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.

Aim

To guide staff in the use of initial burns dressings.

Pre-procedure

Administer first aid, if not already administered. See 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 dressings.

Procedure

Medications

Ensure child has had adequate analgesia before applying burns dressings
Consult Burns - Analgesia and dosing.

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
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 (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 from ED 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) plus a small border
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 Extra Thin 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

AMH Children’s Dosing Companion (July 2021) 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:	Oct 2021
		Review date:	Oct 2024

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