Method of dressing change in dressing change

Before dressing change, you should know the wound situation in advance, so as to prepare the applied instruments, dressings and drugs according to the wound situation, and avoid waste and temporary hurry. Dressers should wear clothes, hats and masks, and prepare their clothes after washing their hands. General conventional dressing change items include two dressing change bowls, one containing dry dressings such as sterile gauze and oily gauze strips, and the other containing wet dressings such as iodophor cotton balls, alcohol cotton balls or wet gauze; A curved plate is used to hold dressings, drainage from wounds, cotton balls, dressings and other contaminants used in dressing change. Two pairs of dressing changing forceps (one with teeth and one without teeth) o Sometimes, drainage strips (tubes), sterile scissors, probes and necessary external drugs, bandages, abdominal belts or wide adhesive tapes should be prepared according to the specific conditions of the wound. (1) general dressing change method

1. Remove the dressing

(1) Remove the bandage and dressing on the outer layer of the wound by hand. When tearing the tape, gently rub the edge of the tape attached to the skin with your fingers. When tilting, gently press the local skin with one hand, and pull the tilted adhesive tape with the other hand to slowly peel it off in the opposite direction close to the skin surface (that is, parallel to the skin surface). Never pull it vertically, so as not to cause pain or tear off the epidermis. You can also put your fingers between the edge of the dressing and the skin, and gently press the skin outward with your fingers or separate the adhesive part between the adhesive tape and the skin. If the tape sticks to the hair, it can be cut off or moistened with gasoline, ether, turpentine, etc.

(2) Take out the dressing and drainage of the inner layer of the wound with sterile forceps and uncover it along the long axis of the wound. If the inner dressing forms scab with the wound surface, the dressing without scab can be cut off, leaving the scabbed dressing to heal it; If the dressing on the inner layer of the wound is soaked with pus, it can be soaked with hydrogen peroxide or normal saline. After the dressing is separated from the wound, it can be gently removed along the long axis of the wound. In the process of dressing change, one of the two dressing change forceps should always be kept in a relatively sterile state, and it is not allowed to be used indiscriminately.

(3) All cleaned dirty dressings should be placed in an arc-shaped tray, and shall not be discarded at will to prevent environmental pollution or cross infection.

2. Treatment of skin around the wound

After removing the dressing, disinfect the wound from the inside out with l% active iodine or 70% alcohol cotton ball, and be careful not to let the disinfectant flow into the wound. If there are many tape marks and dirt on the skin around the wound, it can be wiped off with turpentine or gasoline cotton swab to reduce the irritation to the skin.

3. Wound treatment

(1) Gently wipe the wound secretion from the inside out with 0. 1% bromogeramine or isotonic saline cotton ball. Scrub the cotton ball around the wound skin, and don't clean the inner surface of the wound. When wiping the wound secretion, it is forbidden to wipe it repeatedly, so as not to damage the wound granulation or epithelial tissue; The cotton ball used to wipe the wound should not be too wet, otherwise not only the secretion will be difficult to remove, but also pus will flow out to pollute the skin and bedding. Excess liquid medicine in the cotton ball can be squeezed out with dressing changing forceps.

(2) If the abscess cavity is deep, the cotton ball should be prevented from falling off in the wound when scrubbing.

(3) After the wound is wiped clean, foreign bodies such as the head of the wound, dead bones and carrion should be thoroughly removed.

(4) finally, disinfect the wound skin with an alcohol cotton ball. According to the wound situation, vaseline gauze, medicine or physiological saline gauze are selected to cover it, or drainage tubes and gauze drainage strips are placed.

Binding and fixing

After the wound was treated, it was covered with sterile dry gauze and fixed with adhesive tape. For wounds with large wounds and excessive exudation, a cotton pad can be added. If the tape is not fixed properly, it must be bandaged.

5. Pay attention after dressing change

After dressing change, tidy up the patient's sheets, put the dirty dressing into the dirt bucket, and put the used plates and instruments into the washing pool for disinfection. (2) dressing change of suture wound

1. Suture wound without drainage

Most of them are aseptic wounds, and the wounds are often examined about 3 days after operation to observe the seamless line reaction, needle-eye pustules, subcutaneous or deep suppuration; Whether there is effusion or hematocele, puncture and draw fluid as much as possible if necessary.

(1) Aseptic suture wound: disinfect the suture incision and surrounding skin with l% iodophor or 70% alcohol cotton ball, the disinfection scope is slightly larger than the gauze coverage, and then cover 4-6 layers of sterile gauze.

(2) Wound suture reaction: Within 2 ~ 3 days after operation, the wound generally has mild edema, and there is a little redness around the pinhole and below the suture, but the range is not large, which is a physiological reaction. It can be treated by conventional wound disinfection and 70% alcohol gauze wet compress.

3) Needle-eye abscess: In order to further develop the suture reaction, there is pus at the needle eye and dark red swelling around the needle eye. For smaller abscesses, you can first break them with sterile tweezers, squeeze out pus with sterile dry cotton balls, and then apply iodine tincture and alcohol. If the abscess is large or the infection is deep, stitches should be removed and sutured in advance.

(4) Wound infection or suppuration: local swelling, obvious edema and tenderness of the skin, dark red around the wound, exceeding the pinholes on both sides, and even a sense of fluctuation. You can try to suck out pus with a needle first, or insert a probe through a suture to check it. After the diagnosis of wound suppuration, the stitches should be partially or completely removed as soon as possible; When there is pus, cut the wound and remove pus and foreign bodies (such as thread ends). ) in the wound; After cleaning, place a proper drainage device. If there is not much secretion or only bloody secretion after the wound is cut, after cleaning or taking out the foreign body, pull the wound with butterfly tape and change the dressing as appropriate. For those with systemic symptoms, antibiotics should be used appropriately, combined with local physical therapy or hot compress.

(5) If it is suspected that there is bleeding or effusion in the wound, a needle can be used to puncture the surrounding normal skin, and the needle tip can sneak into the bleeding or effusion for suction; Or insert a probe or tweezers from the wound suture, slightly separate the drainage, and put a drainage strip to change the medicine until the wound heals.

2. Place the drained suture wound.

The drainage placed at the suture wound after operation is mostly rubber plate or rubber tube. The former is usually taken out 24 ~ 48 hours after operation, and the rubber skin can be removed to change the medicine. The latter can change the dressing as usual, and cut a Y-shaped or arc-shaped incision on the side covering the gauze to wrap the root of the drainage tube. If there is too much exudate before this, the soaked external dressing should be replaced at any time.