How to clean post-surgery wounds
A nice skill to have in your locker
Disclaimer:
This is what I was taught in the orthopaedic ward. This involved cleaning surgery wounds specific to the field of orthopaedics so a bunch of staples, external fixators (see image below) and a ton of gauze and bandages.
I have not yet cleaned/changed the dressing in other specialities so I do not know what the steps/procedures are in those. I assume there won’t be much difference but just as a small disclaimer, use this newsletter as a way to just familiarise yourself with the procedure but still ask your seniors to teach you your hospital’s way of doing it.
Let’s get right into it.
Cut off the previous dressing/cast
This is straightforward but can be difficult if you’ve never done it before. Use the cast cutting scissors. I embarrassed myself by taking forever to cut, but this is what I learnt. Don’t try and cut all the layers at once. There are rolls of bandages and cotton rolls etc.. so go 1 or 2 or 3 layers at a time. MAKE SURE you know where the surgery was done, so you can be a bit more careful around that area. I.e, if you know the surgery was done on the ankle when you get to the ankle, you will be extra careful with your movement.
REMEMBER: THUMB AND 4TH FINGER FOR THE SCISSORS.
Place sterile drape below the field
Open sterile pack with a tray inside of it and compartments to hold fluids. This usually has tweezers, gauzes and extra scissors
This isn’t what I used, but it’s very similar Pour betadine in one of the compartments
Just pour quite a bit because it runs out easily. Ideally, someone should be assisting you through all this because later on, you will have sterile gloves on.
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Put on sterile gloves (here is a video I did 3 years ago on how to suture, there is a section where I explain how to put on sterile gloves)
Take gauze, dip into betadine and start cleaning the surgical wound
The patient may be in pain, just be wary and be careful and take your time. Be gentle. Once you’re done with a gauze, place it to the side, not back on the sterile field and use a new one.
Once you have cleaned the area
Take the paraffin gauze, ask your assistant to apply betadine ointment on it, and then place it on the wound. If there is excess surface area of the paraffin gauze, fold it onto the wound.
Take clean gauze and place it on top of the paraffin gauze
This is where I have had a bunch of different instructions
Sometimes I am told to place the clean gauze WITH the ointment on first FOLLOWED by the paraffin + ointment. The main idea is that you now know this is done, just confirm with your doctor/nurse/senior about what order they’d like you to do it in. I doubt there is a right answer, just preference.
Apply cotton gauze gently over the limb/area, roll it around and make sure all of it is covered
Apply the regular gauze over the cotton roll
The rule of thumb for these rolls is once you start rolling it around, always cover half of the previous layer with half of the new layer so at any point on the limb there should be 2 layers on top of each of the regular gauze.
Get tape and secure the gauze in place
Ask the patient if they’re comfortable and if the dressing is okay and for them to let you know if they notice any pain or tightness or just anything not normal
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My name is Habib and I am a final year Medical student currently in Cyprus. I grew up in Tanzania (Hakuna Matata is from the local language of my country and the second tallest mountain (Kilimanjaro) is found there).
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