Clinical Skills - Sterile Wound Dressing Change
by Ellis Parker February 04, 2022 Updated: December 07, 2022 5 min read
Hi, I'm Ellis with Level Up RN. In this video, I'll be demonstrating how to perform a sterile wound dressing change. I'll be utilizing the steps that are found on our Clinical Nursing Skills cards. So if you have this deck, grab the cards and follow along with me. If you don't have the deck, you can head on over to Leveluprn.com to check them out.
Before my demonstration, I just want to point out that it would be best practice to go ahead and medicate your patient. These dressing changes are often extremely uncomfortable, potentially extremely painful, and I wouldn't want my patients to experience that type of discomfort. So if I know I'm going to be doing a dressing change in the near future, I want to go ahead and do a pain assessment, address my patient's pain, wait for the pain medication to start working, and then I would do my dressing change.
To prepare to change my patient's dressing, I've already washed my hands and gotten gloves, and I've gotten a wound care tray. So these trays come with everything that I need to change this patient's dressing using sterile technique. But I may need to get a couple of things as well, depending on the facility that I'm in. So before I open this and prepare all of my sterile things, I'm going to go ahead and remove my patient's old dressing. So I simply remove the top dressing, which in this case is an ABD pad. So I'm going to take that off, and I like to go ahead and just hold it and take out all the inside dressing. And I'm going to take a look at it and just throw all of that away appropriately. While I'm doing all that, I'm assessing the type of drainage, the color, the texture, the amount. I'm looking at the wound itself, checking out the bed, seeing what type of tissue is available. Again, how much drainage is present, what color, if it smells bad, right? I'm doing all of those different things. I'm looking at the edge of my wound, and I'm going to go ahead and take off my gloves and start to prepare my sterile field.
So the first step is, of course, to open my wound care tray. So I'm going to pull it away from me and pull it taut. These trays usually come with gloves, but I simply prefer to wear the size that fits me. So I've gotten extra sterile gloves, but they usually have sterile gloves in them. So I'm going to go ahead and pick up my sterile drape. I can pinch these corners. Just remember, one inch of the sterile border is not sterile. And I'm going to lay that out for me. I'm going to use the edge of this table to go ahead and put on my sterile gloves. This pack is a little bit loved, but it still works. I'm going to fold my edges out, open the pack itself.
With my non-dominant hand, I'm going to pick up my dominant glove by the cuff only. I'm going to put the dominant hand in and then with my dominant hand I'm going to pick up the cuff of my non-dominant hand by sliding my fingers under the cuff and put my [adjusts glove]. All right. And then I'm going to slide that into the garbage. All right. I like to clench my hands when I'm not doing anything so I'm not tempted to do something like touch my hair or move my hands around. I'm going to go ahead and grab the items out of the sterile kit. So in my kit, I've got some saline, some tape. I've got a roll of cling, I've got sterile gauze. I've got an ABD pad. And then I actually have a label to label the dressing itself when I'm done. So I'm going to go ahead and open my sterile gauze, and I'm going to pour some of this sterile saline into my sterile container. So I'm going to unscrew my lid. I'm just going to throw it away because I'm going to use this as a one time use. If I wanted to use it again, I could place it with the open side up on a surface, open my sterile saline, not dropping my hand below my waist. I'm going to palm the label and pour some of the saline into my container. I'm going to use that saline with this gauze to clean my wound.
So that's the first step. So I'm going to dip some of my gauze in the saline itself. And then when I clean my wound, I'm going to start at the center of the wound and go out towards the edges. So I'm going to start at the center and pull out, and each swipe will need a new piece of gauze. And now I want to be clear again. I need to start at the center and go out, because if I took this piece of gauze and I started on the outside edge and I pulled in, then I'm taking any bacteria that's outside of that wound bed and just dragging it into the wound. So if I clean it like this, I'm potentially contaminating that wound further. So I start on the inside. I go out, I discard. I get a new piece. Dip it in saline, start on the inside, come out, and discard. I would continue that process until my wound was clean. Once it's clean, I'll take an additional piece of gauze, and I will pat it dry. Just to make sure that there's not like an excess of liquid in my wound bed, I'm going to drop that, and then I'm going to take whatever material it is that has been ordered to pack it with. So in this case, we'll say that's dry gauze. I could at this point put any type of medication or ointment in if that were ordered, then I'm going to pack the wound itself. So we'll use dry gauze today.
Now, it's important to note that I'm very careful when I'm placing this gauze. If I took this piece of gauze and decided to say pack it down there and I did it like this, I'm again doing what I just mentioned, where this gauze is touching the outside of the wound. And now I'm rolling it and tucking it in. Instead, I need to be very purposeful and take the gauze and put it into those holes without kind of dragging it over the outside of the skin. So we're going to pretend I have enough gauze to actually fill this wound today. That's full. And then I take this ABD pad and I place it over the wound, and then I take my tape and I exclusively tape it so that it's secure to my patient. So I would tape all four areas. And now that my wound is covered, I no longer have to really worry about sterility. So I'm going to document my name, the date which is eight-- and the time so that the next person that assesses this wound knows exactly who changed it and when they changed it, and I'm going to make sure that that's placed on the wound itself and that it's documented in my chart. And now this patient's gotten a dressing change.
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