DRESSING CHANGE

CAESARIAN SECTION
 THE SURGICAL WOUND
POST-CS
• A SURGICAL WOUND (INCISION) IS THE CUT MADE IN THE
SKIN BY THE SURGEON DURING CAESAREAN
SECTION(OPERATIVE PROCEDURE).
• AT THE END OF THE OPERATION, THE WOUND WILL BE
CLOSED USING STITCHES(SUTURES) TO ALLOW THE SKIN
EDGES TO COME TOGETHER AND HEAL.
• THE SKIN EDGES USUALLY FORM A SEAL WITHIN A DAY OR
TWO OF THE OPERATION, BUT THE TIME VARIES FROM ONE
PERSON TO ANOTHER.
10 X 25 CM MEDICAL ADHESIVE WOUND
DRESSING
DRESSINGS

Low transverse
dressing
 STITCHES

• THE MEDICAL TERM FOR STITCHES IS

"SUTURES".
• SOME STITCHES ARE
DISSOLVABLE(ABSORBABLE) AND
DON'T NEED TO BE REMOVED.
• OTHER TYPES OF STITCHES HAVE TO
BE REMOVED BY THE CARE
PROVIDER.
 DRESSINGS

THE PURPOSE OF A DRESSING IS TO:

• ABSORB ANY LEAK FROM THE WOUND
• PROVIDE OPTIMUM CONDITIONS FOR
HEALING
• PROTECT THE AREA FROM INFECTION AND
MOVEMENT UNTIL THE PRIMARY HEALING
HAS BEGUN
• PREVENT STITCHES CATCHING ON CLOTHES
 CARING FOR THE WOUND

• THE ORIGINAL DRESSING IS USUALLY REMOVED AFTER 24 HOURS AND THE CARE
PROVIDER WILL ASSESS THE WOUND AND RE-DRESS IT.
• AFTER 48 HOURS THE WOUND CAN USUALLY BE LEFT WITHOUT A DRESSING,
HOWEVER, SOME PEOPLE PREFER TO WEAR A DRESSING TO PROTECT THE
WOUND, ESPECIALLY IF CLOTHING IS GOING TO RUB AGAINST IT.
• DO NOT APPLY ANTISEPTIC CREAM OR ANY OTHER PRODUCT TO THE WOUND
UNLESS ADVISED BY THE CARE PROVIDER
 CARING FOR THE WOUND (2)

• DISSOLVABLE STITCHES WILL USUALLY DISAPPEAR ON THEIR OWN IN 7-10 DAYS.

• NON DISSOLVABLE STITCHES MAY BE REMOVED AT 5-7 DAYS AFTER BEING
ASSESSED BY THE CARE PROVIDER THAT THEY ARE READY TO COME OUT.
 PROBLEMS WITH HEALING

• MOST WOUNDS HEAL WITHOUT CAUSING ANY PROBLEMS.

• SOME REDNESS AND SWELLING AFTER SURGERY IS TO BE EXPECTED,
HOWEVER, SOMETIMES A WOUND INFECTION CAN BE A COMPLICATION
AFTER SURGERY. THIS MEANS THAT MICROORGANISMS HAVE STARTED TO
GROW IN THE WOUND AND CAN DELAY NORMAL HEALING. THESE WOUND
INFECTIONS ARE USUALLY TREATED WITH A COURSE OF ANTIBIOTICS.
OCCASIONALLY, HOSPITAL ADMISSION MAY BE NEEDED AND POSSIBLY
FURTHER SURGERY.
 AT RISK FOR WOUND INFECTION

• SMOKERS
• PEOPLE WHO HAVE DIABETES
• PEOPLE HAVE A CONDITION OR TREATMENT THAT AFFECTS THEIR
IMMUNE SYSTEM
• OBESITY IS STRONGLY ASSOCIATED WITH THE DEVELOPMENT OF A
SURGICAL SITE INFECTION.
• THE HIGHER THE BMI (BODY MASS INDEX) THE GREATER
THE RISK.
• BMI 25-30 ARE 1.6 TIMES MORE LIKELY TO DEVELOP AN
INFECTION
• BMI 30-35 ARE 2.4 TIMES MORE LIKELY
• BMI OVER 35 ARE 3.7 MORE LIKELY (HPA 2012)
 SIGNS OF INFECTED WOUND

