COMPLEX WOUND CARE:

IRRIGATION & PACKING

CLIN 1330

1
 What we are discussing today…

• Wound assessment
• Irrigating a wound
• Packing a wound
• Applying a moist-to-dry dressing
• Applying bandages

2
 Patient-Centered Care
• Acute and chronic wounds can cause pain, distress,
and financial burden on patients and families
– Provide pain medication if needed
– If dry dressing sticks, moisten with normal saline
• Patients and families often care for wounds at
home
– Initiate teaching as soon as possible
– Provide opportunities for patient and family
participation

(Perry and Potter, 2014)

 Safety
• Wounds may be colonized with bacteria
– Colonization does not interfere with wound
healing
• Monitor for signs of infection
– Wound infection interferes with wound healing
• Follow precautions to prevent introduction
or spread of bacteria
– Wear PPE
– Follow agency isolation protocols

(Perry and Potter, 2014)

 Safety
• Use proper infection control practices to
reduce the risk of wound infection
– Surgical wounds usually require sterile technique
– Chronic wounds often use clean technique
• Prevent tissue injury when measuring wounds
• Gentle irrigation

(Perry and Potter, 2014)

 Wound Assessment
• First essential step in planning wound care
• Patient experience – chronic wounds
– What treatment protocols have been used in the
past
– Value and apply expertise patient may have in
managing their wound

(Perry and Potter, 2014)

 Wound Assessment
• Assess wound status and phase of healing
– Anatomical location
– Incisional – approximated?
– Drainage
– Evidence of infection

May be left to heal by

secondary intention

(Perry and Potter, 2014)

 Wound Healing and Assessment
• Dimensions – length, width, depth – cm guide (use
cotton tipped applicator in area of greatest depth) –
discard all measuring tools
• Undermining – cotton tipped applicator, probe the
wound edges, measure depth and note location
using face of a clock as a guide
• 12o’clock would be the head of the patient

(Perry and Potter, 2014)

(Perry and Potter, 2014)
 Irrigation
• Irrigation removes debris, decreases bacterial
counts, loosens and removes necrotic tissue
• Solutions: N/S, warm water, wound cleansers
• Sterile technique is used
• Once wound bed is clean irrigation and moist
dressings are contraindicated

(Perry and Potter, 2014)

 Performing Irrigation
• Surgical or chronic wounds using prescribed solution
• Tip of syringe 2.5 cm away from wound
– 35ml syringe
• Position patient so solution flows away from wound
• Provide gentle irrigation
– apply slow, continuous pressure
• Deep wound: use a catheter attached to syringe in
order to permit fluid to enter wound

(Perry and Potter, 2014)

 Wound Swab for Culture
• Swab if infection is suspected
• Complete a pain assessment prior to swabbing
• Cleanse the wound first!
• Choose an area of the wound that looks clean (no debris,
drainage, slough)
• Wet the tip of the swab with sterile saline
• Press firmly into the wound to express wound fluid
• Rotate the swab and remove
• Place into sterile swab casing, label per agency and send to lab
• Indicate any antibiotics the patient is taking
(Orsted et al, 2017)

12
 Applying a Moist-to-Dry Dressing
• Prepare and maintain sterile field during dressing
– Clean wound from least to most contaminated
– Gently pack moist-to-dry dressing
• Ensure that all dead space is loosely packed
• Do not leave moist gauze in contact with surrounding
skin
– Blot dry with sterile gauze

(Perry and Potter, 2014)

 Applying a Moist-to-Dry Dressing

• Cover with secondary dressing

• May secure with tape or Montgomery straps

(Perry and Potter, 2014)

 Applying a Pressure Bandage
• Pressure bandages temporarily control excessive
bleeding
• Indications: after an invasive procedure (over a major
vessel, biopsy and puncture, traumatic injury)
• Apply immediate manual pressure with gloved hand
and dry gauze on external bleeding site

(Perry and Potter, 2014)

 Applying a Pressure Bandage
• Prepare gauze compress and tape strips (2nd
person)
• Tape compress with overlapping strips
– Keep firm pressure on site while taping
– Avoid tourniquet effect
• Priority: Observe dressing for control of bleeding

(Perry and Potter, 2014)

 Applying a Transparent Dressing
• Occlusive or moisture-retentive dressings cover
and encapsulate wounds (opsite, tegaderm)
• For superficial wounds, minimal drainage
• Temporary second skin (synthetic membrane)
• Contains the exudate – minimizes wound
contamination

(Perry and Potter, 2014)

 Applying a Transparent Dressing
• May be used on primary or secondary intention
wounds (e.g., vac dressings)
• Protect surrounding skin from maceration,
dehydration, heat loss, exposure to pathogens
• Apply dressing: avoid wrinkles, smooth and adhere
to skin
• Remove old dressing
• Pick up ends and slowly
pull back parallel to wound
• Do not pull upward
(Perry and Potter, 2014)
 Hydrocolloid Dressings
• Absorptive, hydrating and debriding properties
• When in contact with wound drainage – form a
gel promoting a moist environment
• Facilitates debridement
• Less pain – cushioning effect of the dressing
• Moist, insulated, rapid healing

(Perry and Potter, 2014)

Hydrogel Dressings
• Glycerine or water based (hydrate)
• Some absorptive properties
Foam Dressings
• Absorbs moderate to heavy exudates, used for
infected wounds
• Not appropriate for “tunneling” wounds
(Perry and Potter, 2014)
 Negative-Pressure Wound Therapy
• Mechanical wound therapy
– localized negative
pressure/suction to
accelerate wound healing
• Removes fluids from wound
• Stimulates granulation
tissue
• Reduces bacterial burden

(Perry and Potter, 2014)

 Negative-Pressure Wound Therapy
• Semiocclusive adhesive dressing and
suction via a tubing system connected and
controlled by a computerized pump
• Tight, airtight seal to maintain negative
pressure environment

(Perry and Potter, 2014)

 Applying Gauze and Elastic
Bandages
• Use to wrap or secure hard-to-cover areas or exert
pressure over a body part
• Apply from distal point toward proximal boundary,
stretching slightly
• Alternate ascending and descending turns
• Ensure that bandage is snug but not tight
– Check primary dressing or splint for correct position
– Secure with tape or clips
• Assess tightness and routinely evaluate distal
circulation
(Perry and Potter, 2014)
Applying an Abdominal and Breast Binder
• Binders fit a specific body part to support a
wound, reduce or prevent edema, protect
surrounding skin, or decrease pain
– Breast and abdomen most common – large
incisions
– Ensure correct fit to decrease risk of wound
injury or interference with respirations or
mobility

(Perry and Potter, 2014)

Applying an Abdominal and Breast Binder
• Routinely assess patient’s ability to breathe
deeply and cough when binder is in use (can
impair ventilation)
• Routinely remove binder to assess underlying
dressings, skin, and wound characteristics

(Perry and Potter, 2014)

 References
• Orsted, H, Keast, D., Forest-Lalonde, L., Kuhnke, J.,
O’Sullivan-Drombolis, D., Jin, S. et al (2017). Best
Practice Recommendations for the Prevention and
Management of Wounds. Wounds Canada, retrieved
online from:
https://www.woundscanada.ca/docman/public/healt
h-care-professional/bpr-workshop/165-wc-bpr-preve
ntion-and-management-of-wounds/file

• Perry, A.G, Potter, P. A, & Ostendorf,, W. R. (2014).

Clinical Nursing Skills & Techniques (8th ed.). St Louis
Missouri: Elsevier Mosby.