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Wound and dressing management for veterinary nurses - Part 2

Posted in Guest Blogger @ Nov 4th 2021 - By Melissa Giles, Vet Nurse Diary
Wound And Dressing Management For Veterinary Nurses Part 2

For better or worse, as a veterinary nurse, we see the changes that occur and get to be an integral part of caring for and managing our patients’ wounds.

Welcome to Part 2 in Wound and dressing management for veterinary nurses

If you missed Part 1 which discussed: wound assessment and classification, wound staging and healing, click HERE to read: Wound and dressing management for veterinary nurses - Part 1

Wound Treatment

Once the wound has been fully assessed, classified and staged, you and your treating veterinarian can begin the treatment process.

This treatment could include:

  • Clipping the hair from around the wound (using precautions to prevent hair from entering the wound)
  • Flushing the wound using sterile saline to remove debris from within the wound (be careful not to do this at too high a pressure as this may cause further tissue damage. A 20ml syringe and 18g needle is generally suitable.)
  • Cleaning around the wound using surgical scrub as per your clinic’s surgical skin prep policies and procedures.
  • Debridement to remove any unhealthy tissue.

Method of Repair

Before dressing can take place, the method of the wound repair should be identified, as well as any impediments to the healing process.

Such impediments could include:

  • Foreign material
  • Necrotic tissue
  • Dead space
  • Excessive movement
  • Large size of wound
  • Tension
  • Poor vascular supply
  • Infection
  • Environmental factors and owner compliance
  • Other disease processes like cushings or diabetes.

Based on the previous information, the vet will then make a decision about the closure of the wound.

  • First intention

Healthy wounds with adequate blood supple can be closed using primary methods of sutures, staples, or skin glue.

  • Second intension

If a wound is infected or cannot be closed using primary methods, it is left open to heal naturally by epithelialisation.

  • Third intention

Wound closure is delayed for a short period of time (2-3 days) to allow for the elimination of infection and new blood supply to the existing wound prior to closure.

  • Secondary closure

This occurs if the injury is more than 5 days old, where granulation tissue and partially healed skin is debrided and the fresh, newly exposed tissue is closed using a primary closure method

To prevent fluid accumulation within wounds that contain a large amount of dead space after closure, a drain may need to be placed.

This could be a closed suction drain or a passive drain such as a penrose.

NOTE: Passive drains must be aseptically bandaged after placement to avoid ascending infection and to assist in absorbing the fluid secreted around the drain and to help prevent skin irritation.

Bandaging

Dressing layers

All bandages should have 3 layers:

1. Contact layer

This is the layer that is in direct contact with the wound to provide protection. They can be adherent, non-adherent or semi-occlusive and can also provide additional functions such as absorption or keeping the wound moist.

2. Secondary layer

The secondary layer secures the contact dressing and provides support and pressure to reduce or prevent oedema forming around the wound. Tension is applied to this layer.

3. Tertiary layer

The purpose of the tertiary layer is to conform the first two layers of bandaging to the body, as well as to secure other materials such as splints. Tension is not applied to this layer.

To prevent slipping, stirrups or an additional strip of adhesive bandage can be placed in contact with the tertiary layer as well as the patient’s body.

Determining Contact Layer

The choice of bandaging material is of the utmost importance and has an enormous effect on the healing potential of the wound.

An exudate scale can be used to determine if your contact layer should be absorptive, non-absorptive or a hydrogel material.

If, for example, you had a wound that was on the exudate+++ end of the scale, you would need to ensure that your contact layer is absorptive material that will assist with the absorption of the exudate and minimise strike through. For the very dry wound, you might use a hydrogel to help keep the wound moist.

Dressing Materials

Absorptive:

  • Foam dressings such as Allevyn
  • Cotton dressings such as Melolin
  • Hydrocolloid dressings such as Tegaderm or Replicare
  • Calcium Alginate dressings such as Algisite or Curasorb

Non-Absorptive:

  • Polyurethane film such as Opsite and Cutifilm

Hydrogel:

  • Solosite or Intrasite gel

As mentioned above, these contact layer dressings can be adherent, non-adherent or semi-occlusive.

Adherent:

These dressing are designed to stick to the drying exudate and work well in contoured areas of the body and in wounds with larger amounts of exudate. Keep in mind that when removed, these dressings will also remove granulation tissue and could cause pain to your patient.

Non-Adherent:

These dressings are designed to not stick to the exudate of the wound, thereby causing less damage and pain when removed. These are great for providing protection to wounds that have light to moderate exudate.

Semi-Occlusive:

These are semi-permeable dressings that allow oxygen, carbon dioxide and water to pass through. They assist in keeping the wound moist by forming a protective gel-like layer whilst still allowing the wound to ‘breathe’. These are non-adhesive and can be removed with less trauma to the wound.

Things to Remember!

  • Bandages must be checked frequently for strikethrough.
  • Patients should be closely monitored for any swelling distally or proximally to the bandage.
  • When bandaging a limb or a paw, always leave the middle two digits free so you can monitor for spreading. If this occurs there is very likely to be swelling occurring underneath your bandage.
  • When using soffban – natural soffban is absorbent, whilst synthetic soffban is non-absorbent and will NOT soak up any exudate or moisture.
  • Always stretch out your roll of wrap dressing prior to application to avoid unintentionally applying excessive tension to the bandage.
  • Carefully select the size of your bandaging wrap. A narrower wrap means greater pressure will be exerted onto the limb than a wider wrap as the surface area is smaller.
  • Ensure your patient always has adequate pain management.
  • Ensure your patient has a clean environment and clients have been educated on ways to keep dressings clean and dry at home.
  • Always use appropriate size bandage scissors to remove bandages.
  • Take those before and after pictures!

A version of this post first appeared on Mel's Instagram account: vetnursediary_mel

About Mel

Mel was born in South Africa and always knew she needed to work with animals one day. She volunteered at a local Vet clinic as soon as she was able and fell even more in love with the profession. 

When she was 16 her family moved halfway across the world to Australia where she completed her schooling and immediately (2 weeks after her final exams) signed on to a clinic as a trainee Vet Nurse and began her nursing studies!

She hasn't stopped learning since and is incredibly excited by the future of Vet Nursing and all the things she has yet to learn and share! 

Follow Mel on Instagram by clicking HERE: vetnursediary_mel

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