• PAINFUL INCISIONAL SITE

• APPEARS RED (RUBOR), OR MORE
INFLAMED OR SWOLLEN
• LEAK OR WEEP LIQUID, PUS OR
BLOOD
• UNPLEASANT SMELL
PROCEDURE
 SAFETY CONSIDERATIONS

• SAFETY CONSIDERATIONS: 
• PERFORM HAND HYGIENE.
• CHECK ROOM FOR ADDITIONAL PRECAUTIONS.
INTRODUCE YOURSELF TO PATIENT.
• CONFIRM PATIENT ID USING TWO PATIENT IDENTIFIERS (E.G., NAME AND DATE OF BIRTH).
• EXPLAIN PROCESS TO PATIENT; OFFER ANALGESIA, BATHROOM, ETC.
• LISTEN AND ATTEND TO PATIENT CUES.
• ENSURE PATIENT’S PRIVACY AND DIGNITY.
• ASSESS AIRWAY, BREATHING, CIRCULATION, CONSCIOUSNESS, SAFETY
• IDENTIFY THE NAME OF THE PATIENT AND
CHECK THE ORDER (PCP ORDER) FOR CHANGE
DRESSINGS
• INTRODUCE YOURSELF
• PROVIDE PRIVACY
• ASSESS FOR ALLERGIES
• EXPLAIN THE PROCEDURE TO THE CLIENT
• ASSESS PAIN LEVEL
• PREPARE ENVIRONMENT , POSITION PATIENT,
ADJUST HEIGHT OF BED, LOWER SIDE RAILS
TURN ON LIGHTS.
• NOTE: ASSESS FOR PAIN, BEFORE CHANGING
THE DRESSING GIVE PRN MEDICATIONS FOR
PAIN
• *PCP: PRIMARY CARE PHYSICIAN/PROVIDER
 PREPARE EQUIPMENT
PREPARE A WOUND CARE TRAY WITH THE FOLLOWING:
• NEW BANDAGES, FORCEPS
• A ROLL OF MEDICAL TAPE
• CLEAN SCISSORS
• TWO PAIRS OF DISPOSABLE GLOVES
• TWO, CLEAN, SOFT CLOTHS OR PAPER TOWELS
• A DISPOSABLE PLASTIC BAG
• WASTE BASKET
• DRAPE FOR CLIENT (OPTIONAL)
• NOTE: KEEP THESE MATERIALS AWAY FROM THE INCISION
TO REDUCE RISK FOR INFECTION
 PREPARATION

• WASH YOUR HANDS WITH SOAP AND

WATER FOR 30 SECONDS AND DRY
THEM WITH CLEAN TOWELS
• CUT FOUR PIECES OF TAPE AND HANG
THEM FROM A NEARBY TABLE OR
COUNTER, THE PIECES OF TAPE
SHOULD BE THE SAME LENGTH AS
THE OLD ONES AROUND THE INCISION
 PREPARE STERILE FIELD (STERILE FIELD
SHOULD BE NEARBY BUT NOT NEARLY AS
GOING OVER THE INCISION SITE)
POUR CLEANSING SOLUTION ON STERILE
TRAY

Normal saline or sterile water

containers must be used for only
one client and must be dated and
discarded within at least 24 hours
of being opened.
• PREPARE PATIENT AND
EXPOSE DRESSED WOUND.
• DO HAND HYGIENE AND
DON DISPOSABLE GLOVES
 REMOVE OLD DRESSING

• AFTER LOOSENING ALL THE TAPE REMOVE

OUTER DRESSING WITH NON-STERILE GLOVES
AND DISCARD AS PER AGENCY POLICY.
OR:
• WITH ONE HAND, PRESS DOWN GENTLY ON
THE SKIN NEXT TO THE OLD TAPE AROUND
THE INCISION
• WITH THE OTHER HAND, CAREFULLY PEEL
AWAY THE OLD TAPE TOWARD THE INCISION
 REMEMBER

