05 Checklists

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Chapter 5 Wound Care

Procedure 19 Changing A Clean Dressing

Procedure 20 Applying A Bandage

Procedure 21 Applying A Sterile Dressing

Procedure 22 Applying A Dressing Around A Drain

Procedure 23 Changing Wet-To-Dry Dressings

Procedure 24 Applying A Transparent Film Dressing

Procedure 25 Applying A Hydrocolloid Dressing

Procedure 26 Pin Care

Procedure 27 Removing Sutures

Procedure 28 Removing Staples


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Instructor Signature Date

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Student Signature Date

8. Pick up the gauze dressing, holding itonly by the corners.

9. Center the dressing over the wound.

10. Tape the dressing securely in place, orcover with a bandage (Procedure 20), asinstructed.

11. Perform your procedure completionactions.

Procedure Guidelines S/U Date Initials S/U Date Initials


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PERFORMANCE REVIEW CHECKLIST

Procedure 20

Applying A Bandage

Name of Patient Care Technician ________________________ Date of Program ______ to ______

Social Security Number or Identification Number _______________________________

Program Code Number (if any) _________________

S=Satisfactory PerformanceU=Unsatisfactory Performance

Place a full signature to correspond with each set of initials appearing below.

Initials Corresponding Signature of Instructor Title


1. After applying the dressing, apply thebandage. Most bandaging materials areconforming, self-adhering gauze. Brand

name products, such as Kling

and

Kerlix

, or generic products, such asconforming gauze, are commonly used inhealth care facilities.

2. The bandage must cover the dressingcompletely. Begin by holding thebandage in your dominant hand. Holdthe bandage against the skin with yournondominant thumb, approximately oneinch below the dressing.

3. Wrap the bandage around the extremitytwo or three times to hold it securely in

place.

4. Wrap the bandage from distal toproximal, in overlapping spiral turns.Each turn should overlap 12 to 34 of theprevious turn. The bandage should besnug so it does not fall off. However, itmust not be so tight that it restricts bloodflow.


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5. Wrap the bandage at least one inch abovethe top of the dressing. Wrap itcompletely around the extremity twice,then cut the end. Tape the end to the

bandage, not the skin.

6. Assess the circulation distal to thebandage to ensure that the circulation isadequate.




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Procedure 21

Applying A Sterile Dressing






Supplies needed:

1 pair disposable exam gloves 1 pair sterile gloves Cleansing solution Plastic bag for used supplies

Sterile gauze pads or other dressing Tape or bandage material



1. Perform your beginning procedureactions.

2. Holding gentle traction on the skin,loosen the tape by pulling the endstoward the wound, and then remove thedressing. Discard it in the plastic bag.

3. Cleanse and rinse the wound as ordered.If the wound appears abnormal orinfected, notify your supervisor.

4. Remove the gloves and discard in theplastic bag.

5. Wash your hands.


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6. Set up your sterile field and preparesterile dressing supplies. Arrange thefield so that you do not have to crossover it when reaching for supplies.

7. Cut the tape, if used. Place on the edgeof the overbed table, if permitted byyour facility policy.

8. Apply sterile gloves.

9. Pick up sterile dressings, holding themonly by the corners. Center them overthe wound.

10. Tape the dressing securely in place, orcover with a bandage (Procedure 20).You may remove your gloves to apply

the tape or bandage, if desired.




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3. Cleanse and rinse the skin surroundingthe incision, as ordered. If the woundappears abnormal or infected, notifyyour supervisor. Visually check the drain

to ensure that it is attached to the skinsecurely. Avoid disturbing the drain atthis time. Cleanse only the wound.


5. Wash your hands.

6. Set up your sterile field and preparesterile dressing supplies. Pour liquidsolution into the sterile basin, ifnecessary. Arrange the field so that youdo not have to cross over it whenreaching for supplies.



9. Cleanse the incision itself, as ordered.Use a sterile applicator or gauze sponge.Wipe from cleanest to less clean, in asingle downward stroke. Discard theapplicator or gauze sponge. If another is

needed, use a second applicator. Avoidcontaminating the solution with a usedapplicator.

10. Rinse the skin.

11. Pat dry with a gauze sponge, if necessary.

12. Cleanse the area surrounding the drain.Use a circular motion, beginning at thecenter and working outward. Handle thedrain as little as possible. Lift it using asterile applicator or your finger.

13. Apply at least two layers of pre-cut draingauze, or as ordered. Cover with twolayers of uncut gauze.

14. If your gloves are visibly contaminatedwith drainage, remove them, wash yourhands, and reapply new sterile glovesbefore proceeding.



