00:04
Now before the irrigation step,
here's the key time
to assess the wound.
00:09
If indicated, we can measure
and document this appropriately.
00:13
Now before we start,
let's go ahead and put on our gloves
and prepare our irrigant fluid.
00:18
We want to take the irrigant and this could
be whatever is prescribed by the doctor.
00:22
Typically, it's going to be
normal saline that sterile,
we're going to pour this into
our irrigation container.
00:28
Now we're going to take
our catheter tip syringe
to withdraw the irrigation
fluid from the container.
00:35
We're going to take that
syringe and irrigate our wound.
00:38
Now if you take a look
at this image here,
notice that the tip of
that catheter syringe
or the tip of this syringe
is not touching the wound.
00:47
That's important.
00:48
Also, I just want you to keep in
mind when we irrigate the wound,
you want to go from
the clean areas,
which is typically going
to be the wound bed itself
to the dirty areas until
all the areas are cleansed.
01:01
Also just know when
you're using this syringe,
be gentle not a lot of force with the
catheter syringe or on the plunger.
01:09
Be gentle when you're
irrigating here.
01:12
And while we're irrigating,
we're going to allow all of that fluid
to be caught into the basin
that's below the wound.
01:20
Now, you may need to repeat this
step a couple of times if indicated,
then we can discard the syringe.
01:26
Now also just know around the site
because there's a lot of irrigant fluid,
it could be moist,
we can take our sterile gauze
and dry the patient's intact skin
and the skin around the wound.
01:38
If indicated, we may want to
put skin protected if ordered,
and apply the wound dressing
as ordered by the physician.
01:50
Okay, so now that I
performed my hand hygiene,
this is a great time
to assess the wound.
01:56
So a couple of things to know is
we want to look at the wound bed,
we want to look at the edge,
we also want to take a look
at the the skin around the
wound, that's also important.
02:08
The other thing to know
is that at this point,
depending on the order or if
you're tracking the wound,
many time we're going to
measure it at this point.
02:16
So I want you to
take a look here.
02:19
So because I'm going to measure,
I'm going to go ahead and put on my gloves.
02:26
In many times you have cotton tip
applicators that are sterile on your unit.
02:31
This is a great device to
use, because it's sterile.
02:36
Also, I want you to know that there
is a measuring guide on top of here,
so it makes it really easy.
02:42
Now sometimes there will be a
met just a separate paper tape
that's disposable that
your facility may have.
02:48
So you can grab that as well.
02:50
But if you can't find one, there's one
here on the cotton tip applicator for you.
02:55
So we go to measure a wound.
02:57
And I'll just quickly
talk about this.
03:00
We'll open this up,
we're typically going
to do the length
and this one's pretty long,
right, we're going to take this
and compare it here,
we're going to do the width.
03:12
And then we're going
to do the depth.
03:13
When you do the depth, you're going to
go to the deepest part of the wound.
03:18
Then we're going to see
what's flush on top of it.
03:20
Basically I'm going
to put my fingers
where the basically the where
opens on the skin surface here
and flush to the skin surface
and then compare it to my guide.
03:32
So when you're assessing the wound,
you would do for measurement,
you would do length,
width and depth.
03:38
Once we've done with this, we would note
our measurements and then document those.
03:43
Let me go ahead and
get rid of this.
03:46
So once I've done that, we can go ahead and
pour irrigant solution into the canister.
03:51
So I've got this really
handy irrigation tray here.
03:57
I'm going to move this
little bit out of the way.
04:03
So the nice thing is with this,
this has got a
container here for me
and my catheter syringes in
here to withdraw the fluid.
04:11
So I'm going to take
my sterile saline,
open this up.
04:18
Let me go ahead and pour
this into the container now.
04:28
Okay.
04:29
So then I could just
leave my syringe in here
and that way it keeps it
clean and it's handy for me.
04:37
Okay, so now that I've got this,
I've got my irrigant
fluid poured.
04:42
I'm going to take my catheter
tip syringe and pull up my fluid.
04:49
And as you can see here,
I have ample fluid for irrigation.
04:53
Now I'm not going
to show you today,
you kind of get the general gist but
we'll talk through the irrigation.
04:58
So when I'm irrigating, I'm going to
go the cleanest area to the dirty.
05:02
So typically, that's going to mean I'm
going to irrigate with a wound bed,
then we're going to go around.
05:08
Now here's a tip
when you irrigate is,
when I'm pushing
down on the plunger,
the faster I push down, the more force
that's going to go into that wound,
and that can be
really uncomfortable.
05:19
So a good tip is just
to gently push down
and see how the
patient tolerates that.
05:25
And again, you may have to
repeat this as necessary.
05:28
So again, using the syringe,
you're going to go the clean areas
to the dirty areas until
all of those are addressed.
05:34
So if I was using a basin, all of
that would fall under a basin -,
and again, you may need
to irrigate a few times.
05:42
So once I've done this,
I can discard my syringe,
then I'm going to take
my sterile saline,
or excuse me, my sterile gauze.
05:51
And because my wound
got a little bit wet,
we're going to take our gauze and
we're going to pat dry the skin.
05:58
What I don't want to do is scrub
because that could mess up
the integrity of the wound.
