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Wound care

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 PCH ED staff with the assessment and management of wounds.

Background

The majority of wounds in children presenting to ED are caused by acute trauma.

Objectives of wound care are to:

  • reduce pain
  • apply compression for haemorrhage or venous stasis
  • minimise distress to the child
  • restore function and structural integrity
  • promote healing and minimise infection
  • minimise scarring.

Key points

  • All wound management including wound cleaning, irrigation and dressing requires the use of an aseptic technique. Refer to the Aseptic Technique (internal WA Health only) - Infection Prevention and Control Manual.
  • Removing debris, exudate or foreign material from the wound allows for visualisation, thorough assessment and facilitates healing.3
  • Irrigation is the preferred method of cleaning wounds and sodium chloride 0.9% is the preferred cleansing solution.1,2
  • Assess pain levels and consider the need for appropriate pain management throughout procedures.

Assessment1

Wound assessment and documentation should include:

  • Location of the wound
  • Appearance/presentation
  • Exudate type and amount
  • Wound dimensions
  • Colour
  • Condition of surrounding skin
  • Presence of odour
  • Obtain a thorough history
    • mechanism of injury, associated blood loss, risk of contamination
    • tetanus status
    • consider non-accidental injury
    • underlying chronic illness or disability that may impair healing
  • Reassess the wound and the dressing type at each dressing change.

Management

  • Pain management/anaesthesia.
  • Wound cleansing/irrigation
    • Irrigate wound with Sodium Chloride 0.9% to remove obvious foreign material.
    • Antiseptics may damage tissue defences and potentially impede healing.
    • Exception: Contaminated wounds may benefit from Chlorhexidine 0.05% or Povidine-iodine 1% irrigation. Refer to Wound Assessment and Product Selection Guideline
  • Irrigation fluid delivery:   
    • Use a 30mL syringe with a large bore needle (18g or 19g non-bevelled or sharp removed) filled with sodium chloride 0.9% to slowly irrigate the wound.
    • Hold the syringe just above the wound’s top edge and use gentle continuous pressure to flush fluid into the wound.

Dressings

Quick reference dressing guide

Type of Wound Dressing Option (primary/secondary) Review
Burns Refer to Burns - Dressings 2 days later if discharged from ED
Chronic e.g. ulcers

Use moisture retention and fluid absorption dressing

  • calcium alginate (e.g. Algisite) or foam (e.g. Mepilex)
 5 days
Crush Injuries (digits) patient returning for operating theatre the next day

Use non-adherent moisture retention dressing

  • Tulle gras (e.g. Mepitel) with foam (e.g. Mepilex border)
  • Hydrogel impregnated dressing (e.g. Intrasite Conformable)
  • Can use dry Calcium alginate (e.g.: Aquacel) ribbon with secondary dressing (e.g. Melolin) and crepe bandage if it has continuous blood ooze.
 Next day
Dry, necrotic, black

Use moisture retention dressing to promote a moist wound environment

  • Hydrogel (e.g. Intrasite gel) with secondary dressing (e.g. Adaptic) Combine or foam (e.g. Mepilex) to de-slough and promote wound healing.
  • Do not apply to unstageable heel pressure injury, use protective foam.
 3-4 days
Graze, abrasions – clean dry

Use topical emollient only

  • Emollient ointment.
 As required
Graze, abrasions – clean moist

Use moisture retention and fluid absorption dressing

  • Use Hydrocolloid (e.g. DuoDerm thin) or foam (e.g. Mepliex)
 5 days
Infected or heavily colonised

Iodine based dressing or Silver impregnated dressing. Examples:

  • Acticoat (Activate by Sterile water for dry wounds)
  • Aquacel Ag
  • Mepilex Ag
  • ± Secondary dressing
 1-2 days
Laceration

 Leave open or use dry non-adhesive dressing

  • e.g. Opsite post-op, Cutiplast or Melolin

3-7 days
(GP to remove sutures) 
Puncture or bite

Leave open and use dry non-adhesive dressing

 2 days
Slough - dry

Use moisture retention dressing

  • e.g. intrasite conformable
  • ± Secondary dressing (e.g. Combine)
 3-4 days
 Slough - wet

 Fluid absorption

  • Use calcium alginate, Mepilex Lite, Mepilex Border
  • ± Secondary dressing (e.g. Combine)
 As required
  • This quick reference guide reflects dressings available in the PCH ED.
  • For further advice on wound management contact the Stomal/Wound Management Nurse Practioner via Vocera

References

  1. Carville K. Wound care manual 7th ed. Osborne Park, WA: Silver Chain Nursing Association; 2017.
  2. International Wound Infection Institute (IWII). Wound Infection in clinical practice. Wounds International; 2016.
  3. Armstrong D, Meyr A. Basic Principles of Wound Management: Up To Date; 2020 [updated 12/07/2020]. Available from: https://www-uptodatecom.pklibresources.health.wa.gov.au/contents/basic-principles-of-woundmanagement?search=wound%20management&source=search_result&selectedTitle= 1~150&usage_type=default&display_rank=1

 

Reviewer/Team: ED Consultants, ED CNM, ED CNS, Stomal/Wound NP Last reviewed: Oct 2021


Next review date: Oct 2024
Endorsed by:

 Co-Director, Surgical Services Date:  Nov 2021


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