Module - Sterile Procedures: Wet to Damp Dressings with Wound Packing

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State s/he checked orders for dressing change, allergies to latex, tape, betadine, or any medication that is in the ointment to be used. State s/he checked baseline vital signs, nursing notes for previous dressing change information and for last pain medication; Administer pain medication 30 minutes before dressing change (if needed) Collect supplies and go to pts room. Knock on the door. IWIPE Prepare tape for dressing (Student should place a piece of tape on edge of table to provide a clean space for four strips of tape hanging downward from the table, and put initials, date and time on one piece of tape) Apply clean gloves Loosen tape parallel to wound and support skin as tape is removed Remove old dressing by layers (If intimate layers are blood soaked, or need to be loosened

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with sterile saline, use sterile gloves, sterile Q-tips, or sterile forceps to remove the most intimate layers. If intimate layers are dry and easily removed, clean gloves may be used.)
Assess wound drainage (Color, Odor, Consistency, Amount = COCA) Assess wound site (DDDREEESSSS)

Dressing Drainage Drains in place Redness Edges Edema Emission of heat Size Sutures Staples Steri-strips

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Dispose of old dressing (regular trash bag or biohazard per policy) Remove clean gloves (It may not be appropriate to wash hands at this time.)

Wet to Damp Dressing with Wound Packing

13.

Set up sterile field

Open container of roller gauze and/or 4x4 gauze Open cotton-tipped applicators Open sterile saline Open ABD pad Open sterile gloves and apply one glove Remove one dry 4x4 gauze from container and place on sterile glove package With ungloved hand, pour sterile saline over remaining gauze in container

Put on second sterile glove 14. 15. 16. 17. 18. 19. 20.
Pick up one wet gauze from container and squeeze out excess Fold wet gauze (like a mushroom) and cleanse wound (from clean to dirty area); Repeat as needed until wound is clean, but leave one gauze for packing wound

Measure wound Remove gloves. Apply new pair of sterile gloves.

Pick up moist gauze from container and open it fully so that it is fluffy Pick up cotton-tipped applicator and use it to pack gauze into wound.

Pack in the distal tip of the gauze first Then proceed by fan folding the remainder of the gauze into the wound. If the wound is very deep or has extensive tunneling, use sterile roller gauze for wound packing, and proceed using the same fan folding technique. Reinforce need for wet gauze to be only in wound and not on skin to prevent maceration of skin. Do not pack too tightly

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Place dry sterile gauze on top of packed wound Apply ABD pad Apply tape in window pane fashion (may remove gloves to apply tape) Document: Sterile dressing change with packing Wound drainage and site observations Patient response