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UNIT 4 Supporting Physiological Functioning
Procedure 32-1 ■ Obtaining a Wound Culture by Swab (continued)
is nonviable and inhibits healing. Only red granulating tissue should be swabbed for a culture. ■ Assess the type and amount of exudate. Exudate may be a sign of infection. ■ Assess the wound for odor. A foul odor may indicate infection. Cleanse wounds before you assess for odor because some dressings interact with wound drain- age to produce an odor. ■ Assess the tissue surrounding the wound edge. Surrounding tissue that is red, warm, and/or edematous may indi- cate infection.
■ Determine whether the wound requires sterile, modified sterile, or clean technique. Sterile technique is used for acute surgical wounds and for wounds that have undergone recent sharp debridement, or when the health- care provider prescribes it. Chronic wounds are colonized with bacte- ria and may be cared for using clean technique, as in this procedure. To perform sterile wound irrigation, see Procedure 32-2. ■ Assess the amount and type of tissue present in the wound bed. Granulating tissue is beefy red with a velvety appearance. It appears with the growth of new blood vessels and connective tissue. Pale pink tissue may indicate compromised blood supply to the wound bed. Necrotic tissue, which is black, brown, or yellow in appearance,
➤ When performing the procedure, always identify your patient according to agency policy, using two identifiers, and be attentive to standard precautions, hand hygiene, patient safety and privacy, body mechanics, and documentation.
Procedure Steps NOTE: Steps are for aerobic culture, except as noted. 1.Position the patient for easy access to the wound and to allow the irrigation solution to flow freely from the wound with the assistance of gravity. Place a water-resistant dis- posable drape between the patient and the bed to protect the bedding from any possible runoff. 2. After performing hand hygiene , put on a gown, face shield, and clean nonsterile gloves. 3. Remove the soiled dressing . Dis- pose of gloves and soiled dressing in a biohazard bag. 4. Perform hand hygiene and again don clean nonsterile gloves. If splash- ing or excessive drainage is expected, don personal protective equipment, including goggles and a gown. Soiled gloves are a source of contamination. 5.Fill a 35-mL syringe with an attached 19-gauge angiocatheter with 0.9% (normal) saline solution. Dis- tilled, sterile water can also be used but is not as common. Make sure to remove and dispose of metal sty- let in sharps container. Commercial irrigation kits containing a piston-tip syringe may also be used.Their use is discussed in Procedure 32-2. A 19-gauge angiocatheter with a 35-mL syringe provides 8 to 12 pounds per
7. Dispose of the irrigation sup- plies; remove and dispose of gloves in the biohazardous waste recepta- cle. If a stylet is in the area, place it in a sharp collection container. Prevents contamination and needlestick injury. 8.Obtain an aerobic culturette tube with calcium alginate or rayon swap (not cotton tip); twist the top of the tube to loosen the swab. Swab specimens are not suitable for anaerobic culture. Culture for anaerobic organisms may be obtained via tissue biopsy or needle aspiration specimens only. 9. Don clean gloves. 10. Locate an area of red granula- tion tissue in the wound bed. 11. Using Levine’s technique, press the culture swab against a 1 cm square area of red granulating tis- sue, and rotate the swab for 5 sec- onds using a rolling motion. Apply enough downward pressure to the swab to cause tissue fluid to be expressed. Fluid from deeper within the wound bed is more indicative of the microbial coloni- zation than culturing the surface of the wound. Levine’s technique is as accurate a tissue biopsy but is less invasive. a.Do not allow anything other than the granulation area of the wound.Avoid wound edges.
square inch (psi) of pressure and is effec- tive for removing bacteria, necrotic tissue, exudate, and/or metabolic wastes. 6. Gently irrigate the wound with a back-and-forth motion from the cleanest to most contaminated part of wound. Hold the angioca- theter tip generally 2 to 5 cm from the wound bed. Use volumes of 50 to 100 mL per cm of laceration length/diameter. Irrigating from the most contaminated part of the wound prevents flow of con- taminated solution over the cleansed area.
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