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Pressure Ulcers-Preparing & Changing Dressings
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Getting Started
  • Organize and set up the equipment you will need before removing your old dressing.
  • Line up the equipment in the order you will need it on a bedside table, bathroom counter or other clean surface. You may want to wipe the surface off with a disinfectant product before you begin or cover it with a sterile towel.
  • Products you may need for your dressing change include:

     ·non-sterile gloves
     ·sterile gloves
     ·masks
     ·disinfectant
     ·alcohol-free hand rinse
     ·underpads
     ·gowns
     ·aprons
     ·goggles
     ·red trash bag
     ·saline or wound cleanser
     ·primary dressings
     ·secondary dressings
Hand Protection and Disinfecting

Hands should always be washed and dried before AND after performing wound care - even if you are using gloves. Washing hands thoroughly for at least 30 seconds with soap and running water is the MOST important infection control measure you can take to prevent infection and contamination. If running water is not available, consider using an alcohol hand rinse.
 
If you are reusing some of your wound care products, such as basins or syringes, disinfect these products after each use with an all purpose disinfectant.

Measuring Your Ulcer
Measuring the wound on a regular basis is very important. It is a way for you, your caregiver and your healthcare professional to assess the healing progress. The wound will get shallower and smaller in length and width as it heals.
 
Dr. Kenneth Dolynchuk reminds us, "Measurement should be documented in writing at least once a week by the nurse, physician, caregiver or by you.

Measurements can be used to alert your wound care team to delays in wound healing. Measurements are needed for reimbursement by Third Party Payors."

Looking at the wound and just "guesstimating" changes over time is not precise. It is best to measure once a week and write the numbers down!

Cleansing the Pressure Ulcer
Saline (distilled water and salt) is considered by most wound experts to be the best cleansing solution for most wounds. Saline is natural - which means it is exactly the same percentage of water with salt (0.9%) as are in the body fluids. Saline is not toxic to the body cells that are needed for healing. How much solution you use is dependent on the size of the wound and if it is infected or draining. Some antiseptics and skin cleansers are toxic and should not be used for wound cleansing.

Note: A prescription is required in the United States for the direct sale of sterile saline to patients (but not to healthcare professionals or healthcare facilities).

Use enough solution (4 oz.) per dressing change is important if you want to thoroughly cleanse the ulcer of foreign material. Be gentle: if cleansing or irrigation is too strong, you can damage healing tissues!! Your healthcare professional may also suggest that you wear protective devices (like gowns, goggles or aprons).

Caring for the Skin Around the Pressure Ulcer
  • After showering or bathing, pat (don't rub) the skin dry with a soft towel and moisturize with a lotion or cream.
  • Keep the skin dry, especially between skin folds, creases and the webs of the toes.
  • Your healthcare professional may recommend cornstarch to absorb moisture in skin folds, creases and toe webs.
  • Short chain fatty acid powders may be used to prevent fungus growth.
  • Powders can be applied to the feet prior to putting on socks and shoes or used in the groin or axilla (arm pit). Applying powders with a cotton ball prevents caking or clumping.
Changing Dressings
It is important to choose the right dressing for a wound. Many factors have to be taken into consideration:
  • the amount of moisture in the wound
  • the amount of drainage or pus
  • the condition of the skin around the wound
  • the location of the wound
Your healthcare professional will help you choose a dressing. As the wound changes, the type or size of the dressing may change. So don't be surprised if the wound care plans change. Consider ordering approximately enough dressings and supplies for 4 weeks of care.

If the person is incontinent (have a loss of bladder or bowel control), your healthcare professional may recommend an occlusive or semi-occlusive, protective dressing that adheres tightly to the skin and can prevent the wound from getting contaminated. Examples include:

 ·hydrocolloid dressings
 ·transparent film dressings