- Hello, everyone, welcome to Santa Fe College nursing labs. Today, I am gonna be demonstrating a wet-to-dry dressing change, following the nine principles of sterile technique. The first thing we need to do is go ahead and check our doctor's orders and for the description of the dressing change. So, I'm gonna go over here, open my patient's chart and take a look at the order. Next, I'm gonna go ahead and gather my supplies. Now that I have all of my supplies, I'm gonna go into the patient's room. You wanna remember to always bring a couple of extra supplies, extra gloves or gauze dressings. Sometimes, you're never sure how many gauze pads you might need to put into the wound. Or if you break sterile technique, you might need to change your gloves. So, I'm gonna enter the room, I'm gonna wash my hands or sanitize, and I'm gonna introduce myself to the patient, identify the patient, and let them know what we're gonna be doing. Hello, Mr. Jones, how are you doing today? I need to go ahead and do your dressing change. Can you please tell me your name and date of birth? And I'm gonna go ahead and check the patient's ID band as well. So, Mr. Jones, are you feeling any pain or do you have a lot of pain when we do dressing changes? So, if needed I'm gonna go ahead and premedicate the patient with some pain medication before we do the dressing change. So, now that I've premedicated my patient, if needed, I'm gonna go ahead and setup my supplies. You need to make sure you have a trashcan or biohazard can. I'm gonna go ahead and raise my table and move it over in my patient. You can also open your table up to give you more space. So, the supplies that you need to do a wet-to-dry dressing change includes normal saline or sterile water, a pair of sterile gloves. I have two here just in case I contaminate the gloves when I'm putting them on or during the procedure. You need a roll of tape, a tape measure. We also need some Q-tips to help us measure the wound and then also to pack it. We need an ABD pad as well. I have two here just in case. This is my sterile bowl that contains my sterile four-by-four dressings. Every institution has a little different setup. Here, we have a sterile bowl that has the dressing in covered by a sterile drape that we will use for our sterile field. So, now, the first thing we need to do is expose the wound, and then remove the old dressing and measure the wound. So, this is done using clean technique. We're gonna expose the patient, so I'm just gonna move down your sheet and lift up your gown, Mr. Jones. So, I need a clean pair of gloves. When I remove the dressing, I'm gonna pull towards the middle of the wound so that I do not pull the wound apart. So, when I lift the dressing up, sometimes the whole dressing, including the packing, will come out. Other times, you'll just get the packing in pieces. You always wanna remove the dressing where you're removing the top part closest to the head down to the bottom. The bottom part of the dressing, the part that's closest to the feet is always gonna contain the most drainage because of the way patient is sitting and gravity. So, part of my dressing came out. I can use Q-tips or I can pull with my gloves to get the rest of this dressing out. I wanna make sure that I observe the dressing. This dressing hasn't got any drainage on, so I'd wanna know whether it was still moist, whether it has sanguineness, serosanguineous, or what looks like pus exudate. I'd also wanna see if it's on all layers of the dressing, whether it's just on the packing or whether it's on the ABD pad as well. After this, I'm gonna go ahead and wrap my dressing up. And if it's very saturated with blood, it's gonna go into a red biohazard. If it has very little blood on it, it can go into the regular trashcan. I'm gonna attempt to wrap the gauze dressing inside of my gloves. And then I'll go ahead and throw this into the trashcan. So, now that threw out the old dressing, I'm gonna go ahead and wash my hands or hand sanitize. The next thing we're gonna do is measure the wound. So, I'm gonna attach my tape measure to my table to use. We're looking at the centimeter side or millimeter side. Some of the gauze packages or Q-tips will actually have a tape measure on in case you need that as well. So, I'm gonna go ahead and put on some clean gloves. I am then gonna open my Q-tips and measure my wound. You wanna make sure that you keep the end of the Q-tip sterile or as clean as possible. So, with my first Q-tip, I am gonna be measuring the length. You try not to touch the wound. So that is about 13.5 centimeters. I'm then gonna do the width. And the width is about 2.5 centimeters. I'm then gonna throw this first Q-tip out. So, I'm getting my second Q-tip in order to measure depth. So, I'm gonna go ahead and measure the depth. And that is about three centimeters. And I can throw that one out. And I will also dispose of these gloves. I'm gonna write down my measurements on my tap measure here so I do not forget. So, now begins the sterile part of this skill. I wanna arrange my supplies so that the supplies I'm using first are closest to the patient. I'm gonna setup my gloves and put on my gloves on this side of the table here. I want to loosen the cap of my sterile water or saline. When you gather your supplies, you wanna make sure that your sterile water or normal saline is not expired. If you are the first person opening this bottle, you also want a date. Usually, these bottles once open are only good for 24 hours. You would grab your marker and go ahead and date and initial. So, I'm gonna loosen my cap so that it's easier to open later on. I have my sterile bowl. I'm gonna put my supplies over here. And I'm gonna open my sterile field. So, when opening up my sterile bowl, I'm gonna open up the furthest flap first, then I'm gonna open up the two side flaps. And then I open the flap closest to me. Any flap hanging over the table would be considered non-sterile, and remember the one-inch border around your sterile field is not considered sterile. Next, I need to go ahead and add my other sterile supplies. So, the