Surgical Wound Management
When caring for a surgical wound, you carry out procedures that help prevent infection by stopping pathogens from entering the wound. Besides promoting patient comfort, such procedures protect the skin surface from maceration and excoriation caused by contact with irritating drainage. They also allow you to measure wound drainage to monitor fluid balance.
Dressing is the primary method used to manage a draining surgical wound. Lightly seeping wounds with drains and wounds with minimal purulent drainage can typically be managed with packing and gauze dressings. Some wounds, such as those that become chronic, may require an occlusive dressing. If your patient has a surgical wound, monitor him closely and choose the appropriate dressing.
Tailoring Wound Care to Wound Color
Promote healing in any wound by keeping it moist, clean, and free of debris. For open wounds, use wound color to guide the specific management approach and to assess how well the wound is healing.
Red Wounds
Red, the color of healthy granulation tissue, indicates normal healing. When a wound begins to heal, a layer of pale pink granulation tissue covers the wound bed. As this layer thickens, it becomes beefy red. Cover a red wound, keep it moist and clean, and protect it from trauma. Use a transparent dressing, hydrocolloid dressing, or gauze dressing moistened with sterile normal saline solution or impregnated with petroleum jelly or an antibiotic.
Yellow Wounds
Yellow is the color of exudate produced by microorganisms in an open wound. When a wound heals without complications, the immune system removes microorganisms. However, if there are too many microorganisms to remove, exudate accumulates and becomes visible. Exudate usually appears whitish yellow, creamy yellow, yellowish green, or beige. Dry exudate appears darker.
If your patient has a yellow wound, clean it and remove exudate, using irrigation; then cover it with a moist dressing. Use absorptive products or a moist gauze dressing with or without an antibiotic. You may also use hydrotherapy with whirlpool or high-pressure irrigation.
Black Wounds
Black, the least healthy color, signals necrosis. Dead, avascular tissue slows healing and provides a site for microorganisms to proliferate.
A black wound should be debrided. After removing dead tissue, apply a dressing to keep the wound moist and guard against external contamination. As ordered, use enzyme products, surgical debridement, hydrotherapy with whirlpool or irrigation, or a moist gauze dressing.
Multicolored Wounds
You may note two or even all three colors in a wound. In this case, classify the wound according to the least healthy color present. For example, if your patient’s wound is both red and yellow, classify it as a yellow wound.
Dressing a wound calls for sterile technique and sterile supplies to prevent contamination. You may use the color of the wound to help determine which type of dressing to apply. (See Tailoring wound care to wound color.)
Change the dressing frequently enough to keep the skin dry. Always follow standard precautions set by the Centers for Disease Control and Prevention.
Equipment
Waterproof trash bag ▪ gloves ▪ sterile gloves ▪ gown and face shield or goggles, if indicated ▪ sterile 4″ × 4″ gauze pads ▪ large absorbent dressings, if indicated ▪ sterile cotton-tipped applicators ▪ sterile dressing set ▪ povidone-iodine swabs ▪ topical medication, if ordered ▪ adhesive or other tape ▪ soap and water ▪ Optional: forceps; skin protectant; nonadherent pads; collodion spray or acetone-free adhesive remover; sterile normal saline solution; graduated container; prescribed irrigant and piston-style syringe; sterile scissors; Montgomery straps, fishnet tube elasticized dressing support, or T-binder.
Preparation of Equipment
Identify the patient’s allergies, especially to adhesive tape, povidone-iodine or other topical solutions, or medications. Gather all equipment in the patient’s room. Check the expiration date on each sterile package, and inspect for tears.
Open the waterproof trash bag, and place it near the patient’s bed. Position the bag to avoid reaching across the sterile field or the wound when disposing of soiled articles. Form a cuff by turning down the top of the trash bag to provide a wide opening and to prevent contamination of instruments or gloves by touching the bag’s edge.
Implementation
Check the doctor’s order for specific wound care and medication instructions.1
Note the location of surgical drains to avoid dislodging them during the procedure.
Confirm the patient’s identity using at least two patient identifiers according to your facility’s policy.2
Explain the procedure to the patient to allay his fears and ensure his cooperation.
Removing the Old Dressing
Provide privacy and position the patient, as necessary. To avoid chilling him, expose only the wound site.
Assess the patient’s condition.
Loosen the soiled dressing by holding the patient’s skin and pulling the tape or dressing toward the wound. This protects the newly formed tissue and prevents stress on the incision.
Moisten the tape with acetone-free adhesive remover, if necessary, to make the tape removal less painful (particularly if the skin is hairy). Don’t apply solvents to the incision because they could contaminate the wound.
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