For better or worse, as veterinary nurses, 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
- The large size of the wound
- Tension
- Poor vascular supply
- Infection
- Environmental factors and owner compliance
- Other disease processes like Cushing’s or diabetes.
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.
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 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.
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 a 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 films 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 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.
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
