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 aim of wound care is to:

  • 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 non touch technique (ANTT). Refer to ANTT Wound Care protocol
  • Irrigation is the preferred method of cleaning wounds.
  • Assess pain levels and consider the need for appropriate pain management throughout procedures.

Management

Wound cleaning/irrigation

  • Irrigate wound with 0.9% saline to remove obvious foreign material.
    • Antiseptics may damage tissue defences and potentially impede healing.
    • Exception: Contaminated wounds may benefit from Chlorhexidine 0.05% or 1% Povidine-iodine irrigation.
  • Irrigation fluid delivery:        
    • Use a 30mL syringe with a large bore needle(18g or 19g non-bevelled or sharp removed) filled with 0.9% saline 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

  • Consensus opinion (due to minimal clinical evidence) guides wound dressing choice. A thorough wound assessment (including underlying aetiology; wound size, tissue type, exudate, blood supply and infection status) is to be carried out to determine the appropriate dressing.

Quick reference dressing guide

Type of Wound Dressing Option (primary/secondary) Review
Chronic e.g. stoma, ulcers

Use moisture retention and fluid absorption dressing

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

Use moisture retention dressing

  • Tulle gras e.g. Adaptic/Jelonet with foam e.g. Mepilex border
  • Hydrogel impregnated dressing e.g. Intrasite Comformable
  • Can use dry calcium alginate eg: Algisite/Kaltostat 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

  • Hydrocolloid dressing (e.g. DuoDerm) or
  • Hydrogel (e.g. Intrasite gel) with secondary dressing e.g. Adaptic, Combine or foam (e.g. Mepilex) to de-slough and promote wound healing
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

Use moisture absorption dressing. Avoid semi occlusive dressing

  • Silicone e.g. Mepitel with secondary foam dressing (e.g. Mepilex)
  • Calcium alginate (Kaltostat) or hydrocolloid (DuoDerm) if high exudate
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

  • e.g. Melolin/Cutiplast
2 days
Slough – covered

Moisture retention and fluid absorption

  • Use calcium alginate (Kaltostat) with secondary dressing e.g. Combine
3-4 days
  • This quick reference guide reflects dressings available in the PCH ED.
  • For further advice on wound management contact the NursePractioner Stomal/Wound Management via switch or refer to the A guide to choosing the appropriate dressing (WA Health access only). 

Bibliography

  1. Armstrong DG and Metr A, Basic Principles of wound Management, May 2015 UpToDate. Accessed at www.uptodate.com.
  2. Joanna Briggs Institute. Solutions, techniques and pressure in wound cleansing. Best Practice Information Sheet. 10:2:1-4: 2006.
  3. Boylan C.  A guide to choosing the appropriate dressing, February 2013. Western Australia Department of Health, Child and Adolescent Health Service.


Reviewer/Team: Emergency Department Guidelines Team Last reviewed: Sept 2017


Review date: Sept 2020
Endorsed by:

Director, Emergency Department Date:  Sept 2017


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