Nursing Skills: Wound Care and Dressings

Sterile Dressing Changes

Types of Dressings

• Refer to Skills chapter 40 and pages 1131-1142 in the provided text.

• Review ‘Complications of Wound Healing’ in the ‘Canadian Fundamentals of Nursing’, page 1311.

Hydrocolloid Dressings

• Variety of sizes and shapes are available.

• Reference: Step 15a(1) from Bonnie Sue Rolstad.

Lab Demonstration

Opening Sterile Packages

• Process involves several steps:

  • How to effectively open a sterile dressing tray.

  • Pouring solution from a bottle.

  • Adding sterile items using transfer forceps.

  • Changing various types of dressings.

Clean vs. Sterile Technique

Clean Technique (Medical Asepsis)

• Goal: Reduce the number of microorganisms, limit their spread.

• Employed to minimize infection risk during routine care—not to eliminate all microbes.

• Hand Hygiene: Use soap, water, or alcohol rubs.

• Gloves: Non-sterile are used; gowns/masks/PPE used as needed.

• Environment: Generally disinfected.

• Equipment: Disinfected reusable items.

• Contact: Intact skin, superficial wounds.

• Contamination Breach: May tolerate minor breaches with re-cleaning.

Sterile Technique (Surgical Asepsis)

• Goal: Completely eliminate all microorganisms, including spores.

• Standard for ensuring absolute safety during invasive procedures.

• Hand Hygiene: Same as clean technique with additional scrutiny.

• Gloves: Sterile gloves must be worn.

• Gowns/masks/other PPE: Always required as per policy.

• Environment: Strict sterile field and disinfection practices.

• Equipment: Use only pre-sterilized instruments.

• Contact: Non-intact skin and sterile body cavities.

• Contamination Breach: No tolerance; must reset to maintain sterility.

Cleansing Wounds

• Refer to Skills 1084 & CFN 1332.

Cleansing Drains

• Essential for maintaining wound integrity.

Lab Demonstration: Types of Dressings

• Demonstrations will include:

  • Island dressings.

  • Fluffed gauze.

  • Drain sponges.

  • Abdominal pads.

  • Various types of tapes.

  • Montgomery straps.

Suture and Staple Removal

Definitions

• Sutures: Threads of wire or other material used to sew body tissues together. Can be absorbent or nonabsorbent.

• Staples: Stainless steel wires used to close large wounds, may lack the cosmetic outcome of finer sutures.

Institutional Policies

• Policies will dictate who is authorized to remove sutures and staples, necessitating a review of the policy manual.

• Removal timing is based on healing stage and surgical extent, generally within 7 to 14 days post-surgery if healing is adequate. Retention sutures may remain for 14-21 days.

• Suture removal must be timely to prevent infection and scarring.

Medical Orders

• A physician’s order is necessary, detailing whether all sutures are to be removed at once or in phases.

Types of Sutures

• Different types of sutures include:

  • Intermittent.

  • Continuous.

  • Blanket.

  • Retention sutures (usually removed by a surgeon).

Removal Techniques

Intermittent Sutures

• Removal procedure:

  • Begin by removing every 2nd suture first.

  • Grasp the knot with forceps and gently pull up.

  • Use scissors to snip the suture near the skin.

  • Pull suture out with forceps, avoiding pulling contaminated surfaces into tissues.

Continuous Sutures

• Removal process involves:

  • Snipping the suture close to the skin first on one side.

  • Grasping the knotted end to pull the entire line free.

  • Any separation beyond two stitches/staples requires placement of steri-strips.

Steri-Strips

• Steri-Strips: Adhesive skin closure strips used for small wounds or surgical incisions, acting to hold skin edges together for healing.

Packing Wounds

• Knowledge of principles for packing wounds is essential.

• Reference Box 40-3, page 1134 for guidelines; decision points can be found on pages 1138-1139.

• LPNs must demonstrate competency in packing superficial wounds measuring up to 1 inch (2.5 cm) deep.

Irrigating Wounds

• Irrigation is performed to:

  • Remove eschar and debris.

  • Decrease bacterial counts.

• Utilize clean technique for chronic wounds; sterile for surgical wounds.

Eschar

• Definition: A dry, thick, leathery scab or crust that is black or dark brown, indicative of dead tissue and poor blood supply.

• Key Points:

  • Commonly associated with pressure injuries, burns, and ischemic wounds.

  • Should not be removed from heels unless infection is present.

  • Monitoring for infection is crucial.

Comparison between Eschar and Slough

Wound Irrigation Procedure

• Client Positioning:

  • Should be on their side to allow drainage flow away.

  • An emesis basin is positioned close to collect any drainage along with padding as necessary.

Techniques and Tools

• Use a syringe or catheter for irrigation, holding the syringe about 1 inch above the wound.

• For deep wounds, a soft catheter is recommended for ease of flow.

• Standard practice employs a 35 ml syringe with a 19 G needle to deliver a pressure of 4 to 15 psi—adequate for debris removal without harming healthy tissue.

Irrigating Solutions

• Typically, normal saline is used; occasionally warm water or mild wound cleansers (e.g., Cara Klenz, Saf Clens, Biolex) may be appropriate.

• The amount of solution used should be 1.5 to 2 times the estimated wound volume.

Negative Pressure Wound Therapy (VAC)

• VAC Dressing (Vacuum-Assisted Closure): Method using suction to accelerate healing.

  • Foam pad is placed inside the wound.

  • An airtight seal is created with a clear sticky film.

  • Tubing connects foam to a pump, generating gentle suction (negative pressure).

  • Effects include:

  • Fluid removal from the wound, reducing swelling.

  • Closer approximation of wound edges.

  • Encouragement of healthy tissue growth.

  • Conceptual analogy: functions like a vacuum for maintaining cleanliness and facilitating healing.

Conclusion

• For a comprehensive grasp of sterile dressing techniques and wound care, refer to all mentioned guidelines, demonstration shapes, and procedures detailed along the notes.