Burns - Dressings
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.
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Aim
To guide staff in the use of initial burns dressings.
Pre-procedure
- Administer first aid, if not already administered. Refer to ED Guideline - Burns.
- Use aseptic technique at all times to minimise risk of infection
- Do not use Sodium Chloride 0.9% on wound as it de-activates the silver dressing
- Wash the burn and surrounding area
- Debride any large blisters and remove loose skin with gauze
- Do not use Fixomull® on any burns
- Use sterile gloves to apply dressings3.
Procedure
Medications
Clinical holding
When a clinical hold is required, document the following statement in the patient’s medical record.
“Consent to clinically hold (patient’s name) (part of body held, e.g., left arm) for (assessment/treatment/procedure; e.g. PIVC insertion) was provided by (name of patient/parent/guardian).”
Management
Sunburn
- Apply silicone based dressing (i.e. Mepitel® or Mepilex®), gauze, Webril®, crepe
- Avoid use of Fixomull®
- For more severe burns (blistered or skin loss) follow the management guidelines for ‘Dressings of other burns at PCH’ below.
Facial burns
- Apply a thin layer of emollient
- Consider inpatient admission.
Circumferential or almost circumferential burns
- Always require immediate referral and transfer to PCH for possible admission
- Elevate the affected area
- Neurovascular observations and monitoring of distal perfusion
- Dress the burn loosely with amorphous hydrogel (e.g. Intrasite Gel®), nanocrystalline silver dressing (e.g. Acticoat®), a water compress, Webril®, and crepe with the fingertips and toes exposed to allow for ongoing neurovascular observation and monitoring.
Dressings of other burns at PCH
For children being admitted to the Burns Ward from PCH ED without delay:
- Keep the wound moist by wrapping in sterile water soaked dressing towel or cover the burn in Acticoat®.
For delays in admission or if returning to Burns Clinic the following day:
- Use Acticoat® moistened with sterile water
- Cut the Acticoat® to the size of the burn (include blistered and / or erythematous area) plus a small border
- Apply layer of intrasite gel® to blue side of Acticoat®
- Apply prepared Acticoat® directly to wound surface (Intrasite Gel® 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 tape.
For discharge from ED with Burns Clinic appointment in 2 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) plus a small border
- Apply layer of intrasite gel® to blue side of Acticoat®.
- Apply prepared Acticoat® directly to the wound surface (Intrasite Gel® side down).
- Cover Acticoat® with Duoderm® Extra Thin dressing ensuring that edges overlap Acticoat® dressing by 2 cm and adhere to skin.
- Wrap with sterile Webril® and crepe bandage and secure with tape.
Bibliography
- AMH Children’s Dosing Companion (January 2025) Australian Medicines Handbook Pty Lt
- Textbook of Paediatric Emergency Medicine 3rd Edition Cameron P, Browne GJ, Mitra B, et al (2018) Publisher: Elesevier Edition updated
- McWilliams TL, Twigg D, Hendricks J, et al (2019) The Implementation of an infection control bundle within a Total Care Burns Unit. Burns 47 (2021), 569-571
- Nelson Textbook of Pediatrics: 21st Edition Robert M. Kliegman, St Geme JW, Blum MJ et al. 2020 Publisher: Elsevier
| Endorsed by: |
Co-Director, Surgical Services |
Date: |
Sep 2024 |
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