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UNIT 4 Supporting Physiological Functioning
Procedure 32-6 ■ Applying a Negative Pressure WoundTherapy (NPWT) Device (continued)
Procedure 32-6B ■ Gauze Dressing Application (i.e., Chariker-Jeter Method) ➤ 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.
9. Connect tubing from the dress- ing to the evacuation tubing going to the collection canister. Allows for collection and measurement of drainage.
Begin with steps 1 through 13, at the beginning of Procedure 32-6. Then proceed as follows: 1. Measure the length of drain from wound margin, starting with the first hole perforation and pull back 1 cm. 2. Moisten gauze with normal saline. 3. Wrap or “sandwich” the drain in the moistened gauze and place in the wound base.Tuck gauze into any undermining areas to ensure contact with the wound bed. 4. Apply a strip or small amount of ostomy paste 1 cm from the wound edge and secure the drain as needed. Paste is occlusive and will help maintain a seal between the drain and the transpar- ent film dressing. Paste that is too close to the wound edge can get sucked into the drain and occlude pressure. 5.Apply liquid skin preparation product to periwound, if needed. Extra drape, hydrocolloid, or trans- parent dressing may be used to pro- tect fragile skin. Skin preps can protect the periwound skin from excess fluid, adhesive stripping, or other damage. 6. Apply transparent film approxi- mately 1.0 to 2.5 cm (1/2 to 1 in.) beyond the wound margin to intact skin. Pinch the film around the drain tubing to ensure a tight seal. 7. Avoid wrapping dressings around an extremity. If necessary, place sev- eral smaller pieces of drape rather than one continuous piece. When pressure is applied, a circumferen- tial dressing may interfere with circulation. 8. Attach filter tubing to the canis- ter spout.
What if . . . ■ I am changing the dressing instead of applying it for the first time? Use the following procedure steps. NOTE: Dressings should be changed every 48 to 72 hours. Dressings left in the wound longer than the recommended time can become difficult to remove if tissue grows into the foam, or they can lead to infection or other adverse events. a. Evaluate the need for analgesia. b.Turn the suction pump unit off during the procedure. c. Place a waterproof biohazard pad under the body part requiring the dressing change. d. Perform hand hygiene and don ster- ile or clean gloves as appropriate. e.Remove the transparent dressing using a push–pull method to gen- tly pull up drape while pushing it slowly from the skin. Separating the drape from the skin in this manner will decrease the risk of tape stripping. f.Gently remove gauze or foam dressing. If dressing is difficult to remove, instill normal saline onto the dressing for 15 to 30 minutes. Dressing removal can damage new granulation tissue if tissue has grown into the dressing. g. Count all pieces of gauze or foam dressing that were removed to ensure none remains in the wound bed. Ensure no dressing is left in tunneled or undermined areas. Dressings are not bioabsorbable and can abscess if left in the wound. h. Discard soiled dressings in a bio- hazard container. i. Start at the beginning of Procedure 32-6 and perform steps 1 through 13. Then, as instructed in step 13, follow either Procedure 32-6A or 32-6B.
10. Position the tubing and connec- tor away from bony prominences and skin creases. Prevents pressure injury to the skin. 11. Ensure clamps are open on all tubing. 12. Turn on power to pump and set to the prescribed therapy settings to initiate therapy. Therapy should be maintained for at least 22 out of 24 hours daily.Alternative wound care should be considered if suc- tion cannot be tolerated for this length of time. 13.Listen for audible leaks and observe dressing collapse as pres- sure is applied to the wound bed. With an adequate seal, the dressing will collapse almost immediately. Any leak (i.e., between the dressing and drape, around tubing, at skin crevices, or at tub- ing connection sites) will prevent collapse. 14.Change the canister at least once a week or when filled. Write the date on the canister. This will help to know when it was changed last as well as how often it is being changed for fluid loss.
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