SURGICAL DRESSING – Nurse Info 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)

UPDATED 2024

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