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15. Pick up the sterile cover dressings byholding them only by the corners.Center them over the wound and drain,or dress each area separately, according

to location and physicians orders.

16. Tape the dressing securely in place.




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Procedure 23

Changing Wet-To-Dry Dressings






Supplies needed:

1 pair disposable exam gloves 1 pair sterile gloves Gown, mask, and eye protection if copious drainage or splashing of blood or body fluids is

anticipated

Plastic bag for used supplies Cleansing solution Sterile normal saline Small sterile bowl Sterile towel or drape Sterile gauze pads or other dressings Tape or bandage material




2. Holding gentle traction on the skin,loosen the tape by pulling the endstoward the wound, and then remove thedressing. The purpose of a wet-to-drydressing is to debride the skin. Thedressing will stick slightly. Remove itgently, but do not moisten the dressingwith saline to facilitate removal, if youcan avoid it. Discard the used dressing inthe plastic bag.


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3. Cleanse and rinse the area, as ordered. Ifthe wound appears abnormal orinfected, notify your supervisor.


5. Wash your hands.

6. Set up your sterile field and preparesterile dressing supplies. Pour liquidsolution into the sterile basin, ifnecessary. Arrange the field so that youdo not have to cross over it whenreaching for supplies.

7. Place sterile gauze sponges in the basinand pour sterile normal saline over

them. The gauze may be packaged in aplastic tray. The inside of the tray issterile, and saline may be poured intothis container, if desired.



10. Cleanse the incision itself, as ordered.Use a sterile applicator or gauze sponge.Wipe from cleanest to less clean, in a

single downward stroke. Discard theapplicator or gauze sponge. If another isneeded, use a second applicator. Avoidcontaminating the solution with a usedapplicator.

11. Pick up the moist gauze sponges, one ata time. Squeeze them so they are dampand not dripping. Open and unfold thedressings. Avoid touching other surfacesor the patients skin when opening thegauze sponges. Place the dressings overthe wound. Cover the wound

completely.

12. Pick up the sterile cover dressings,holding them only by the corners. Coverthe damp dressings and woundcompletely.

13. Tape the dressing securely in place.




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Procedure 24

Applying A Transparent Film Dressing






Supplies needed:

2 pairs disposable exam gloves Normal saline or cleansing solution Sterile gauze sponges Transparent dressing

Plastic bag for used supplies




2. If placing the dressing for the first time,shaving the hair may be necessary.Check with your supervisor. Remove oilfrom skin surrounding the wound, ifpresent, with alcohol. Avoid contactingan open wound with alcohol. Allow to

dry.

3. Apply disposable exam gloves.


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4. Holding gentle traction on the skin,press down on the skin, then loosen theadhesive in one corner, and remove thedressing by peeling it back. Stretch the

dressing horizontally, gently lifting itover the open area. The stretching helpsto break the adhesive bond. Alwaysremove the dressing by pulling in thedirection of hair growth. If the skin isnot hairy, the corners on opposite sidesof the dressing can be lifted. Stretch thedressing from the edges toward thecenter and lift off. Discard in plastic bag.

5. Cleanse the wound with normal salineor skin cleansing solution, as ordered.Rinse.

6. Pat the skin dry with sterile gauzesponges.

7. Remove gloves and discard in plasticbag.

8. Wash your hands.

9. Open the package by peeling the tabsback, and remove the dressing.

10. Grasp the tabs on the underside of thedressing, and peel them back

approximately one inch.11. Center the dressing over the wound,

then gently lower it, smoothing thecenter portion in place.

12. Peel away the backing paper slowly fromone side at a time, while gentlysmoothing the film in place. Gentlysmooth out wrinkles as you go.

13. Perform your procedure completionactions



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Procedure 25

Applying A Hydrocolloid Dressing






Supplies needed:

2 pairs disposable exam gloves Normal saline or cleansing solution Sterile gauze sponges Hydrocolloid dressing

Adhesive or other bandage tape Plastic bag for used supplies




2. If placing the dressing for the first time,shaving the hair may be necessary.Check with your supervisor. Remove oilfrom skin surrounding the wound, ifpresent, with alcohol. Avoid contacting

an open wound with alcohol. Allow todry.

3. Apply disposable exam gloves.


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4. Holding gentle traction on the skin,press down on the skin, loosening theadhesive in one corner. Continuepressing and lifting around the edges of

the dressing until all are loose. Carefullypeel back the remainder of the dressing,in the direction of hair growth. Discardin plastic bag.

