Definition
Cleaning a burn wound with normal saline using aseptic technique for removal of exudates and applying antibacterial agent.
Purposes
- To enhance wound healing.
- To prevent complications
- To perform wound debridement.
Articles
Dressing trolley with:
- Dressing pack
- Sterile bandages in a bin.
- Sterile dressing pads in a bin.
- Sterile Vaseline gauze.
- Silver sulfadiazine 1%.
- Sterile normal saline.
- Cheatle forceps
- Adhesive tape and scissors.
- Sterile scissors.
- Receptacle for waste
- Sterile sheet.
Types of Wound Dressing
- Open dressing
- Closed dressing
Open Method
The antimicrobial cream is applied with a gloved hand and the wound is left open to the air without gauze dressing. The cream is reapplied as needed.
Advantages
- Increased visibility of the wound.
- Freedom for joint mobility
Disadvantage
Increased chance of hypothermia
Closed Method
In closed method, gauze dressing is impregnated with antimicrobial cream anal applied to the wound
Advantages
- Decrease in evaporative fluid and heat loss from wound surface.
- Gauze dressing aids in debridement.
Disadvantages
- Mobility limitations
- Wound assessment is limited.
Procedure
| Nursing action | Rationale | |
| 1 | Before procedure Explain procedure to patient. | Helps in obtaining cooperation of patient |
| 2 | Administer analgesics about 20 minutes before procedure as per physician’s order | Minimizes pain during dressing. |
| 3 | During procedure Soak previous dressing with normal saline and remove. | Moistening adherent dressing reduces discomfort when removed. |
| 4 | Provide hydrotherapy/shower bath. | Helps for cleansing of wound. |
| 5 | Regulate the temperature of the room at 24°C (80°F) and humidity at 40-50% using portable humidifiers if available. | |
| 6 | Put on mask and cap. | |
| 7 | Scrub hands and don sterile gown and gloves. | Prevents transmission of microorganisms. |
| 8 | Clean and debride the wound using sterile scissors and forceps. Trim loose eschar and separate devitalized skin. | Prevents transmission of microorganisms. |
| 9 | Clean the wound with normal saline and pat dry | |
| 10 | Inspect wound and surrounding area. | |
| 11 | Apply topical medications over the wound. | |
| 12 | If closed method is used for dressing, cover the wound with Vaseline gauze and place sterile dressing pad. | |
| 13 | Apply bandage over the dressing pad. | |
| 14 | After procedure Wash reusable articles to be sent for autoclaving | Autoclaving destroys microorganisms and spores. |
| 15 | Discard gloves and gown and wash hands. | |
| 16 | Record procedure and note the odor, color, size, amount of exudate, signs of epithelialization and any change from previous dressing | Gives information about the patient’s response and wound healing |
Topical Antimicrobial Agents Used For Burn Wounds
- Silver sulfadiazine 1%
- Mafenide acetate 10%cream or 5% solution
- Silver nitrate 0.5% solution.
- Povidone – iodine
| ANTIMICROBIAL AGENTS USED IN BURNS. | ||||
| Topical agent | Description and indications | disadvantages | Nursing implications | |
| 1 | Silver sulfadiazine 1% | A white crystalline, highly Insoluble opaque, odorless water-soluble cream. Exerts antimicrobial effect at level of cell membrane and cell wall against gram negative and grans-positive bacteria and yeast. | May Increase possibility of kernicterus. Not to the used by pregnant women in last Trimester of pregnancy. Exposure to sunlight produces gray discoloration Transient leukopenia can occur. | Use with either open treatment, light or occlusive dressing. Apply with sterile gloved hand directly to wound or apply to gauze dressing 0.16 cm thickness, once or twice daily after thorough wound cleaning. silver sulfadiazine will be discontinued if WBCs are less than 1,500 in an adult or less than 2,000 In a child. WBC, count usually recovers in 2-4 days and application may be resumed |
| 2 | Mafenide acetate 10%cream. | Usually supplied in water miscible hydroscopic cream base. Active against most Gram-positive organisms. Active against common Gram-negative organisms which infect burn wound but has less fungal activity. Hemolytic anemia is a ram complication. | Painful during and for a while after application. A potent carbonic anhydrase inhibitors in metabolic acidosis therefore ne used in 20% total burns surface area or more. Brisk alkaline diuresis and polyuria may result when used in patients with large burn surface area. | Cream is applied with/without dressing. If possible, it must be reapplied every 12 hours for therapeutic effectiveness. Therapeutic solution concentration is maintained with bulky wet dressing. |
| 3 | Silver nitrate 0.5% solution | Clear solution with low toxicity and significant antimicrobial effect against common burn wound pathogens Nonallergic and not usually painful on application.Best used as prophylaxis against infection | Can cause electrolyte depleting abnormal serum sodium, chloride potassium and magnesium. Stains normal skin brown or black | Monitor electrolyte balance carefully supplementation with potassium and sodium salt is routinely needed for patients with extensive burns. Use bulky dressings, rewet every 2-4 hours to maintain therapeutic concentration. Maintain patient warm and minimize transient evaporative waster loss with dry top layer, such as stockinette or bath blanket |
REFERENCES
- Annamma Jacob, Rekha, Jhadav Sonali Tarachand: Clinical Nursing Procedures: The Art of Nursing Practice, 5th Edition, March 2023, Jaypee Publishers, ISBN-13: 978-9356961845 ISBN-10: 9356961840
- Omayalachi CON, Manual of Nursing Procedures and Practice, Vol 1, 3 Edition 2023, Published by Wolters Kluwer’s, ISBN: 978-9393553294
- Sandra Nettina, Lippincott Manual of Nursing Practice, 11th Edition, January 2019, Published by Wolters Kluwers, ISBN-13:978-9388313285
- Adrianne Dill Linton, Medical-Surgical Nursing, 8th Edition, 2023, Elsevier Publications, ISBN: 978-0323826716
- Donna Ignatavicius, Medical-Surgical Nursing: Concepts for Clinical Judgment and Collaborative Care, 11th Edition ,2024, Elsevier Publications, ISBN: 978-0323878265
- Lewis’s Medical-Surgical Nursing, 12th Edition,2024, Elsevier Publications, ISBN: 978-0323789615
- AACN Essentials of Critical Care Nursing, 5th Ed. Sarah. Delgado, 2023, Published by American Association of Critical-Care Nurses ISBN: 978-1264269884
- Ernstmeyer K, Christman E, editors. Nursing Fundamentals [Internet]. 2nd edition. Eau Claire (WI): Chippewa Valley Technical College; 2024. PART IV, NURSING PROCESS. Available from: https://www.ncbi.nlm.nih.gov/books/NBK610818/
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