06:07
So I can take one, discard and
then just use as many as needed.
06:21
Now once I've dried all of this,
sometimes there may be a physician
order for certain skin protectant
that needs to go around
the skin of the whim.
06:29
So just keep that in mind.
06:31
Now once I've done irrigating,
this is just me,
it's just a great idea.
06:35
Since I've been kind of irrigating
and my gloves can get wet,
I'm going to go ahead
and change those now
and perform hand hygiene
and put on some new ones.
06:45
I like to do this because I'm
touching clean supplies now.
07:11
Okay, so I mean,
I take my dressing.
07:15
You're going to open this up.
07:17
And I'm using an ABD pad.
07:20
So when I open this up,
be conscious not to touch the inside of the
dressing and I'm going to put this flat.
07:29
So good thing here is once it's
covered, we're pretty safe.
07:33
So sometimes it's
hard to handle tape,
or things like that
or the dressing.
07:38
But as long as you're covered
here, we're good to go.
07:41
So one thing I want
you to talk about,
we love these ABD pads as nurses because
they're a little bit more absorbent,
and the blue line
goes to the sky.
07:54
And the more absorbent
piece is on the wound.
07:57
So just keep that
in mind with these.
07:59
These are called ABD pads.
08:01
And actually, in fact,
we do use these a lot for abdominal wounds
because they're much bigger,
and they're absorbent.
08:08
So once I've done this and I've
applied the wound dressing,
now's a good time to go
ahead and secure this.
08:15
So I can go ahead
and take my tape,
what we want to do is
a window type dressing.
08:19
So I'll show you how to do that.
08:24
So also just keep in mind that
when you are taping this down,
every patient has
different allergy.
08:32
So I'm using this,
this plastic tape.
08:35
If your patient has adhesive
allergies, note that as well.
08:38
There's different
options we can use.
08:41
So as you see when I'm doing the
window, I'm just tearing pieces
and truly going to each
side to enclose that.
08:49
Now clearly this is kind
of an odd shape wound.
08:51
You would have much more body
service to do on a patient
but the whole point is to make a
window with the dressing in the middle.
09:03
If you can minimize the amount
of tape on the patient's skin,
while also securing
it down is ideal.
09:11
You can imagine how much tape
can get on a patient's skin
when we keep having to
change the dressing.
09:22
Okay, so we would tape this
down in a window like fashion.
09:25
Again, you would go that bottom,
top, sides or whichever order
just to make a window here.
09:36
Now before you leave, don't forget like
we've seen earlier with the previous shift
to make sure that you initial,
then you're going to date and
you're going to time your dressing.
09:46
Because when the
new shift comes on,
then we'll know when the
last dressing was done.
09:56
Once we've completed irrigation,
we want to go ahead dispose
all of the soiled equipment.
10:01
Assist the patient back
into a comfortable position.
10:04
Place a bed to the lowest
position for safety.
10:07
Remove our gloves,
perform our hand hygiene.
10:11
And don't forget to
reassess the patient's pain.
10:14
That procedure, again, could be a
little uncomfortable for the patient.
10:17
So make sure you're reassess
and treat accordingly.
10:20
And of course,
don't forget to document.
10:23
Let's look at a few considerations
regarding wound irrigation.
10:27
So there's some possible
complications that can occur.
10:30
Anytime you expose the wound,
there's increased risk of infection.
10:34
And of course,
we talked about when you irrigate,
some of that forcing a
fluid inside the wound
can increase the level
of pain for your patient.
10:43
And don't forget to assess out that
skin that's surrounding the wound,
we call this Peri-wound and this can
be excoriated read and uncomfortable.
10:53
And again,
let's look at these points,
these considerations
that's really important
when you're talking
about wound care.
10:59
Now, irrigation
solutions are great,
but they're usually a
part of wound care orders.
11:04
Most of the time,
this is going to be sterile normal saline,
but make sure you assess, check your
physician's order, because this can vary.
11:13
Now, here's a really
important topic.
11:15
And sometimes this
gets students confused.
11:18
If we need to culture the world,
meaning that we get in there
and we take tissue and
we send it to the lab
and check to see if there's
any sort of infection going on
or if it's growing something
odd, we need to treat,
we actually want to cleanse the wound
first, and then get the culture.
11:36
That may seem kind of backwards.
11:38
But if you think about it,
if you've got an open wound,
sometimes there's some extra stuff
in the air or bacteria or microbes.
11:46
That's not what we want to test,
we want to test actually the wound bed.
11:51
So we want to cleanse
first, and then culture.
11:53
So don't forget that point.
11:55
Now, a few more points here,
and we've talked about this a little bit.
11:59
Wound care can be very painful.
12:01
So again, make sure you treat accordingly
and premedicate if you're able to.
12:06
So one of the last
considerations to keep in mind.
12:09
Some healthcare facilities have
an excellent wound care team.
12:12
These are nurses that have advanced
training in the treatment of wound care,
thank goodness for them.
12:19
But many times they're
going to be the ones
that track the progression
and the healing of the wound.
12:24
So because we don't want those wound
expose the air any more than we have to,
make sure you coordinate
with the wound care team.