Simple Dsg & Complex Dsg & Surgical Asepsis/Sterile Technique

  1. What is the purpose of simple dsg?
    • Protect wound from mechanical injury
    • Protect wound from microbial contamination
  2. What should dsg be?
    • Conform to the body
    • Durable yet flexible- don't restrict ROM, how much tape, how do we secure?
    • Absorb or contain exudate
    • Cost effective
    • Easily removed without damage to healing surface
    • Different dsg types depending on wound and goal of wound management
  3. Dry sterile dsg heals by...
    primary intention
  4. What does sterile dsg protect?
    Protects wounds from injury
  5. What does sterile dsg prevent?
    Prevents introduction of bacteria
  6. Dry sterile dsg reduces...
  7. What kind of dsg speeds up healing?
    Dry sterile dsg
  8. Complex dsg heals by...
    secondary and tertiary healing
  9. Which pts are at risk for latex allergies?
    • pts with congenital or urinary defects
    • repeated catherizations or surgeries
    • history of condom catheters
    • multiple childhood surgeries
    • certain food allergies: bananas, tomatoes, potatoes, avocadoes, kiwis
  10. What is the first thing we do before dsg change?
    Assess pt's comfort (ex. BRP, premedicate for pain)
  11. List the steps to dsg change.
    • Assess pt's comfort
    • Explain procedure to pt
    • Ensure privacy
    • Position pt for procedure in comfortable position
    • Obtain supplies
  12. This is known as "clean technique", reduces number of pathogens, used for meds, enemas, tube feedings, daily hygiene, handwashing is #1...this known as?
    Medical Asepsis
  13. This eliminates ALL pathogens, known as "sterile technique", used for dsg change, catherizations, surgical procedures. What is this known as?
    Surgical Asepsis
  14. How long does a bottle of saline last? What should we always do with an open bottle?
    • Q24h
    • Date and initial
  15. What should we do when preparing a sterile field?
    Clean over bed table. Make sure it's dry, clean, flat
  16. For Validation what equipment do we need for dry sterile dsg?
    • Clean gloves
    • Sterile gloves
    • 2 packages of 4x4
    • Normal saline
    • Tape
    • Plastic bag for trash
  17. How do we remove the tape from the dsg of the wound? Once we remove tape what should we do?
    Pulling toward dsg using counter pressure, and assess the tape sites
  18. What do we look for when assessing the wound?
    • Appearance
    • Size
    • Drainage
    • Swelling
    • Pain
    • Status of any drains or tubes
  19. How do we clean surgical wounds?
    • Start at cleanest area to dirtiest.
    • Top to bottom
    • Inside to outside
    • Each stroke is a new gauze
  20. When taping a dsg over a joint what do we do?
    Place the tape over the joint at a right angle to the direction the joint moves.
  21. Simple dsg are for...
    Surgical or approximated wounds
  22. What are the purposes behind complex dsg?
    • Provide and maintain moist wound healing
    • Provide thermal insulation
    • Absorb drainage or debride a wound or both
    • Prevent hemorrhage (when applied as a pressure dsg or with elastic bandage)
    • To splint or immobilize the wound site and thereby facilitate healing and prevent injury
  23. Why can't we delegate dsg change to a CNA?
    RNs assess
  24. What are the goals of complex dsg?
    • Removal of necrotic tissue
    • Absorption of exudate
    • Prevention or elimination of infection
    • Provide a moist environment for healing
    • Protect from further injury
    • Protect surrounding tissue
  25. What do we assess when changing a complex dsg?
    • Wound depth
    • Wound size
    • Wound bed (eschar or slough vs. granulation tissue)
    • Drainage characteristics
    • Signs of infection
  26. Assessment acronym
    • A Anatomic location
    • S size, shape
    • S stage
    • E exudate
    • S surrounding skin
    • S sinus tract, tunneling
    • M margins
    • E edges
    • N nose (odor- indicates infection)
    • T tissue
  27. What are the risk factors for infection?
    • wounds with dead tissue
    • wounds with decreased blood supply (comorbidity, pressure ulcer, peripheral artery disease)
    • foreign bodies in or near wound
    • anatomically at risk for contamination (bowel surgery)
  28. How do we choose our supplies for a complex dsg?
    • Expected amt and type of drainage
    • Goal of wound management (debridement, protection, pressure)
    • Dry sterile dsg vs. Moisture retention
  29. Moisture Retention used for...
    open clean wounds to promote granulation tissue
  30. What is the job of the wound care team?
    • Improve pt outcomes for chronic wounds
    • decrease cost of supplies
    • decrease number of nursing visits
    • early identification of pt needs
    • facilitates continuity of pt care
    • resource for EBN related to wound care
    • EXPERTS!
