Wound Irrigation 4-9--4-10 Section III. 42. 4. 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. Hold syringe about 1 inch above wound and flush wound using gently continuous pressure until returns run clear into the basin. Irrigation should be drained into basin. Disclaimer: Always review and follow your hospital policy regarding this specific skill. 9. Use enough prescribed solution to saturate gauze. Generally, a 35 ml syringe with a 19 gauge blunt tip is sufficient for irrigation. <>>> What information is documented when a wet to dry dressing change is performed? 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. If the packing sticks, gently soak the packing with normal saline or sterile water and gently lift off the packing. Record dressing change: time, place of wound, wound characteristics, presence of staples or sutures, size, drainage type and amount, type of cleansing solution and dressing applied. <>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/MediaBox[ 0 0 612 792] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> Confirm that physician’s orders are appropriate to wound assessment. 25 In 2009, the FDA approved a surgical lavage system containing a low concentration (ie, 0.05%) of chlorhexidine gluconate in sterile water for irrigation. Changing a Sterile Dressing 4-1--4-8 Section II. Assess appearance of wound bed, noting percentage of tissue types. Normal saline gauze packing needs to be changed at least once daily. 2 0 obj The irrigation tip controls the pressure of the fluid, not the force of the plunger. Remove outer dressing with non-sterile gloves. endobj Swab for culture, if required. 8. Always compare the current wound assessment with the previous assessment to determine if the wound is healing, delayed, worsening, or showing signs of infection. 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. Irrigating a wound: 40. Important: Ensure pain is well managed prior to a dressing change to maximize patient comfort. Wound irrigation and packing refer to the application of fluid to a wound to remove exudate, slough, necrotic debris, bacterial contaminants, and dressing residue without adversely impacting cellular activity vital to the wound healing process (British Columbia Provincial Nursing Skin and Wound Committee, 2014). All packing must be removed with each dressing change. Confirm the quantity and type of packing is the same as recorded on previous dressing change. Gather necessary equipment and supplies: 4. always swab a wound after irrigation. Unless otherwise noted, LibreTexts content is licensed by CC BY-NC-SA 3.0. 1. Review order for wound irrigation and packing. x��Z[oܺ~����bĊH��@��) H�����+T+nu�����E��5�����Zr8�o. 13. %PDF-1.5 Moisten the gauze with sterile normal saline and wring it out so it is damp but not wet. Containers with cleansing solution must be patient specific and must be discarded after 24 hours if solution is left over. This helps prepare patient and bedside for procedure. The wound is irrigated each time the dressing is changed. This reduces the risk of contaminating your hands with the patient’s blood and other body fluids. Learn about this medical procedure. Drape patient with underpad (optional). For undermining or tunnelling, note location and size. The use of personal protective equipment (PPE) reduces the risk of contamination. 3 0 obj Sterile technique or no-touch technique must be used in all acute care settings. Apply dry layer of sterile gauze over moist gauze using sterile technique. Repeat the irrigation until the solution returns clear. Inspect wound for the amount of drainage, odours, and type of drainage. Discard non-sterile gloves according to agency policy and perform hand hygiene. A break in sterile technique, with contamination of the field, is a common procedural error. Checklist 38 outlines the steps for irrigating and packing a wound. 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. Discard supplies and perform hand hygiene. If fluid is instilled into a sinus, tunnel, or undermined area and cannot be removed from the area, stop irrigating and refer to a wound specialist or physician or NP. Discard transfer forceps and non-sterile gloves. Remove inner dressing with transfer forceps. A copy of the most recent wound care assessment and dressing change should be sent with patient upon transfer to another health care facility. Sources: Meyers B. 3. The purpose of irrigating and packing a wound is to remove debris and exudate from the wound and encourage the growth of granulation tissue to prevent premature closure and abscess formation (Saskatoon Health Region, 2013).