Burns - Dressing

Disclaimer

These guidelines have been produced to guide clinical decision making for the medical, nursing and allied health staff of Perth Children’s Hospital. They are not strict protocols, and they do not replace the judgement of a senior clinician. Clinical common-sense should be applied at all times. These clinical guidelines should never be relied on as a substitute for proper assessment with respect to the particular circumstances of each case and the needs of each patient. Clinicians should also consider the local skill level available and their local area policies before following any guideline. 

Read the full PCH Emergency Department disclaimer.

Aim

To guide staff in the use of burns dressings.

Pre-procedure

  • Use aseptic technique at all times to minimise risk of infection
  • Do not use 0.9% saline on wound as it de-activates the silver dressing
  • Debride any large blisters and remove loose skin with sterile scissors and metal forceps
  • Do not use Fixomul® on any burns.

Procedure

Medications

  • Ensure child has had adequate analgesia before applying burns dressing
  • Consult Burns - Medication.

Management

Sunburn

  • For non-blistered superficial erythema use Aloe vera gel and leave uncovered
  • For more severe burns (blistered or skin loss) treat as management of all other burns below.

Facial burns

  • Apply a thin layer of emollient.

Dressings of other burns at PCH

For children being admitted to the burns ward without delay:

  • Keep the wound moist by wrapping in sterile water soaked dressing towel or in cling wrap (if age appropriate) until transfer to the Burns ward.

Delay in admission or returning to Burns clinic the following day:

  • Use Nanocrystalline Silver dressing (Acticoat) moistened with sterile water
  • Cut the Acticoat to the size of the burn (include blistered and / or erythematous area)
  • Apply layer of intrasite gel to blue side of Acticoat
  • Apply prepared Acticoat directly to wound surface (blue side down)
  • Cover Acticoat with water compress (gauze soaked in sterile water) to keep the Acticoat moist
  • Wrap with sterile webril and crepe bandage and secure with leucoplast tape.
For discharge with Burns clinic appointment in two days or later:
  • Use Nanocrystalline Silver dressing (Acticoat) moistened with sterile water.
  • Cut the Acticoat to the size of the burn (include blistered and / or erythematous area).
  • Apply layer of intrasite gel to blue side of Acticoat.
  • Apply prepared Acticoat directly to the wound surface (blue side down).
  • Cover Acticoat with Duoderm dressing ensuring that edges overlap Acticoat dressing by 2cm and adhere to skin.
  • Wrap with sterile webril and crepe bandage and secure with leucoplast tape.

Bibliography

  1. AMH Children’s Dosing Companion (2015) Australian Medicines Handbook Pty Ltd
  2. Textbook of Paediatric Emergency Medicine 2nd Edition Cameron Elesevier 2012
  3. Nelson Textbook of Pediatrics: 20th Edition Robert M. Kliegman, Bonita M.D. Stanton, Joseph St. Geme, Nina F Schor Publisher: Elsevier


Endorsed by:  Director, Emergency Department   Date:  Feb 2018


 Review date:   Feb 2021


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