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Changing a Dry Dressing (102.148)

Changing a Dry Dressing (102.148) - Policies, Clinical, UWMF Clinical, UWMF-wide, Clinical Policies and Procedures, Wound and Skin

102.148

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UNIVERSITY OF WISCONSIN MEDICAL FOUNDATION
CLINICAL POLICY AND PROCEDURE

TITLE: CHANGING A DRY DRESSING

Effective Date: April, 2002 Approval: See Authorization
Supersedes Protocol: None Contact: Clinical Staff Education

Reviewed October, 2003 March, 2005 February, 2008 May 2010
October 2011

PURPOSE: To provide guidelines for changing a dry dressing at UWMF Clinics.

DEFINITION: A dry dressing protects wounds with minimal drainage against
microorganism contamination. The dressing can be a gauze pad that does not adhere to
wound tissues and causes very little irritation, or a Telfa pad that likewise does not
adhere. As long as an incision or wound remains open, the application of a dry dressing
requires sterile technique.

POLICY: The clinical staff who has had proper training in aseptic technique will utilize
the following guidelines to properly change a dry dressing for a UWMF patient.

EQUIPMENT:
Sterile supplies of following: (may depend on wound) gloves, dressing set (scissors and
forceps) gauze dressings and pads, basin for antiseptic or cleaning solution, normal saline
or water.
Antiseptic ointment (if ordered), cleaning solution prescribed by provider
Disposable gloves, tape, ties, or bandage as needed
biohazard for disposal of old dressing
Protective gown (if needed)
Mask and goggles (required if the threat of splash or spray from the wound exists)

PROCEDURE:

1. Check provider’s order and clarify any inconsistencies.

2. Wash hands and gather supplies.

3. Introduce yourself, identify the patient by verifying name and date of birth; provide
good light and privacy.

4. Check patient allergies to any antiseptic solutions; ie. Betadine. (if going to be used)

5. Explain dressing procedure and assist patient to comfortable position

6. Drape patient - to expose only wound site.

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7. Wash hands thoroughly and put on clean disposable gloves.

8. Remove old bandage from patient wound by using your gloved hand or forceps,
lifting dressing off patient’s wound..

NOTE: When removing dressing, take care not to dislodge or pull on a drain.
NOTE: If dressing sticks to wound, loosen by applying sterile saline or sterile
water.

9. Observe the dressing for amount of drainage, color and odor on dressing.

10. Dispose of soiled dressings in proper container
NOTE: If drainage is grossly bloody in nature, dispose in “red bio-hazard” bag.

11. Remove disposable gloves and dispose of them properly, then wash hands.

12. Maintaining sterile technique unwrap individually wrapped sterile supplies and place
on a sterile field.

13. Put on sterile or clean gloves (depending if it is an open wound and need).
14. Inspect wound. Note its condition, color, odor, depth, width and margins or wound
placement of drain, integrity of suture or skin closure, and character of drainage.

15. Clean wound with prescribed antiseptic solution or normal saline by grasping gauze
moistened in solution with forceps.

 Use separate gauze for each cleaning stroke.
 Clean from least contaminated to most contaminated area.
 Move in progressive strokes away from incision or wound edges.
 Use fresh gauze to dry wound or incision line.

16. Apply antiseptic ointment (if ordered), using same technique as for cleaning. Do not
apply over drainage site.

17. Apply dry sterile dressings to incision or wound site.
18. Apply dressings one at a time, keeping hand(s) on the outside of dressing as much as
possible.

19. Secure dressing with tape, Montgomery ties, bandage, or binder.
20. Remove gloves and dispose of them properly in container. Wash hands.

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21. Document in patient’s chart, using .npdress. Documentation should also include all
or some of the following items: -
 the wounds condition: color of drainage, odor, depth, width and margins or
 placement of drain(s),
 integrity of suture or skin closure,
 additional procedures: packing wound, irrigating wound, or application of
topical medication.. .

22. Assist the patient to a comfortable position.

REVIEWED BY:
LaVay Morrison, RN, BSN, Clinical Staff Educator

WRITTEN BY:
Ronnie Peterson, R.N., M.S., Manager of Clinical Support
REFERENCES:

1. Kowalak, J. P. (Ed.). (2009). Lippincott’s Nursing Procedures (5
th
ed.). Ambler,
PA: Lippincott Williams & Wilkins.
2. Perry, A.G. & Potter, P.A. (2002). Clinical nursing skills & techniques. (5
th
ed.). St.
Louis, MO: Mosby.
3. Perry, A.G. & Potter, P.A. (2009). Fundamentals of nursing. (7
th
ed.). Hall, A. &
Stockert, P.A. (Eds.). St. Louis, MO: Mosby Elsevier.

AUTHORIZATION:

Medical Director Date