  31. What kind of dsg is used for debridement?
    Wet to dry dsg
  32. This dsg is moistened with normal saline, antiseptic, or antibacterial solution
    Wet to Dry dsg
  33. This dsg absorbs exudate and debris as it dries
    Wet to dry
  34. Do not moisten this dsg to remove.
    Wet to Dry dsg
  35. This dsg requires frequent dsg changes, usually every 6 hrs
    Wet to Dry
  36. This dsg is used when wound bed is clean and ready for healing
    Wet to Damp
  37. This dsg protects fragile granulation.
    Wet to Damp
  38. Moisten this dsg before removing if gauze adheres to wound bed
    Wet to Damp
  39. This dsg is used when the wound bed is clean and ready for healing
    Wet to Damp
  40. When packing a wound what do we do first?
    Moisten packing material with noncytotoxic solution (normal saline)
  41. What do we use to pack a wound?
    Fluffed gauze or ribbon gauze
  42. How do we pack the wound?
    • Hold packing material in non-dominate hand and feed into wound with dominate hand or instrument
    • Loosely pack in contact with all surfaces, no dead spaces
    • No moist gauze in contact with intact skin
    • Use Q-tip or instrument to pack small areas
    • Never pack the wound higher than the wound surface
    • Cover moist packing with dry gauze and ABD pad
  43. What should we remember to not do while packing the wound?
    Do not touch surrounding skin with sterile packing as it is fed into the wound
  44. Where do we use Montgomery straps? When?
    • Large abdominal area, thighs, back
    • For frequent dsg changes
  45. "Pen rose drain" uses...
    pre-cut gauze pads
  46. This specializes dsg is used for non-infected partial and full thickness wounds
    Hydrogels (ex. Vigilon, Aquasorb)
  47. This specialized dsg is for dry to minimal exudate.
    Hydrogels like Vigilon, Aquasorb
  48. This specialized dsg absorbs exudate
    Alginates like Sorbsan, Algiderm
  49. This specialized dsg is used for partial thickness wounds
    Transparent like Op-site, Tegaderm
  50. This specialized dsg is for autolytic debridement of eschar, used for partial and full thickness wounds
    Hydrocolloids like Duoderm
  51. This specialized dsg is for absorption of minimal to moderate exudate
    Hydrocolloids like Duoderm
  52. Wound irrigation is effective for...
    • wound cleansing
    • treatment for prevention of wound infection
  53. What kind of syringe and gauge do we use for wound irrigation? why?
    • 35mL/19 gauge needle or angiocath
    • Delivers between 4 and 15 PSI
  54. What do we do prior to obtaining a wound culture? Do we need sterile technique?
    • Cleansing the wound
    • No sterile technique
  55. What do we document for complex dsg?
    • Specific date assessed
    • Drainage
    • Size
    • Depth
    • Undermining or tunneling
    • Wound bed: red, yellow, black?
    • Surrounding tissue appearance
    • Treatment
    • pt response to dsg change
  56. Surgical Asepsis is also known as...
    • Sterile technique
    • Aseptic technique
  57. Where is sterile technique commonly practiced?
    OR, L&D, major diagnostic or procedural areas, also by bedside (Foley, dsg change)
  58. Sterile technique is also used during intentional perforation of skin like...
    Injections or IV catheters
  59. Sterile technique is used when skin integrity is broken through...
    • trauma
    • surgical incison
    • burns
  60. Sterile technique is used during procedures that involve insertion of...
    catheters or instruments into sterile body cavities like urinary catheter (bladder is sterile) or laparoscopy
  61. What are some principles of surgical asepsis?
    • Sterile object ONLY touches another sterile object
    • If sterile object or sterile field is out of range of vision or held below waist then it is contaminated
    • Never cough, sneeze, or laugh over sterile field
    • Never reach over a sterile field, go around
    • Never leave or turn your back on sterile field
    • Do not open packages over sterile field
    • If field becomes wet= contaminated
    • 1" border of sterile field is considered contaminated
  62. "Strike through"
    when sterile field becomes contaminated, liquid will "wick" up to sterile field (wicking)
Card Set
Simple Dsg & Complex Dsg & Surgical Asepsis/Sterile Technique
How to apply a simple dsg and complex dsg