King Campus · Transcript · · Updated
Wound Care Demo – Transcript
Video by King Campus · Watch the original on YouTube
Summary
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- The speaker demonstrates a wound dressing change under full sterile technique using sterile supplies, a sterile field, and sterile gloves.
- The procedure involves removing the old dressing, irrigating the wound with normal saline, measuring the wound, and packing it with ribbon gauze.
- After covering the wound with an abdominal pad and tape, the nurse cleans up, discards sharps appropriately, and repositions the patient.
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Transcript
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okay so today we are going to be doing a wound dressing and i'm not going to be talking about any of the assessments consent checking patient id all that will be in the reading i'm just doing a wound dressing change so i'm going to do a wound dressing change under sterile full sterile technique with sterile gloves using all sterile supplies and setting up a sterile field obviously not all wounds are done using
full sterile technique but that's what i'm going to do so when you first come in the room first of all we want to do hand hygiene right if you remember your moments of hand hygiene back from when you did semester one when you're first entering a room we do hand hygiene so then i am going to raise the level of the bed partly for my back you should always be doing procedures with the bed up at waist level but because
this is going to be an extension of my sterile field i want it about waist level down and then i'm also going to put so this is my prep space i'm going to put this up at the level of my waist as well i might put it down a touch just so it's a little bit easier for you guys to see but you want it up at your waist so anytime you're doing a procedure you want to think through the procedure and
everything you're going to need so that you make sure you haven't forgotten anything even more important with a sterile procedure because if you get halfway through a sterile procedure and you've forgotten something you can't leave your sterile field so i'm going to think through everything i'm going to do so first of all i'm going to remove the old dressing so for that i just need clean gloves and then i'm just going to have a blue pad that i'm going to place under the
wound and maybe something for the irrigation place that down then after i remove the old dressing i'm going to irrigate it so to irrigate it i need irrigation solution this is normal saline which is very common to be used
for irrigating a wound i am going to need also so a syringe um usually at least a 30cc syringe with irrigation usually more is better so a larger size syringe then you're going to want something just to increase the pressure so usually we would use a blunt needle or an angio cap so i have that i'm going to measure the wound so i have my cotton tipped applicator to measure
the wound after i irrigate it i'm going to take a culture of the wound you may not always be taking a culture of a wound every time you do a wound dressing but if you are you need a charcoal swab like this one um table up a little bit it feels too low and then i might dry the wound so there's four by fours two by twos in here but just partly for demonstration purposes
i'm going to add a sterile 4x4 gauze and i'm going to add a sterile 2x2 gauze then i'm going to pack the wound so i've got ribbon gauze that's what we happen to be using to pack it and then i need scissors to cut my ribbon gauze i've got that uh then i'm gonna put four by fours should be in there two by twos that should be in there and an abdominal pad
which i have here some tape to tape the wound so just another few things i need i'm going to use a sterile dressing tray so this is a disposable sterile dressing tray anytime you have a sterile tray what is in it will be listed on it right because you can't open it to figure out what's in it and they may vary from manufacturer to manufacturer so if you want to double check what's in your
sterile tray it'll be written on it most of the dressing trays don't have gloved sterile gloves in them so i need to grab the sterile gloves these ones are a size 8 which is about a medium which should be good for my hands this i'm just going to use to help me measure depending on what type of measurement tool you use it may be on the actual swab itself or you may need
gauze packaging or something like this uh just a word about ppe if you're anytime you're irrigating something you probably should have at least eyewear on to protect your eyes from the splatter because you're irrigating under pressure sometimes the mask you can have a mask with the shield on it i'm not going to wear either of these because it just makes it harder for you to hear me and for me to see
but probably that's ppe that you might want to consider so i did pp i did a hand hygiene when i first came in the room but another moment of hand hygiene your second is before you actually touch the patient so i'm going to do hand hygiene a second time i'm going to put on ster clean gloves sorry not sterile gloves
and then i'm going to remove the dressing so just positioning the patient i've kind of already set it up but you want ideally to have the patient positioned so that when you're irrigating the wound it will drain downwards and not sit in the wound if you can just want to be rather gentle about removing the tape i'm just going to remove the top of it i'm going to leave if you can see in there the packing i'm just going to
leave that in there for now i'm not going to ideally i don't really want to be reaching into my wound with not sterile gloves on so you can just examine this if there's any discharge or anything on that that you that you think you might need and then i'm going to i'm going to use this just to replicate like a garbage can um often when you're when you're doing a procedure before you start the sterile
procedure there might be stuff you just want to discard but you don't actually need a sterile set up for garbage so i'm just going to use that as my garbage can okay so if you wanted to palpate around the wound feel for warmth redness anything like that you could do that at this point but pretty much all i'm doing right now is i'm going to remove the dirty dressing i think i'll just place like a k basin or something like that oh actually i'm not going to do that right now i'm going to leave that and then i'm
