00:04
Hey guys,
welcome to the scale,
How To Culture a Wound.
00:08
When we talk about culture,
all that means is we're
gathering a sample from the wound
that's either tissue
or drainage or exudate,
or even all of those things.
00:18
We're really just testing to see
if there's infectious organism
that's causing a delay
in our wound healing.
00:25
So how we start to culture
is the first thing we got to do
is check the providers order.
00:31
Just know there could be
some variation in order,
so you want to make sure
we start there first.
00:37
Now, here's the key thing,
anytime you go to expose
a wound bed to culture,
gather all your supplies first.
00:44
So you got to remember,
we want to clean the wound,
because we've got to clean
before we culture the wound bed,
get all your cleaning supplies,
get all of your supplies
for obtaining the specimen,
and also all the supplies you
need to redress the wound.
01:01
Once we've gathered
all of our supplies,
we'll enter a patient's room and of
course, provide privacy.
01:06
Now, it's really important
when we're culturing a wound,
that we get the right patient,
so confirm their identity.
01:13
We want to explain the
procedure to the patient
and put them in the optimal position
for us to gain our wound culture.
01:20
We can perform hand hygiene,
put on our gloves,
and with the old dressing,
make sure to remove that.
01:27
Then we're going to dispose
of our dirty gloves
and perform our hand hygiene.
01:32
Now is a good time to assess the
wound and surrounding tissue.
01:36
So we can go ahead and
arrange our supplies
on our sterile field and
get ready to culture.
01:41
We now want to put
on clean gloves
and this is the time we're going
to irrigate or cleanse the wound.
01:47
Most of the time, we're going
to use sterile saline solution.
01:51
So just remember,
anytime we culture a wound,
make sure we irrigate
or cleanse first,
then we culture.
01:59
Now that we've done this and
performed our irrigation,
we can remove our gloves
before more hand hygiene
and put on clean ones.
02:07
Now when we're collecting
the specimen itself,
we want to take the swab
in the wound and
gently rotate it
and this could be either a
sterile calcium alginate,
or rayon swab, for example.
02:20
And again,
we're taking that swab,
we're putting it
in the wound bed,
then we're going to swab the
wound from margin to margin
and like a 10-point
zigzag fashion.
02:32
So here's the thing
about culturing a wound,
not very fun for your patient,
this can be uncomfortable.
02:37
And many times when
you're swabbing the wound,
you need to put enough pressure
to express some of the
fluid in the wound bed.
02:45
And you can imagine that's
not very comfortable.
02:48
But that's important to make
sure we get all of the tissue,
the fluid and the exudate
for sampling and testing.
02:56
Now,
once we've cultured our wound,
we can take the swab and put
it in the culture medium.
03:02
So just know many times when
you use a wound culture,
there's the swab that comes with
and there's a
little bit of medium
that you stick it back
in to send it to lab.
03:12
Now when you send it to lab,
make sure you label it accordingly
to the facility's
policies and procedures
and send this off
as soon as possible.
03:21
Now that we've
cultured our wound,
we want to redress
it as ordered,
we can take off our gloves
and perform hand hygiene.
03:28
And of course,
make sure you document,
you're also going to document your
assessment findings of the wound
and the patient's response.
03:37
When we're talking
about culturing a wound,
here's a few points that you
want to make sure we do not do.
03:44
So you don't want to take
the specimen from the exudate
meaning just the
drainage itself,
or eschar of a wound.
03:52
When you hear the word eschar,
this is the black stuff that
setting inside the wound.
03:58
Many times we're not
getting to the wound itself.
04:01
So this is where we don't
want to take the specimen.
04:04
We also don't want to use
just the cotton tip swab.
04:07
There are special wound culture tubes
that we're going to use for this.
04:11
So make sure you check with
your facilities equipment.
04:14
Now it's also really
important here
that we don't
contaminate that swab.
04:20
We want to only make sure
we're getting in the wound bed.
04:23
And we don't want to let that
once we've cultured that swab
to touch my fingers or the bedside
table, for example,
because this will skew or
misinterpret our results.
04:34
And don't culture a dirty wound.
