Surgical dressing is a sterile protective covering, applied to a surgical wound/incision using aseptic techniques with or without medication.
Purposes
- To promote granulation and healing of surgical wound
- To prevent the entering and growth of
- microorganisms
- To apply medications
- To immobilize and support the wounds
- To remove dead tissues
- To minimize discomfort to the child who underwent surgery
Types of Surgical Dressing
Selection of surgical dressing is based on the site, size, condition, and type of the wound:
Dry dressings:
Tend to absorb wound moisture, for example, gauze bandages, membranes and foils, and foams. These dressings may tightly adhere to granulation and will break up during removal. Children also feel less discomfort.
Moisture keeping dressings:
These dressing help the wound to heal faster and do not breakup during removal, for example, pastes, creams, and ointments; hydrocolloids and hydrogels; and nonpermeable membranes or foils.
Bioactive dressings:
Enhance granulation tissue formation, reduce slough formation, and inhibit growth of microorganism there by promote wound healing, for example, antimicrobial and interactive dressings.
Skin substitutes:
These are heterogeneous type of wound coverings that help in closure of wound and replace the function of the skin as well, for example, epidermal substitutes, autologous and allogenous skin.
Commonly Used Dressing Materials
- Foams
- Gauzes
- Polymeric films
- Hydrocolloids
- Hydrogels
- Debriding agents
- Enzymatic dressings
- Human amniotic membrane
- Porcine skin
- Tulles: Light thin net-like gauze cloth impregnated with paraffin and antibiotics, which helps for nontraumatic removal.
Equipment Needed
A sterile tray containing:
- Small bowls-two
- Sterile glove-one pair
- Cotton swabs
- Artery forceps
- Dissecting forceps
- Scissor
- Gauze pieces and gauze pad
An unsterile tray containing:
- Adhesive tape
- Betadine solution
- Normal saline solution
- Kidney tray (small size) —one
- Medications as prescribed
- Mackintosh and towel
Preparation
- Explain the parents and the child about the procedure. Use dramatic play; use doctor and nurse toy kit to minimize anxiety.
- Provide comfortable position to the child.
- Arrange articles near the client.
Procedure
- Wash hands and wear gloves (surgical asepsis).
- Remove the old dressing and discard it in kidney tray.
- Observe the condition of wound.
- Take the cotton swab and soak swab with betadine solution.
- Clean the affected area from the center outward in a circular pattern.
- Clean only in circular pattern and do not use back and forth motion.
- When the betadine solution is dry, in about 30 seconds, use another cotton swab soaked in the normal saline solution and repeat the procedure, cleaning from center outward.
- Apply the medication ointment (if prescribed) using sterile cotton applicators.
- Pick up two outer corners of the sterile gauze with your fingers. (Do not touch the gauze anywhere else to avoid the contamination that may cause wound infection.)
- Apply adhesive tape all around edges of gauze to keep wound clean and dry.
Aftercare
- Discard the waste as per hospital policy of biomedical waste management.
- Clean and replace the articles.
- Perform hand hygiene.
- Document the procedure in nurses record with observation made:
- Condition of wound (color, any foul smelling, any discharge)
- Technique followed in dressing
- Solutions and medication used (if any)
Nursing Considerations in Surgical Dressing
- Follow strict aseptic technique.
- Wound cleansing should not be undertaken to remove normal exudates.
- Cleaning should be performed in a way that minimizes trauma to the wound
- Wounds are best cleaned with sterile isotonic saline or water.
- Fluids should be warmed to 37°C to support cellular activity.
- Skin and wound cleansers should have a neutral pH, if it is altered then resistance to bacteria decreases.
- Antiseptics are not routinely recommended for cleansing and should only be used sparingly for infected wounds.
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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