Removing and Applying Wet to Damp Dressings

Removing and Applying Wet to Damp Dressings

Equipment
■ 3 pairs of clean nonsterile gloves.
■ Sterile solution or tap water for irrigation, warmed to body temperature when possible.
■ Water-resistant disposable drapes.
■ Sterile fine-mesh gauze in a tray for dressing.
■ Surgipad.
■ Tape or Montgomery straps.

Assessment
■ Assess:
■ Amount and type of tissue present in the wound bed.
■ Type and amount of exudate.
■ Wound odor.
■ Tissue surrounding the wound edge.
■ Patient pain.

Post-Procedure Reassessment
■ Verify that the patient experiences minimal discomfort with the procedure.
■ Note whether the patient verbalizes understanding of the procedure.

Key Points
■ Assess for pain, and medicate 30 minutes before procedure, if necessary.
■ Place the patient in a comfortable position that provides easy access to the wound.
■ Wearing clean gloves, remove the soiled dressing and discard it in a biohazard receptacle.
■ Be Safe! Change gloves and cleanse the wound with gauze moistened with sterile saline or tap water.
■ Assess the wound for location, appearance, odor, and drainage.
■ Don clean gloves and apply a single layer of moist, fine-mesh gauze to the wound. Be sure to place gauze in all depressions of the wound.
■ Apply a secondary moist layer over the first layer. Repeat this process until the wound is filled with moistened sterile gauze.
■ Cover the moistened gauze with a surgipad.
■ Be Smart! Secure the dressing with tape or Montgomery straps.

Documentation
■ Record:
■ Appearance and location of the wound, type and amount of exudate, and odor after cleansing.
■ Patient’s pain level before the procedure.
■ Pain medication given including the dose, time, your name, and the patient’s response.
■ Method of cleansing the wound.
■ Type of dressing applied to the wound.
■ Education provided to the patient.

Removing a wet-to-damp dressing

Packing a wet to damp dressing

Covering a wet to damp dressing