Look for evidence of bone or tendon exposure. A knot exerting pressure on the wound surface may impair blood flow and potentially cause necrosis in the wound. For any cavity, undermining, sinus tract, or tunnel with a depth greater than 1cm (>1cm), count and document the number of packing pieces removed from the wound, and the number of packing pieces inserted into the wound. Confirm patient ID using two patient identifiers (e.g., name and date of birth). Take measurements, including length, width, and depth. This step prevents maceration of surrounding tissue from excess moisture. Sources: Meyers B. <> We also acknowledge previous National Science Foundation support under grant numbers 1246120, 1525057, and 1413739. Wound assessment helps identify if the wound care is effective. Wound irrigation is a common task performed by wound care clinicians. Irrigation should be drained into basin. Discard transfer forceps and non-sterile gloves. 14. The health care professional chooses the method of cleansing (a squeezable sterile normal saline container or a 30 to 35 cc syringe with a wound irrigation tip catheter) and the type of wound cleansing solution to be used based on the presence of undermining, sinus tracts or tunnels, necrotic slough, and local wound infection. Use a Steri-Strip to secure the packing tail to the peri-wound skin. If the knot is visible in the wound, it is less likely that a packing piece will be lost if the knot comes undone. What information is documented when a wet to dry dressing change is performed? 4. If irrigating a deep wound with a very small opening, attach a small needleless catheter to prefilled irrigation syringe and insert about 1/2 inch. What temperature should the wound cleansing solution be. Prepare environment, position patient, adjust height of bed, turn on lights. Wound irrigation is the act of flushing a wound with a gentle stream of liquid in order to remove dead tissue or other debris. Open wounds require a specific environment for optimal healing from secondary intention. Unless otherwise noted, LibreTexts content is licensed by CC BY-NC-SA 3.0. 1. Packing should only be done by a trained health care professional and according to agency guidelines. Documentation should include date and time of procedure. A copy of the most recent wound care assessment and dressing change should be sent with patient upon transfer to another health care facility. Do not overlap wound edges with wet packing. ��ޏ����Fl�m[��!O�0��^Fb��5#Y��jƦ�A��SPV�;n��l�]���:�7=�S�Q����xbs �����>!��=~d'"�Ou7�_��. These steps ensure the patient’s continued safety. Legal. Document procedure and findings according to agency policy. If the packing sticks, gently soak the packing with normal saline or sterile water and gently lift off the packing. This reduces the risk of contaminating your hands with the patient’s blood and other body fluids. Missed the LibreFest? If there is a concern that packing is retained in the wound, contact the wound specialist or physician for follow-up. Hold syringe about 1 inch above wound and flush wound using gently continuous pressure until returns run clear into the basin. The following links provide additional information about wound packing and wound measuring. <>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/MediaBox[ 0 0 612 792] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> endobj Hold syringe tip 2cm from the wound bed and gently irrigate the wound with a back and forth motion, moving from superior aspect to the inferior aspect. If two or more packing pieces have been knotted together, ensure that the knots are placed in the wound cavity, not in the undermining, sinus tract, or tunnel. Types of Isolation 5-1--5-2 Section II. 21. Confirm that physician’s orders are appropriate to wound assessment. Type and quantity of packing material (length or pieces), along with the number of inner and outer dressings should be recorded as per agency policy. Apply non-sterile gloves, gown, and goggles or face shield according to agency policy. Apply skin preparation as per agency protocol, if required. Generally, a 35 ml syringe with a 19 gauge blunt tip is sufficient for irrigation. Apply moist gauze as a single layer onto wound surface, pack gauze into wound if necessary, and ensure gauze does not touch skin around the wound. Notify required health care providers if wound appears infected or is not healing as expected. Irrigation of a wound prior to an operative treatment is discussed in section III. It is done prior to dressing changes and can facilitate healing and prevent infection. 12. 2 0 obj If packing adheres to the wound, reassess the amount of wound exudate and consider a different packing material. Gather necessary equipment and supplies: 4. ��4�2%%,+�0.^CDXZ�Z�� Changing a Sterile Dressing 4-1--4-8 Section II. The use of a specific technique is based on agency policy, condition of the client, healability of the wound, invasiveness, and goal of the wound care. Assess appearance of wound bed, noting percentage of tissue types. Drain is cleansed using circular strokes starting near the drain and moving outward and away from the insertion site. The type of packing for the wound is based on a wound assessment, goal for the wound, and wound care management objectives. 19. 11. Protect patient’s clothing and bedding from irrigation fluid. 10. This prepares the wound bed for optimal healing with a moist to dry dressing. Ensure the wound is not over-packed or under-packed as this may diminish the healing process.

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