Dressing a Pressure Injury With Basic Wound Care Supplies by Susan Hamilton.
Hi. My name is Sue Hamilton.
I'm a Nurse Practice Specialist at Boston Children's Hospital.
Today, I'm going to talk about dressing a pressure injury.
Treatment.
The principles that we use to treat wounds is the DIWAMOPI acronym.
That stands for you want to debride a wound so that you can get the wound bed open.
You want to look and identify infection.
You want to be able to wick up dead space, fill the wound in, and you want to be able
to absorb the extra exudate or drainage.
You want to maintain a moist environment.
A moist environment is an alive environment.
You don't want things to dry out with the exception of potentially on a heel because
the tissue is considered dead.
You want to make sure that the wound edges are open so that the wound can actually heal
in.
And, of course, you want to protect the site and insulate the site.
And then once you've finished all of this, you want to make a clear documentation of
what you've seen so the next person who comes along can actually make the same assessment
that you did.
Once you realize that you have a problem with a pressure injury, you need to be very proactive
about treating it using the ESP plus E principles.
We talk a lot about prevention, and prevention is most important.
But if a wound does develop, you need to think about the E being correcting etiological factors.
Is there some reason why this patient got this?
Then, you need to think about systemic support.
If the patient has poor nutrition, you need to do what you can to maximize the nutrition.
And then you need to use principle-based topical therapy.
You may have limited resources for different kinds of dressings.
But basically, we will go over that and how to keep a wound bed moist and how to debride
a wound and how to get it to granulate in.
And then, after you've done the care, you need to continue to evaluate wounds on a regular
basis to assure that they are progressing.
Types of Dressing.
Now I'm going to show you some of the wound products.
We'll start with the more simple such as the gauze products.
You can use the 2 by 2 size.
And these can actually be opened up and placed into the wound.
There's also 4 by 4 size, which if they come in a folded, you can take them and actually
put them into the wound in a fluffed position.
The goal is not to stuff the wound full but to fill it loosely to give some room for drainage
and for the wound to contract in.
There's also different types of packing gauzes, which you can use which are narrower for thin
or deep wounds.
And you can use a Q-tip to help move the packing into the wound.
It's a good idea to know how much you put in the wound and to leave a small piece outside
the wound so that when you go to redress it, you can pull the gauze straight out.
There's also cover dressings, such as abdominal pads or something that will just absorb excess
drainage that comes out over the primary dressing.
There's also transparent film dressings.
These dressings are particularly good as a secondary covering dressing or to use for
a stage 1 or stage 2 pressure injury that you just want to protect the site.
You can use these for blisters, which would be considered a stage 2 pressure ulcer if
it was related to pressure.
And it will help keep the blister intact.
For blisters, you can also use as a wet dressing such as a Vaseline gauze or a Xeroform gauze.
Just place these over the wound to help keep them moist and protected.
There's also higher end dressings such as hydrocolloid dressings, which will absorb
some moisture.
But these are not meant for highly draining wounds, but they will provide some protection,
as well as absorb some drainage.
There's also foam dressings that not only protect the skin but also are fairly absorbent
as well.
There's also silicone dressings, which these dressings, while they are expensive, they
actually have several purposes.
The middle is considered an absorptive pad and will take up to three times their weight
in drainage.
And the outside is made of a silicone filling that will not hurt the skin that surrounds
the wound.
They will bring all the moisture away from the wound and help to heal the wound more
quickly.
There's also hydrofiber dressings such as this.
This dressing also will absorb more than three times its weight.
It goes in as a fiber, but it will come out like a jelly.
It will absorb all the drainage and bring it out of the wound.
This is the regular kind.
It also comes in silver.
There are many different options for silver dressings on the market now.
And this dressing with silver is good for a wound that is infected because it will have
gram negative and some gram positive effect on helping infected wounds to heal.
So those are some of the products that we can use.
And don't forget that in choosing tape, you should use a tape that is mild on the skin,
preferably like a paper tape that will not cause further skin tears on the patient.
Demonstration.
Now we're going to assess and clean and dress a wound.
So you can see this patient's wound is on his coccyx area or sacrum just at the base
of the buttocks.
This is a common area for older children to get a wound, especially if they are bedbound
or chairfast and unable to move themselves.
Just wet, normal saline gauze is good for cleaning wounds.
You want to use some pressure to clean off any dry skin or areas that are just dead and
dry and flaky.
You want to clean the wound bed.
If it bleeds a little, that's actually a good sign that there's healthy, viable tissue there.
If you push too hard on the wound though, you may actually disrupt the wound bed.
So you want to use some pressure but not aggressive pressure in cleaning the wound.
Once the wound is all clean, you can go ahead and dry the areas.
You want to do whatever you can to protect the skin that surrounds the wound.
There are products that you can use.
But also just use a dressing that will contain as much of the drainage as possible.
For this wound, I'm going to choose, for now, a moist gauze covered with a dry gauze.
And then we'll use a foam dressing to help absorb some of the drainage.
The goal for this wound would be to get that slough and that eschar to come out of the
wound.
So then we can see what the base of the wound looks like and then get it to heal from the
inside out.
So now that I've cleaned it, I'm going to take a piece of damp gauze.
And again, like I said earlier, if you fluff the gauze onto the wound, then I'm going to
place a dry gauze over that.
And then I'll put the foam dressing over for extra protection, insulation, and padding.
And then I would tape the whole dressing.
And I would change that dressing at least once a day or if it became soiled with stool
or if the drainage came through to the foam dressing.
Thank you for watching this video on dressing a pressure injury.
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