first supply I'm gonna add to my field is my sterile ABD pad. You wanna minimize the amount of time that you are over your sterile field. Next, I'm gonna put my extra supplies off to the side. And I'm gonna go ahead and use the other side of my table to put on my sterile gloves. So, I'm gonna don my sterile gloves. I'm gonna only put one sterile glove on to begin with. Move my trashcan. I'm gonna place the sterile glove on my non-dominant hand first. I'm gonna keep my hand up 'cause this hand is now sterile. I wanna go ahead and arrange my supplies on my dressing. I need to pour the water into my bowl. Remember, if water on a sterile field lands onto paper or fabric, it is then considered contaminated, which is why we're pouring into a sterile metal bowl, or you need to pour into some other sterile container. So, we're gonna arrange ours supplies. Our ABD pad is used last so I'm gonna put it furthest from the patient. Our Q-tips are used in the middle. We have four gauze dressings in the bowl. I need to remove two, two are gonna be moist, and two are gonna be dry. I am then going to remove my cap. You wanna place the cap facing up. You also want to when you grab the bottle, you want the label facing your palm, so you do not drip water on the label. I wanna avoid reaching over my field. So, before putting on my second sterile glove, I'm just gonna make sure I have enough water or sterile saline to moisten my gauze, which I do. I'm gonna recap my bottle. I seem to have, that's plenty of water. I am now gonna put on my second sterile glove. Now that I have both of my sterile gloves on, I am gonna begin to pack the wound. So, you wanna grab the first of the two dressings, and you wanna just wring out any excess water into your bowl. I'm then gonna open up the gauze pads, and what we call fluffing them, which is just increasing the surface area a little bit, making it easier to pack. So, you just need to open it up once. And then we're gonna go ahead and you can either fold it or you can make like a tube. And then you wanna gather your dressing up like an accordion. We need one of the Q-tips to help us pack the wound. You do not want to let any of the gauze touch the patient's skin that is intact, 'cause the moisture over time will cause breakdown of the skin, so we want most of the dressing inside of the wound. You can use the Q-tip or you could use your finger to pack the wound. You wanna start from the top to the bottom. And you usually replace, if I pull two gauze dressings out here, you usually know that you need two more to replace. So, I can discard this first Q-tip. I do not wanna turn my back on my sterile field. I'm gonna grab the second dressing now, wring out any excess moisture. Again, I'm gonna fluff my four-by-four. So, it's opening once. Opening twice. Again, you can either fold it or you can create a loop, like a tube. Then I'm gonna gather the dressing up like an accordion. I'm gonna get my other Q-tip, and then I'm gonna pack the rest of my wound. So, I finished packing my wound. If there's any excess dressing, you wanna put it on top of the other gauze and not on the patient's wound. I'm gonna go ahead and throw out the Q-tip without turning my back on the patients on the sterile field and without lowering my hand below my waist. Next, I'm gonna get the two gauze dressings, dry ones, to put on top. You wanna go ahead and open your dressing. You want the crease to be facing up, and you want the double part of the four-by-four gauze at the bottom of the wound, that's where most of the drainage is gonna be when the patient is sitting or standing due to gravity. I'm just gonna go ahead and drop this onto the wound. Wherever it falls is where it stays. I'm gonna grab my second dry piece. And again, I'm gonna open that up, make sure my double fold is at the bottom and the edge is facing up, and I'm just gonna go ahead and drop that over the wound. The last part of the dressing is the ABD pad. The ABD pad has a blue line. This is the line that faces the sky, which is always a good way to remember, blue for sky. You wanna go ahead and open up your ABD pad, try to avoid touching the part that's gonna be against the wound. And I'm just gonna go ahead and place this on the patient. So, I placed my ABD pad on the patient. For this patient, the wound is in the middle of the abdomen, it's not going to fall. If you are doing a dressing on a foot or the side of the patient, as soon as you let go of this dressing, it's likely to slip off. So in that case, you wanna make sure that you maintain your hand on the dressing until it is taped down and secure. Since this dressing is not gonna move, I am gonna let go and grab my tape. Now that the dressing is on the patient, this concludes the sterile part of the procedure. I have my tape, which I'm gonna tab the end off to make it easier. Estimate about how much I want, you wanna avoid putting excess tape on your patient. I'm gonna go ahead and secure the middle first. Everyone tapes their wound a little differently. You can do a picture frame or you can do the three pieces of tape across. The main part is the bottom needs to remain closed. I'm gonna get my third piece of tape, gonna secure the bottom part, and you want the dressing at the bottom to be closed. And then the last piece of tape. Now, you either need to label it now, or once you put your tape on, you can pull a smaller piece of tape and put it onto the dressing, but you do need to label your dressing with your initials, the date that the dressing was changed, and the time. I'm gonna go ahead and put the last piece of tape and you do not want to include the top of the dressing. I can now remove my gloves and discard. Gonna cover the patient back up to provide privacy. So that concludes the end of our wet-to-dry dressing change. When you leave your patient, you wanna make sure that the bed is in a low position, they have their call light, and they are left in a comfortable position. Thank you so much for joining us, and I hope to see you next time. Remember there are other nursing videos from us that you can watch too.