds as on granulating surfaces. Sterile saline as an antimicrobial agent may be read to saturate the dressings
  • Provide a more physiologic environment, which can enhance the local healing process as well as ensure greater patient comfort
  • Disadvantage: surrounding tissues can become macerated, the risk of infection may rise and bed linens become damp

GENERAL INSTRUCTIONS

  • The procedure of changing dressings, examining and closing the wound, use principles of asepsis
  • The initial dressing change in frequently done by the physician especially for craniotomy orthopedic or thoracotomy procedure; subsequent dressing changes are the nurse’s responsibility

EQUIPMENT

Sterile

  • Gloves – disposable
  • Scissors, forceps
  • Appropriate dressing materials
  • Sterile saline
  • Cotton dipped swabs
  • Culture tubes (infection)
  • For draining wound add extra-gauze and packing material absorbent and pad and irrigation set

Unsterile

  • Gloves
  • Plastic bag for discarded dressings
  • Tape proper size and type
  • Pads to protect patient bed
  • Gown for nurse, if wound is infected

PROCEDURE

Pre-preparation

  • Inform the patient of dressing change. Explain procedure and have patient lie in bed
  • Avoid changing dressing at mealtime
  • Ensure privacy by drawing the curtains on closing the door. Expose dressing site
  • Respect patient modesty and prevent patient from being chilled
  • Wash hands thoroughly
  • Place dressing supplies on a clean, flat surface
  • Place clean towel or plastic bag under part of the body where wound is located
  • Cut off pieces of tape to be. Used in dressing change
  • Place disposable bag nearby to collect soiled dressings
  • Determine what types of dressing are necessary

CLEANING THE SURGICAL WOUND

  • Use aseptic technique
  • Open package of sterile gloves; open sterile cleaning sterile supplies
  • Wear sterile gloves
  • Clean along wound edges using a small circular motion from one end of incision to the other do not scrub back and forth across the incision line
  • Sterile saline in the cleansing agent of choice. Topical antiseptics (alcohol, basic a may be used on intact skin surrounding the wound but should never be used within the wound)
  • Repeat same process with drain site separately
  • Discard used cleaning supplies in disposable
  • Pad the incision site and drain site dry with sterile dressing sponge

DRESSING THE WOUND

  • Maintain asepsis with use of sterile gloves
  • After wound in dry apply appropriate dressing
  • Tape dressing, using only the amount of tape required for secure attachment of dressing

Use premade drain sponge (can be prepared by making 5 cm slit with sterile scissors in 4 multiply 4 inches gauzes sponge)

       Dressing the drainage tube insertion tube: be sure that one sponge in place at a right angle to the second sponge. So the slits are going in different direction if drainage in heavy, a sterile absorbent pad or extra gauze may be placed overall

  • When dressing an excessive draining wound

Consider need for extra dressings and packing materials

Use Montgomery straps if frequent dressing are required

Protect skin surrounding wound from copious on irritating drainage by applying some type of skin barriers

AFTER CARE (Follow-up Care)

  • Assess patient’s tolerance to the procedure and help patient more comfortable
  • Discard disposable items according to hospital protocol and clean equipment that is to be recessed
  • Wash hands
  • Record nature of procedure and condition of wound, as well as patient reaction
SURGICAL DRESSING – Purpose, Type of Dressing, General Instructions, Procedure, Cleaning the Surgical Wound, Dressing the Wound and After Care (Follow-up Care)
SURGICAL DRESSING – Purpose, Type of Dressing, General Instructions, Procedure, Cleaning the Surgical Wound, Dressing the Wound and After Care (Follow-up Care)

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