5. Cleanse the wound with normal salineor skin cleansing solution, as ordered.Rinse.

6. Pat the skin dry with sterile gauzesponges.

7. Remove gloves and discard in plasticbag.

8. Wash your hands.

9. Open the package by peeling the tabsback, and remove the dressing.

10. Separate the backing paper on the backside of the dressing. Peel backapproximately one inch.

11. Center the dressing over the wound,then gently lower it, smoothing thecenter portion in place.

12. Peel away the backing paper slowly fromone side at a time, while gentlysmoothing the dressing in place. Gentlysmooth out wrinkles as you go.

13. Place the palm of your hand over thedressing and hold for 30 to 45 seconds.This warms the dressing, promotingadherence.

14. Tape the edges, if necessary.

15. Perform your procedure completionactions



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Procedure 26

Pin Care






Supplies needed:

Sterile gloves Sterile normal saline or prescribed cleansing solution Sterile applicators Sterile gauze dressings, if ordered

Plastic bag for used supplies




2. Moisten an applicator with normal salineor prescribed cleansing solution.

3. Beginning with the skin closest to theinsertion site, wipe the skin in a circlearound the pin. Discard the applicator.

4. With a second moistened applicator,wipe the skin around the pin in a secondcircle, working outward from the pininsertion site. Discard the applicator.

5. Continue wiping outward, using oneapplicator for each circle, until you havecleansed a 112-inch area surrounding theinsertion site. Use each applicator for onecircle only. Avoid contaminating thecleansing solution with used applicators.


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6. Apply sterile dressings as ordered. Ahealed pin insertion site may be left opento the air.




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Procedure 27

Removing Sutures






Supplies needed:

Suture removal kit or sterile suture removal scissors and sterile forceps Sterile normal saline solution or other cleansing agent Sterile gauze for wound cleansing and removing sutures from forceps Sterile dressings as necessary for covering the wound after suture removal

Disposable exam gloves Sterile gloves

Butterfly bandage, steri-strips, or other skin adhesive, as needed Plastic bag for used supplies




2. Open the suture removal kit and set updressing supplies.

3. Apply exam gloves.

4. Remove the dressing and discard inplastic bag.

5. Remove the gloves and discard in plasticbag.

6. Wash your hands.



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8. Cleanse the incision line with normalsaline or prescribed cleansing solution.

9. Remove every other suture by lifting the

suture up, away from the skin, with thetweezers. Cut the suture close to theskin.

10. With the tweezers, lift the suture up bythe knot, and pull it through the skin inone piece.

11. Discard used sutures on a gauze pad.Then discard all the sutures and the padin plastic bag after all sutures areremoved.

12. Remove every other suture. Evaluate the

skin to determine if the edges areseparating. If so, notify the nurse beforeproceeding. If the skin separates at anytime during the procedure, notify thenurse.

13. Cleanse the skin with the skin cleanser,allowing it to dry.

14. Apply a butterfly or steri-strip to theskin where each suture was removed.

15. Remove remaining sutures.

16. Apply a butterfly or steri-strip to theskin where each suture was removed.

17. Dress the wound as ordered.




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Procedure 28

Removing Staples






Supplies needed:

Staple removal kit or sterile staple extractor Sterile normal saline solution or other cleansing agent Sterile gauze for wound cleansing and removing sutures from forceps Sterile dressings as necessary for covering the wound after suture removal

Disposable exam gloves Sterile gloves

Butterfly bandage, steri-strips or other skin adhesive, as needed Plastic bag for used supplies




2. Open the staple removal kit and set updressing supplies.

3. Apply exam gloves.

4. Remove the dressing and discard inplastic bag.

5. Remove the gloves and discard in plasticbag.

6. Wash your hands.



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8. Cleanse the incision line with normalsaline or prescribed cleansing solution.

9. Slide the staple remover under the

staple. Squeeze the handles. Gently liftthe staple out.

10. Discard used staples on a gauze pad,then discard all the staples and the padin plastic bag after all staples areremoved.

11. Remove every other staple. Evaluate theskin to determine if the edges areseparating. If so, notify the nurse beforeproceeding. If the skin separates at anytime during the procedure, notify thenurse.

12. Cleanse the skin with the skin cleanser,allowing it to dry.

13. Apply a butterfly or steri-strip to theskin where each staple was removed.

14. Remove remaining staples.

15. Apply a butterfly or steri-strip to theskin where the remaining staples wereremoved.

16. Dress the wound as ordered.



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