Dressing change, also known as dressing change, includes examining the wound, removing pus and secretions, cleaning the wound, and covering the dressing. It is an important surgical procedure for preventing and controlling wound infections, eliminating factors that hinder wound healing, and promoting wound healing.

1、 The purpose of dressing change is to observe the condition of the wound and make corresponding treatment;

Keep the wound clean, remove foreign objects, necrotic tissue, and drain secretions to ensure smooth drainage of pus;

Maintain and prevent wound damage and external infections.

Overall objective: To promote and promote tissue growth through the above three points; The ultimate goal of wound healing comparison.

Basic principle: aseptic principle!

2、 Indications for wound suture removal.

Loosen or remove the drainage material.

If there is bleeding or accumulation of blood, exudate, or pus in the wound that needs to be stopped or cleared.

The affected limb has tension blisters.

Loose or contaminated dressings.

After opening the dressing and observing the wound

3、 Prepare to fully understand the wound before changing dressing.

1. The location, size, and depth of the wound

2. The quantity of gauze filled in the wound cavity

3. Whether the drainage material is present, whether it is removed or replaced; Do we need to expand or flush the wound

4. Do you need to remove or sew the thread

Prepare the dressing change materials. A detailed understanding and adequate preparation should be made for the patient’s mental state, overall condition, and possible situations that may occur during the dressing change process.

Aseptic preparation:

When changing dressings, strict aseptic operation techniques should be mastered. If the dressing changer has come into contact with wound bandages and dressings, they should not come into contact with sterile equipment again. Adhere to the principle of sterile dressing before bacterial growth. Sterile wounds are disinfected from the inside out, while bacterial wounds are disinfected from the edge to the center. When changing the dressing, it is necessary to carefully observe the changes in the wound, such as the extent of redness and swelling, the amount and nature of exudate, the alignment of the wound edge, the presence of skin edge necrosis, and the condition of granulation on on the wound surface. Observe whether drainage is normal. For wounds with exudation, necessary observation and bacterial culture of secretions must be carried out. When there are drainage materials, it is necessary to verify whether the number of drainage materials is accurate. After changing each patient, wash your hands carefully before changing the dressing for another patient.

4、 The frequency of dressing change should be based on the principle that the dressing should be changed when it is wet and transparent.

1. Aseptic wound: First dressing change on the second day, if there are no abnormal signs, 3 days/time, can be used until the stitches are removed.

2. After skin grafting: 2-3 days for the first time, then 2-3 days per time.

3. Infected wound, change dressing at least once a day. Individuals with severe infections and excessive exudation can increase the frequency of infection as appropriate, even 4-5 times per day.

5、 Common drug selection

1. Iodine tincture (also known as iodine wine)

Preparation: Take potassium iodide, dissolve it in 20ml of water, add iodine and ethanol, stir to dissolve, and then add an appropriate amount of water to make 1000ml, which is the result.

Disinfection principle: Iodine in iodine wine can directly halogenate bacterial proteins and produce bactericidal effects. Its bactericidal effect is strong and fast, taking 1-2 minutes. The skin disinfection concentration is 2-3%, and the oral mucosal disinfection concentration is 0.5-1%.

Advantages: Iodine can kill bacteria, fungi, viruses, amoeba parasites, and even stubborn bacterial spores.

Disadvantages: Strong tissue penetration, high irritation to skin and mucous membranes, can burn the skin and mucous membranes, cause skin foaming and peeling after use, and cause severe pain when applied to damaged wounds. Therefore, iodine should not be directly applied to damaged wounds, as well as mucous membranes such as the mouth, nose, and vagina. Alcohol needs to be used for deiodination.

2. Alcohol

Disinfection principle: Absorb water from bacterial proteins, dehydrate, denature and solidify them, thereby achieving the goal of killing bacteria. Some people believe that the higher the alcohol concentration, the better the disinfection effect, which is incorrect. The function of alcohol disinfection is to coagulate the proteins in the bacterial body, thereby killing the bacteria. But 95% alcohol can quickly coagulate the protein on the surface of bacteria and form a protective film, preventing alcohol from entering the bacterial body, thus unable to completely kill the bacteria. If the alcohol concentration is below 70%, although it can enter the bacterial body, it cannot coagulate the protein in its body, nor can it completely kill the bacteria. Only 70% -75% alcohol can smoothly enter the bacterial body and effectively coagulate the protein in the bacterial body, thus completely killing the bacteria.

Alcohol can only kill bacteria, not spores and viruses

Application conditions: The epidermis is intact. If the epidermis is damaged, alcohol cannot be used, and iodine is generally used. The classic disinfection method is to use 2% iodine wine twice and alcohol three times for deiodination disinfection.

