Notes
- Remove old dressing using nonsterile gloves:
- Pull tape toward incision, parallel to skin.
- Be careful not to dislodge drainage tubes or sutures.
- Assess condition and appearance of wound including size, color, and presence of exudate, odor, ecchymosis, or induration. (See Wound Assessment.)
- Discard gloves and wash hands.
- Using sterile technique, don face mask and sterile gloves, open supplies, set up a sterile field, and fill sterile containers with prescribed solutions.
- Cleanse wound with prescribed solution:
- Start from area of least contamination—cleanse toward area of most contamination (use separate swabs).
- Cleanse outward using circular motion around drains.
- Apply antiseptic/medicated ointments as prescribed.
- Apply prescribed dressing (see Dressing Types):
- Cut dressings to fit around drain if present (use sterile scissors).
- Reinforce with thick cover dressing (ABD or Surgipad).
- Secure dressing with 2-in. tape, rolled gauze, or use Montgomery ties for frequent (every 4–6 hr) dressing changes.
- Record date and time on paper tape and secure to dressing.