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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
Once the wound has been fully assessed, classified and staged, you and your treating veterinarian can begin the treatment process.
This treatment could include:
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:
Based on the previous information, the vet will then make a decision about the closure of the wound.
Healthy wounds with adequate blood supply can be closed using primary methods of sutures, staples, or skin glue.
If a wound is infected or cannot be closed using primary methods, it is left open to heal naturally by epithelialisation.
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.
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 assist in absorbing the fluid secreted around the drain and help prevent skin irritation.
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 from 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.
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 a very dry wound, you might use a hydrogel to help keep the wound moist.
As mentioned above, these contact layer dressings can be adherent, non-adherent or semi-occlusive.
These dressings 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.
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.
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.
A version of this post first appeared on Mel’s Instagram account: vetnursediary_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 @vetnursediary_mel
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