40% -50% alcohol is used to prevent pressure ulcers

25% -50% alcohol is used for physical cooling. The alcohol concentration used for bathing should not be too high, otherwise using high concentration alcohol on a large area can stimulate the skin and absorb a large amount of moisture from the epidermis.

3. Iodophor

Iodophor is an amorphous complex of elemental iodine and polyvinylpyrrolidone. Presents a purple black liquid. Medical iodine usually has a low concentration (1% or less) and appears light brown.

Disinfection principle: Utilizing the oxidation effect of iodine, its iodine is chelated iodine. After iodine is dried, it will form an oily thin film. Can kill bacterial propagules, spores, fungi, protozoa, and some viruses.

Advantages: Low irritation to mucous membranes, no need for ethanol deiodination, no corrosive effect, and low toxicity. Iodine is superior to iodine wine in terms of application scope (mucous membranes, skin, etc.) and disinfection effect (less allergic reactions).

Disadvantage: Poor permeability. Wounds with excessive bleeding and large wounds have poor effectiveness. Iodophor is a complex iodine that is ineffective or ineffective for oily wounds or areas with developed sebaceous glands. At this point, alcohol can be used as a substitute.

4. Medical 3% hydrogen peroxide

Principle: It is a strong oxidizing agent. When it encounters wounds, pus, or dirt on the skin, mouth, and mucous membranes, it immediately decomposes to produce oxygen. This type of oxygen atom, which has not yet been combined into an oxygen molecule, has strong oxidation ability. When in contact with bacteria, it can destroy the structure of bacterial proteins and DNA, and kill bacteria. After local application and washing, bubbles can be generated, which is beneficial for removing pus, blood clots, and necrotic tissue.

Application: The D value of a 3% solution for bacterial propagules (time required to kill 90%, minutes) is 0.3-4.0, for viruses it is 2.42, for fungi it is 4-18, and for bacterial spores it requires a large dose. The D value of a 25% concentration solution is 0.8-7.3. Due to its bactericidal effect on bacterial spores, it has a sterilization effect. Especially for anaerobic bacteria such as tetanus, it has a strong bactericidal effect.

5. Physiological saline

Rinse and wet compress the wound. It is generally used in mucous membranes with abundant blood supply, high wound secretions, low chance of infection, and sensitive sensation. Rinsing can remove some impurities and infections.

Studying moist wounds on the surface is beneficial for tissue growth, which is the main reason why we like to use saline gauze to cover wounds in our daily lives. At the same time, saline gauze also has the function of unobstructed drainage

6. Hypertonic saline solution

Reduce swelling. The purpose of hypertonic salt is to achieve local dehydration without healing the local swelling of the wound. High osmotic saline combined with Vaseline gauze can stimulate the growth of granulation, and is often used in clinical practice for wounds without primary closure or after thorough debridement of infected wounds.

The concentration should be at least 3% or above, and 5% is more effective.

7. Vaseline gauze (oil sand)

For open wounds with exudation

Due to its oily content, it can prevent adhesion between dressings and wounds

Has a drainage effect on exudation

Keep moist, promote granulation growth and wound healing

After skin grafting, protect the skin pieces that are not firmly growing from being peeled off. If the skin grafting area is packed and fixed, it should be replaced with the previous one within 3 days. The situation may vary in the future

8. Magnesium sulfate

Concentration of 50%, hypertonic solution.

External wet compress: can significantly reduce swelling and relieve pain. Can be used for swelling wounds, extravasation of fluids, and phlebitis caused by intravenous mannitol.

Volumetric diarrhea: Oral magnesium sulfate solution is not easily absorbed by the intestine and stays in the intestinal cavity, causing an increase in the osmotic pressure of the intestinal contents, preventing the absorption of water in the intestine, and attracting water from the tissue to the intestinal cavity, increasing the intestinal volume and stimulating the intestinal wall, reflexively increasing intestinal peristalsis and leading to diarrhea.

9. Acetic acid chlorhexidine (chlorhexidine acetate)

Pharmacology: This product is a cationic surfactant preservative. Its mechanism of action is to change the permeability of bacterial cell membranes. But it is ineffective against spores, viruses, and acid resistant bacteria.

Usage: Disinfectant and preservative, with strong broad-spectrum antibacterial and bactericidal effects, effective against both Gram positive and Gram negative bacteria. Used for disinfecting hands, instruments, wounds, and skin.

Advantages: Low irritation to skin and mucous membranes. Even in the presence of serum, blood, etc., it is still effective.

Usage: Soak continuously. Hand disinfection for 3 minutes. Open the wound for 10-15 minutes, depending on bleeding and contamination, or even longer

10. Other

In addition, there are also nitrofuran solution, gentamicin solution, and boric acid ointment