04:37
Just remember and this is one thing that
nursing students really struggle with,
make sure that you irrigate
or cleanse the wound first,
then you're going to
culture the wound.
04:47
So clean and then culture.
04:54
Hey guys, welcome to the live
demo of how to culture a wound.
04:58
So what I really mean by this
is taking a sample
of inside the wound,
we're usually doing this because
the wounds not looking too great.
05:07
There may be signs and
symptoms of infection.
05:09
And we're going to sample
this and send this off
to see what potentially could
be growing inside there.
05:15
So let's take a minute and
talk about our supplies,
we're going to need the
appropriate swab for example.
05:21
Now usually,
we're going to use something like this
called a calcium alginate swab.
05:27
But just know you may
want to triple check
with your lab
department to make sure
you have the appropriate
one for culture.
05:33
Also we're going to swab,
here's the kicker,
this is kind of
confusing for students,
but make sure that
you cleanse the wound.
05:43
And then culture,
I'm going to say it again,
cleanse the wound
and then culture
and you may be thinking, "Okay,
well, that kind of seems backwards?".
05:51
But just think about
all the extra debris
and maybe other microbes
that if we culture it,
we could pick up the wrong
stuff, right.
05:59
So we want to get
to the wound itself.
06:02
So make sure you when you go into
the room to collect your sample,
bring your irrigation supplies,
and obviously,
we're going to need to redress that wound.
06:10
So make sure you bring
those supplies as well.
06:13
Now to start off,
don't forget to review the
health care providers order
for obtaining the culture.
06:19
There could be some
variations here.
06:21
So pay close attention
before you go into the room.
06:24
And of course,
gather those supplies
to irrigate and
cleanse that wound,
obtaining your specimen so
that's usually your swab,
and also those to
redress the wound.
06:35
And obviously,
we're always going to provide
privacy for our patients.
06:39
Sometimes those wounds can be
on a lot of personal areas,
it could be on the patient's
buttocks, for example,
or their abdomen.
06:46
So make sure you
provide privacy for them
and confirm the
patient's identity.
06:52
I know we learn this out the
gate from nursing school but,
just think about it this way
that if we are sending off lab
or excuse me, a specimen,
we want to make sure it's
from the right patient.
07:05
So confirm the patient's identity
with your name and your date of birth,
your two patient identifiers.
07:11
Now you want to thoroughly explain
the procedure to the patient.
07:14
This sometimes can be a
little bit uncomfortable,
because we're working
in that wound.
07:19
So make sure you keep this
in mind with your patient.
07:22
Then once we're ready,
we need to position the patient
and drape if it's applicable.
07:26
So sometimes wounds are in different
spots on the patient's body.
07:30
So we want to position them in
the ultimate place to cleanse,
grab the culture and also to
change the dressing as well.
07:38
So now we can go ahead
perform our hand hygiene,
and then put on our gloves.
07:51
Okay, so once we've done this,
we're going to go ahead
and remove the dressing.
07:56
This is the old stuff here.
07:58
So we've got to get
to the wound itself.
08:00
Let me go ahead
and take this off.
08:03
And once I go ahead and
take off the old dressing,
this is when I'm going to dispose of
this soiled dressing and my soil gloves.
08:15
Okay, and I've got my trash can,
and I'm going to get rid of,
it's a great idea to
have that close by.
08:22
Now this is a great time
to go ahead and assess the wound
and the surrounding tissue.
08:27
More than likely we're
culturing the wound because
it's probably good chance
or something going on.
08:33
So make sure that you
assess this tissue as well.
08:37
So once we've done that,
we want to arrange our
supplies on our sterile field
to prepare to irrigate.
08:42
So here we would put
on our clean gloves,
and then we perform our irrigation
with our prescribed solution.
08:49
So just know it will
be per physician order,
but many times we're
going to cleanse the wound
with just a sterile
saline solution.
08:57
So guys, as nursing students,
I know we have lots of names for
things that makes it kind of confusing,
but if someone
says normal saline,
what we're really
talking about is
0.9 sodium chloride.
