Surgical site management in the post-operative time frame is paramount in preventing infection and wound dehiscence. It is essential to use practical knowledge in good wound cleansing and skin care and in providing moisture balance in surgical site wound care management.
By Cheryl Carver, LPN, WCC, CWCA, FACCWS, DAPWCA, CLTC
I feel like I am spinning my wheels on this warm sunny day in Ohio. My passion for wound care continues to grow, but I have days like these every once in a while. I always say, "We don't know what we don't know, right?" So I keep chipping away to educate and mentor other health care professionals.
I observe clinicians innocently dumping loads of expensive product into wounds using them incorrectly. Many products have specific usage instructions just like medications. But for some reason, clinicians do not have this same perception. Wound care is much more than squeezing a dollop of ointment, or using embellished foams. Not all dressings are the same. They may look alike, but are not. There are many good reasons why certain dressings have specific usage instructions. Get in the habit of knowing what the dressing product category is, and how to use it. When using products correctly, you will see better clinical outcomes.
How to Select the Right Wound Care Dressing
To select the appropriate dressing for a given wound, ask yourself the following questions:
How is the wound being cleansed each dressing change?
Whether you are using normal saline or a non-cytotoxic wound cleanser, we must be consistent with wound cleansing for wound bed preparation.
Is the wound partial- or full-thickness, with or without tunneling and undermining?
Dead space of a wound must be packed, but not over packed. Will the dressing maintain its shape to keep direct contact with the wound bed? Will the dressing fray or come apart?
Is the wound dressing going to complement the type of wound?
Use dressings that conform, and/or are easy to apply and remove. Heel wounds are a good example. You may need to design or select a heel cup dressing to avoid bulkiness.
How much is the wound draining?
Use dressings that will keep the wound warm, and that absorb the amount of drainage you have assessed. There are many longer wear time dressings available such as foams, self-adaptive, and hydrocolloid dressings.
How big of a dressing should I use?
Most dressings are to be 1-2 inches larger than the wound. Protecting the periwound is as important as the wound. Prevent maceration to avoid further skin impairments.
Who is the payor source?
Unfortunately, we as clinicians need to follow dressing guidelines per payor source. Get familiar with the Medicare dressing guidelines as most payor sources follow this list.
Who will be changing the dressing?
The patient and/or their caregiver(s) should be able to demonstrate the dressing application. Educate your patients and caregivers.
How often should the dressing be changed?
If the wound is draining a scant amount, you can stretch the wear time. Research shows wounds heal faster when the wound bed is covered, keeping temperature consistent.
As an educator, I not only provide dressing category and usage information, but I also encourage the clinician to truly understand the technology behind the dressing, or the "how to" apply the product. We do not want our clinicians coming down with a big case of "Product Confusion"!
Other Considerations for Dressing Application
Once you have chosen the appropriate dressing for the wound you are treating, there are some other some other common dressing application specifics to look for or consider.
- Dressing compatibility: Does the use of viscous materials block the absorptive properties of the dressing? Do the properties of the dressing interfere with or deactivate collagenase or antimicrobial products?
- Ointment or cream thickness: Did you check for the correct dosage so as to ensure efficacy and prevent potential periwound maceration?
- Wear time of medicated dressing: Are you changing the dressing often enough to ensure consistent mechanism of action, wicking or absorption?
- Cleanser compatibility: Is the dressing compatible with the cleansers you are using on the wound (to avoid cytotoxicity or deactivation of certain bioactive products)?
- Dressing size: If using a dressing larger than the wound, have you ensured that the periwound skin is protected from maceration? Can the dressing you chose be cut to fit the wound?
- Packing dead space: Have you ensured that the dressing will be entirely retrievable from the dead space (woven so as not to leave fibers, counting individual pieces, leaving a tail)?
- Clean wound bed: Have you ensured that any devitalized tissue that may block the mechanism of action of your dressing has been removed from the wound?
There are many resources out there to help you bolster your staff education. Sales representatives are always eager to help you educate your staff. Many are certified in wound care and offer free CEUs. Place ongoing education as being at the top of your dressing shelf. If there is a gap in quality of care, I can guarantee you that a gap in education is one of the culprits.
EMPOWER. EDUCATE. MENTOR. SUCCEED.
About the Author
Cheryl Carver is an independent wound educator and consultant. Carver's experience includes over a decade of hospital wound care and hyperbaric medicine. Carver single-handedly developed a comprehensive educational training manual for onboarding physicians and is the star of disease-specific educational video sessions accessible to employee providers and colleagues. Carver educates onboarding providers, in addition to bedside nurses in the numerous nursing homes across the country. Carver serves as a wound care certification committee member for the National Alliance of Wound Care and Ostomy, and is a board member of the Undersea Hyperbaric Medical Society Mid-West Chapter.
The views and opinions expressed in this blog are solely those of the author, and do not represent the views of WoundSource, Kestrel Health Information, Inc., its affiliates, or subsidiary companies.