DRESSING PROCEDURE

PREPARED BY: RESHU ARORA

CLINICAL EDUCATOR
 Definition

A dressing is a sterile pad or compress applied to wound

to promote healing & protect the wound from further
harm. Dressing is used to have direct contact with a
wound but bandage is used to hold a dressing in
place.
 General instructions

• Follow strict aseptic technique to prevent cross infection to

the wound & from the wound.
• All articles should be disinfected thoroughly to make sure
that they are free from pathogens.
• Wash hands thoroughly before & after the procedure.
• Instruments used for one dressing cannot be used for
another until they have been re-sterilized.
• Use masks, sterile gloves & gowns for large dressings to
minimize the wound contamination.
• Dressings are not changed for atleast 15 minutes after the
room has been swept or cleaned.
• Use individually wrapped sterile dressings &
equipments for the greatest safety of the wound.
• Create a sterile field around the wound by spreading
sterile towels.
• Avoid talking, coughing & sneezing when the wound is
opened.
• During the procedure the nurse works carefully to
avoid contaminating the patient’s skin, clothing & bed
linen with soiled instruments & dressings.
• Cleaning the wound should be done from the cleanest
area to the less clean area. Consider the wound area
cleaner than the skin area even if the wound is
infected. Therefore, clean the wound from its centre to
periphery.
• If the dressings are adherent to the wound due to the
drying of the secretions or blood, wet it with
physiologic saline before it is removed from the
wound.
• When dressing the wound, keep the wound edges are
near as possible to promote healing.
• When drains are in place, anticipate drainage & re-
enforce the dressing accordingly. The dressings over
the drains should not be combined with the dressings
on the wound line.
• The amount of discharge from the wound should be
accurately measured by recording the number & size
of the dressings changed. Note the color, odor,
amount & consistency of the drainage.
• When the wound drainage is diminished the drains
are to be shortened. This should be done in
consultation with the doctor. Usually doctor gives a
written order.
• Before doing the dressing, inspect the wound for any
complications such as dehiscence & evisceration. If
present, report it immediately to the surgeon &
immediate steps are to be taken.
• Avoid meal timings.
• Give an analgesic prior to the painful dressings.
 Preliminary Assessment

• Check the diagnosis & the general condition of the

patient.
• Check the purpose for which the dressing is to be
done.
• Check the condition of the wound- the type of the
wound, the types of suturing applied, the type of
dressings to be applied etc.
• Check the physician’s order for the type of dressing
to be applied & the specific instructions, if any,
regarding the cleansing solutions, removal of sutures,
drains & the application of medications etc.
• Check the patient’s name, bed number & other
identifications.
• Check the nurse’s records to find out the general
condition of wound.
• Check the abilities & limitations of the patient.
• Check the consciousness of the patient & the ability
to follow instructions.
• Check the articles available in the unit.
 Preparation of the Articles

A sterile tray containing:

• Artery forcep-1 (to clean the wound)
• Dissecting forceps-2 (to clean/to hold the gauze
piece/ to scratch dead tissue)
• Scissors-1(for the debridement of the wound, if
necessary or to cut the gauze pieces to fit around the
drainage tube etc.)
• Sinus forceps: 1(to open the sinus tract or to pack the
sinus tract if necessary).
• Probe- 1 (to open the sinus tract or to pack the sinus
tract if necessary).
• Small bowl- 1(to take the cleaning solution)
• Safety pin-1(to fix the drain, in case the drain are cut
short)
• Gloves, mask, & gown: (to use when large wounds
are dressed).
• Cotton balls, gauze pieces, cotton pads etc. – as
necessary (to clean & dress the wound)
• Slit or dressing towels- ( to create a sterile field
around the wound).
 An unsterile tray containing

• Cleaning solutions as necessary- (to clean the

wound & surrounding area)
• Ointment & powder as ordered- (to apply the
wound)
• Vaseline gauze in sterile containers- (to prevent
the dressing adhering to the wound)
• Swab sticks in sterile container- (to apply the
medication if necessary)
• Cheatle forceps- (to handle the sterile supplies)
• Bandages, binders, pins, adhesive plaster, &
scissors- (to fix the dressing in place)
• A large bowl with disinfectant solution- (to discard
the used instruments)
• Kidney tray & paper bag- (to collect the waste)
• Mackintosh & towel- (to protect the bed with linen
& patient clothes).
Preparation of the patient & the environment

• Identify the patient & explain the procedure to win

the confidence & co-operation. Explain the sequence
of the procedure & tell the patient how he can co-
operate in the procedure.
• Provide privacy with curtains & drapes.
• Apply restraint, in case of children.
• Offer bedpan or urinal prior to the dressing.
• As far as possible, avoid meal timings, the dressing
may be done either one hour before the meals or after
meals.
• Give some analgesics if the patient is in pain.
• See that the cleaning of the room is done at least one
hour before the expected time of the dressing.
• Shave the area if needed to remove the hairs.
Removal of adhesive is more painful if the hair is
present. So that the shaving should be done before the
first dressing is applied.
• Place the patient in a comfortable & relaxed position
depending on the area to be dressed.
• Give proper support to the body parts if the patient
has to raise & hold it in position for a considerable
time.
• Close the doors & windows to prevent drafts. Put off
the fan.
• Adjust the height of the bed for the comfortable
working of the doctor or nurse so that they have
neither to stoop or overreach to do the dressing.
• Call for assistance if necessary.
• Protect the bed with mackintosh & towel.
• Fold back the upper bedding towards the foot end of
the bed leaving a bath blanket or sheet over the
patient. Expose the part as necessary.
• Untie the bandage & remove them.
• Turn the head of the patient to one side, so that the
patient may not see the wound & get worried about it.
 Procedure

• Wear the mask.

• Wash hands thoroughly.
• Put on gown/gloves etc. as necessary.
• Open the sterile tray. Spread the sterile towel around
the wound.
• Pick up a dissecting forceps & remove the dressings
& put it in the paper bag. Discard the dissecting
forceps in the bowl of lotion.
• Note the type & amount of drainage present.
• Ask the assistant to pour small amount of cleansing
solution into the bowl.
• Clean the wound from the centre to periphery,
discarding the used swabs after each stroke.
• After thoroughly cleaning of the wound, dry the wound
with dry swabs using the same precautions. Discard the
forceps in the bowl of lotion.
• Apply medication if ordered.
• Apply the sterile dressings. Apply the gauze piece first,
then the cotton pads. Reinforce the dressings on the
dependent parts where the drainage may collect.
• Remove the gloves & discard it properly.
• Secure the dressing with bandage / adhesive tapes.
 After care of the patient & articles.

• Help the patient to dress up & to take a comfortable

position in the bed. Change the garments if soiled
with drainage.
• Replace the bed linen.
• Remove the mackintosh & towel.
• Take all the articles in the utility room , discard the
soiled dressings. Clean all the articles.
• Re-set the tray & send for autoclave.
• Wash hands
• Tidy up the bed & unit of the patient.
 Documentation

• Record the procedure on the nurses record with date

& time.
• Record the condition of the wound, the type &
amount of drainage, condition of the sutures etc.
• On the nurses record date, time, type of wound, status
of wound & sign.
• Report to the surgeon if any abnormalities found.
THANK YOU