Dressing of postoperative wound

Authors: Rednenko VV, Rednenko LI, Poplavets E.V., Brikez JI

Editor: Rednenko V.V.

Equipment for the practical skill:

• skin suture trainer
• disinfection table with containers with a working solution of a chemical disinfectant:
  • "Disinfection of dressings, PPE"
  • "Disinfection of MI"
  • anatomical tweezers in a container with a disinfectant solution
• instrumentals table with
  • set of sterile instruments in kraft-paper packag (tray, surgical tweezers - 2 pcs., sharp-pointed scissors)
  • set of sterile dressing in kraft-paper packag (gauze pad - 6 pcs., gauze balls -3 pcs)
  • skin antiseptic: aqueous solution of iodonate and and etc.
  • 3% hydrogen peroxide solution -1 fl.
  • adhesive tape (plaster)
• gloves, mask, goggles, apron

Clinical situation: 

• You are a nurse of a surgical department. Make the dressing of the postoperative wound ( 2 days after the operation, wound with sutures, clean) in a dressing room

Order of the skill performance:

Preparatory stage:

• identify the patient
• explain the purpose of the manipulation, obtain verbal consent, place the patient on a couch
• put on mask, goggles, apron
• open the outer layer of the packages with sterile instruments and dressings
• open the antiseptic bottle
• perform hygienic hand antisepsis
• put on sterile gloves
• open the inner layer of the individual packages with sterile instruments and dressings

Main stage:

• remove a fixing layer of the dressing
  • plaster removing
    • take the surgical tweezers in your dominant hand
    • press the finger of your free hand against the skin next to the strip of adhesive tape adhering to the skin
    • take a strip of adhesive tape with tweezers near your finger and peel it off the patient's skin
    • peel off all strips of the adhesive tape holding the bandage one by one
  • bandage removing 
    • take the surgical forceps in your non-dominant hand
    • take scissors in your dominant hand
    • pull back the top layer (fixing) of the bandage, cut it with scissors
  • (Note! Pulling across the wound may increase its gaping and pain)
• remove all layers of bandage
  • moisten the dried bandage
    • pour 3% peroxide from the bottle onto the dry spots
    • or moisten a napkin with 3% hydrogen peroxide solution and treat the dried-on areas of the dressing
  • remove all layers of the dressing with tweezers by moving along the wound (NB! traction across the wound increases its gaping and causes pain), place the used dressing and tweezers in the waste tray
• examine and palpate the wound:
  • gently palpate the wound, determining the presence of wound discharge and swelling (inform with a voice about the condition of the wound, for example, "The wound is clean, there is no discharge")
  • ask the patient about soreness on palpation
• treat the postoperative wound with an antiseptic
  • take a new tweezers
  • take a gauze ball from the package with tweezers, moisten it with a skin antiseptic (aqueous solution of iodonate, etc.)
  • gently treat the skin around the seam with streak-like movements in the direction from the wound to the periphery, place the gauze ball in the waste tray
  • take a gauze ball from the package with the same tweezers, moisten it with a skin antiseptic (aqueous solution of iodonate, etc.)
  • gently treat the seam itself with blotting movements, place the gauze ball in the waste tray
• cover the wound with a bandage
  • take a gauze pad from the package with the same tweezers, place it on the postoperative wound (suture)
  • repeat the action so as to completely cover the wound in three layers of dressing material (NB! the presence of raw edges (threads) of the dressing material in the wound, as well as a dressing made of cotton wool is not allowed)
  • fix the new dressing with one of the fixing methods (adhesive plaster, bandage, glue)

Final stage:

• remove gloves and place them in the container “Disinfection of dressings, PPE” (see practical skill«Removal contaminated gloves»);
  
• take off a mask and place it in the container “Disinfection of dressings, PPE”;
• take off glasses;
• wash your hands (см. Hygienic hand washing)