• DO NOT REMOVE ANY SKIN CLOSURE STRIPS COVERING THE

INCISION, LET THEM FALL OFF ON THEIR OWN IN ABOUT 5-10
DAYS
• IF THE DRESSING STICKS ON THE INCISION, DON’T TEAR IT OFF,
TEARING IT OFF MAY CAUSE BLEEDING, MOISTEN THE
DRESSING WITH WARM, SALINE WATER, WAIT 1-2 MINUTES
UNTIL IT COMES OFF EASILY
• ASSESS THE OLD DRESSING FOR
COLOR, QUANTITY AND TYPE OF
DRAINAGE (FOUL OR SWEET SMELL
OR YELLOW OR GREENISH STAIN,
REPORT TO THE PHYSICIAN)
• PLACE THE OLD DRESSING INTO THE
DISPOSABLE PLASTIC BAG
• REMOVE INNER DRESSING WITH
TRANSFER FORCEPS, IF NECESSARY.
• ASSESS INNER DRESSING FOR FOUL
SMELL AND STAIN
• DISCARD TO DISPOSABLE BAG
• DISCARD TRANSFER FORCEPS AND
NON-STERILE GLOVES ACCORDING TO
AGENCY POLICY.
• DRAPE PATIENT WITH WATER-
RESISTANT UNDERPAD (OPTIONAL)
INCISION SITE CARE
• HAND HYGIENE
• APPLY NON-STERILE GLOVES .
 CLEANSING THE INCISIONAL SITE

• CLEANSE WOUND USING ONE 2 X 2

GAUZE PER STROKE. STROKES
SHOULD BE:
• FROM CLEAN TO DIRTY (INCISION,
THEN OUTER EDGES)
• FROM TOP TO BOTTOM
• USING A STERILE SWAB OR GAUZE, CLEAN THE SUTURE LINE
BY STARTING AT THE CENTRE AND WORKING TOWARD ONE
END.

• WITH ANOTHER STERILE SWAB OR GAUZE, START AT THE

CENTRE OF THE INCISION AND WORK TOWARD THE OTHER
END.

• ALL OTHER CLEANSING INVOLVES MOVING FROM ONE END

TO THE OTHER ON EACH SIDE OF THE INCISION.

• WORK IN STRAIGHT LINES, MOVING AWAY FROM THE SUTURE

LINE WITH EACH SUCCESSIVE STROKE.
• CLEANSE AROUND DRAIN (IF PRESENT).
• IF A DRAIN IS PRESENT, CLEAN THE DRAIN SITE
USING A CIRCULAR STROKE, STARTING WITH
THE AREA IMMEDIATELY NEXT TO THE DRAIN.
• USING A NEW SWAB, CLEANSE IMMEDIATELY
NEXT TO THE DRAIN AND ATTEMPT TO CLEAN
A LITTLE FURTHER OUT FROM THE DRAIN.
CONTINUE THIS PROCESS WITH SUBSEQUENT
SWABS UNTIL THE SKIN SURROUNDING THE
DRAIN IS CLEANED.
 Cover
incision

• APPLY INNER DRESSING (4 X 4 GAUZE)

WITH FORCEPS TO INCISION, THEN
DRAIN SITE (DRAIN SPONGES/CUT Cover drain
GAUZE). site

Tape drain tubing to

skin
• DISCARD NON-STERILE GLOVES IF
THEY WERE USED.
• APPLY OUTER DRESSING, KEEPING
THE INSIDE OF THE STERILE
DRESSING TOUCHING THE WOUND.
• TAPE ALL SIDES USING THE PREPARED
SURGICAL TAPE
• PLACE ABDOMINAL BINDER
TO COMPLETE DRESSING CHANGE:
• ASSIST PATIENT TO COMFORTABLE
POSITION.
• LOWER PATIENT’S BED.
• DISCARD USED EQUIPMENT
APPROPRIATELY.
• PERFORM HAND HYGIENE.
• DOCUMENT: RN’S NAME,
DATE, TIME AND ALL
OBSERVATIONS
THANK YOU!