Dressing a Pressure Injury, by Susan Hamilton

Description

Quick Concepts are short videos that describe a key physiological or theoretical concept, or demonstrate a brief procedure.
In this video, Susan Hamilton, RN, demonstrates how to clean and dress a pressure injury.
Initial publication: March 8, 2018.

So you can see this patient's wound is on his coccyx area, or sacrum, just at the base of the buttocks.
This is a common area for older children to get a wound, especially if they are bed-bound or chair-fast and unable to move themselves.
The first thing you want to do is just get an overall assessment of what the wound looks like, and the surrounding tissue around it.
My first glance at this wound, it's a rather large wound and it has a mixed wound bed.
There is some black eschar, as well as some yellow slough in the wound, and some granulation around the edges of the wound, and some bleeding-- which would be a sign of some healthy tissue.
To accurately assess this, we want to get measurements on this wound.
So you want to take a tape measure, and in centimeters, measure first the length, and then the width, and then the depth of the wound.
In measuring this wound, it's 6 centimeters long by 4 centimeters wide.
And then, to assess the depth, you can take a Q-tip and you can go in to the wound and assess its maximal depth, and do it in several areas.
And then, measure how deep.
In this case, this wound is 1 centimeter deep.
There are areas that potentially will become deeper in this wound as the slough and this eschar starts to come off.
Also, if this wound has some open areas, you want to feel all the way around the wound to see whether there's any areas of tunneling-- which the wound goes underneath the skin-- or undermining-- where there may be spaces underneath the edge of the wound.
And when you document those, you should document those as on a clock.
So, if I found an area down here, I would document that there was a tunnel or undermining at 6 o'clock.
Then, the next person who comes to take care of this wound has a good idea of what they're going to find when they come to assess this wound.
The next thing that we want to do is clean up this wound.
And then, we're going to choose a dressing to help heal it.
Just wet normal saline gauze is good for cleaning wounds.
You want to use some pressure to clean off any dry skin or areas that are just dead and dry and flaky.
You want to clean the wound bed.
If it bleeds a little, that's actually a good sign that there's healthy, viable tissue there.
If you push too hard on the wound, though, you may actually disrupt the wound bed.
So you want to use some pressure, but not aggressive pressure in cleaning the wound.
Once the wound is all clean, you can go ahead and dry the areas.
You want to do whatever you can to protect the skin that surrounds the wound.
There are products that you can use, but also, just use a dressing that will contain as much of the drainage as possible.
For this wound, I'm going to choose for now, a moist gauze covered with a dry gauze.
And then, we'll use a foam dressing to help absorb some of the drainage.
The goal for this wound would be to get that slough and that eschar to come out of the wound.
So then, we can see what the base of the wound looks like, and then get it to heal from the inside out.
So now that I've cleaned it, I'm going to take a piece of damp gauze.
And again, like I said earlier, if you fluff the gauze onto the wound, then I'm going to place a dry gauze over that, and then I'll put the foam dressing over for extra protection, insulation, and padding.
And then, I would tape the whole dressing.
And I would change that dressing at least once a day, or if it became soiled with stool, or if the drainage came through to the foam dressing.