going to remove my clean gloves so when you're taking off your gloves think about it like there's something gross on it right so i don't want to do this i want to do it like this and then i hold that in my hand and now i'm going to peel under here and i'm going to put it up there so another moment of hand hygiene before procedure generally any time you take gloves off you want to do hand hygiene so i'm going to do hand hygiene again and then that should probably be it i
don't you don't really need to do it again before putting on your sterile gloves because everything you're touching here is clean so first thing i'm going to do is open my dressing tray you want to make sure it's intact no holes anything like that oh good thing i have my glasses because i do need these anything that's sterile packaging you should not need to rip there should be some way to open it cleanly this has a little perforation you probably can't see it here but you
can see it on your own right so you can open it cleanly when you're doing a sterile procedure you want something clean to use to discard your garbage once you actually get started on your sterile procedure some of these dressing trays will have little garbage bags in them this one doesn't so i'm just going to use this so you can just set it somewhere on the bed or often what we'll do is just tape it
to the side of the table you just want it somewhere that is easy to access and that you don't have to reach across your sterile field to get to it right so i don't really want it here because i don't want to have to reach over my sterile field so somewhere where i can put it like this and just kind of make sure it's open so that you can access it pretty easily so i'm going to open my dressing tray
right i'm going to open it away from myself away from myself and only touching that one-inch border that is not sterile because obviously my hands aren't sterile at this point when you get to the last flap i'm just going to turn it around so you can see there'll be transfer forceps in there so i'm going to pick them up
and i can use these while i'm setting up my sterile field right so let's get it open and then i'm just going to square it off like this turn it around so that it's not hanging so these they're called transfer forceps because this part here i'm going to keep sterile but this part here that i'm touching with my obviously not sterile hands is not sterile so you can use this
to add supplies move stuff around before you put your sterile gloves on so usually they come with a little extension here so i'm just going to pick this up by the one inch border again because my hands are not sterile obviously at this part point and then you can just lay it down if you want to extend your sterile field sometimes nurses will do this procedure and they'll actually put all their supplies over here instead of in there
we're just going to use it as a little extension of our sterile field here now i'm going to put my k base in there or just something so when i'm irrigating it it's not going all over the patient's bed okay so in your sterile field there's four by fours there's two by twos and there are your sterile forceps that you're going to use for now i'm just using my transfer forceps if you can see i like to make sure that this green part
here is on white you don't want them sitting like this right because remember your one inch border is not sterile so i want to make sure that this part is not lying in that one inch border so make sure they're sitting far enough in so i'm going to think through my procedure again and add things one at a time as i think i need to do it so i'm going to um measure the wound be one of the first
things i would do there's different methods of measuring we're using these cotton tip applicators you may have ones that actually have markings on them so i'm going to do this two different ways i'll show you two different ways you could do it i'm going to add one of these cotton tip applicators to the sterile field and if i was doing it that way i would measure the wound after i had my gloves on
one i'm going to leave in here and i'll measure it before i put my sterile gloves on so besides measuring i'm going to irrigate the wound so i need my syringe when you're adding this use what we call the banana peel method right again i was talking about anything that's sterile any sterile package you need to open should have a way to open it cleanly so i'm going to peel it back now sometimes
you'll see nurses do this and kind of dump it in i don't recommend that especially when you're learning you have transfer forceps for a reason it makes it a lot easier to put your stuff in your sterile field right so i'm going to place it in and then i'm going to put my sterile my transfer forceps down paying attention to where they are that they're not in that one inch border then i need
a blunt needle or an angio cath so banana peel method watch where you're standing right i'm not too close nothing i'm not putting anything below my waist right i'm going to add it to my sterile field and then i'm going to place my transfer forceps down again i need my irrigation solution normal saline is normally what you would add if it's not if it's not a brand new bottle you need to do what we call
lipping it so i'm going to pour a little bit out and then i'm going to pour it into my sterile field you want it not too close right because i don't want to block my vision if the bottle is blocking my vision then it's technically out of my range of vision and contaminate it you also don't want it too high or it's going to splash all over and make sure you add enough right more you're better to have too much than too
little irrigation solution so i'm going to say that's enough for me i'm gonna put that to the side so then after i irrigate maybe i'm gonna dry the wound so i'm just gonna add a two by two and a four by four even though there's some in there so again paying attention to where this is i don't want to be touching my sterile feel so hold it far enough back that it doesn't contaminate your sterile field