09:10
So I know that seems confusing,
but just know if you
hear normal saline,
we're talking about sterile
0.9% sodium chloride,
but again,
check your providers order.
09:22
So of course with irrigation,
we'll use our prescribed solution.
09:25
It's also a great idea to
have an irrigation tray
that has a container and also a
syringe to pull up the irrigant fluid.
09:34
Now once you've
irrigated your wound,
you're going to take
some sterile gauze
and just dab dry
around that wound.
09:41
We don't want to
leave that wound moist
and all that moisture
setting on the skin.
09:46
Now once we've completed
our irrigation,
we can remove our gloves
before our hand hygiene and
put on clean ones for the swab.
09:53
So, I'm going to do that now.
10:01
So once we put on our gloves,
and we're going to
collect our specimen.
10:05
So just remember to
double check yourself
that you're in the
right patient's room,
and the right name
and the date of birth,
and you're checking
those identifiers.
10:16
And next also really important,
we're using the right swab
for the right lab test.
10:21
So check that as well.
10:23
And again, your lab is a
great resource for that.
10:26
So I've got my swab here.
10:28
So I want you to
take a look at this,
make sure that this is in date,
that's the other thing,
we want an accurate result.
10:34
So make sure this
is not expired.
10:37
So when you open this up,
there's a little tab here
that's got a little blue,
typically a little cheat on where you're
going to open up that swab package.
10:49
And there's two components
typically with your swab.
10:53
So this is very important,
what I want you to see,
you will have the swab,
and then you're going to
have this other piece.
11:01
So what I like to do,
let me pull these out for you.
11:06
It's really important
that this swab
doesn't touch anything
else besides the wound,
this has to stay sterile,
we don't want it touching our
hands or the table, for example.
11:17
So just be really diligent
about keeping this away
of anything that
can contaminate it.
11:23
Now this is the medium
that it's going to go to.
11:25
And this is going to look
a little bit different
depending on each swab and
what your facility has.
11:30
So as you see here,
this is sealed.
11:32
So I'm going to take this,
crack that and just
pull this top off,
and I can just get rid of this.
11:39
So this swab is what
we're using for the wound
and it's going to go inside
the tube to be sent to the lab.
11:46
So now that I've got my swab,
we want to take this and gently
rotate this in the wound itself.
11:52
So many times we're going to get into the
deepest part of the wound to start,
I'm going to put this
in and gently rotate it.
12:00
Now as you can see here,
many times we've talked about earlier
about using a 10 point zigzag fashion
depends on the size of the
wound, right.
12:08
So really,
you just want to know,
you want to get
all in the wound,
you want to make sure that
you're actually depressing
and some of that fluid
and some of that exudate
and getting some of that
tissue from the wound,
all the good stuff,
if you will, get all of that.
12:25
Now once you've done that,
we're going to place this culture
swab in the meeting itself.
12:30
So if at all possible,
try to keep this
without touching the sides so you
don't lose all the good stuff.
12:37
Now, this is the hard part guys.
12:39
So we're going to see
if I get lucky.
12:48
Okay, so you see that was
a lot of concentration,
but if at all possible,
when you're grabbing this,
you want to do your best not to push all
of that stuff on the side of the tube,
you want to try to go straight
in as much as possible.
13:03
Now we can label it according to your
facility's policies and procedure
and send it to the lab
as soon as possible.
13:10
So I'm going to take this and I'm
going to send this off to our lab,
but I'll set it aside for now.
13:16
So once we've done that,
we want to make sure we of course,
don't leave our wound open.
13:20
So I'm going to
redress the wound.
13:27
And just depending on whatever use
make sure you have sterile gauze,
or I'm using an ABD pad here,
and I'm going to cover my wound,
and a lot of times I like to use
what we call a window tape method,
where I go around each corner
and we make a little window.
13:43
So we're going to
redress the wound.
13:45
And don't forget to
put your initials,
your date and your time so the next
shift knows when this was redressed.
13:53
Take off my gloves and
perform hand hygiene.
13:56
And don't forget to
document your procedure.
13:59
Whatever your assessment findings
were in the patient response.
14:02
Thanks for watching, guys.