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Helps promote a moist healing EVR

Protects the wound from contamination

Provides thermal insulation

Manages exudate

Eliminates dead space

Reduces pain during dressing changes

Hemostasis

Edema control

Assists body with removal of necrotic tissue, foreign material, and debris.

Provides adequate gas exchange between wound and EVR.

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Description pg 98

A single layer of fluid saline-moistened gauze to a necrotic wound, covering with more gauze, and then allowing the dressing to dry 18-24 hours. As the dressing dehydrates, the gauze adheres to the wound bed, trapping wound exudate, foreign materal, and debris within the interstices. When the dressing is dry, it is torn away at a right angle from the wound surface, thus lifting away materal adhering to the gauze.

Advantages

Provides nonselective mechanical debridement

Low cost and readily available

Can help remove necrotic tissue without specialized equipment

Disadvantages

Nonselective — removes viable tissue along with necrotic tissue

Can cause pain during removal

May desiccate the wound bed, delaying healing

Increases risk of infection due to frequent dressing changes

Labor-intensive and may require analgesia

Procedure

Don gloves and prepare supplies.

Moisten coarse-mesh gauze with sterile saline.

Lightly pack the wound, ensuring contact with all wound surfaces without overpacking.

Cover with a dry secondary dressing.

Leave in place until the dressing dries.

Remove dressing dry to mechanically debride adherent tissue.

Dispose of materials per infection control guidelines.

Medical Asepsis

Perform hand hygiene before and after procedure.

Use clean or sterile gloves as appropriate.

Maintain a clean field for dressing supplies.

Avoid contaminating the wound or supplies during application and removal.

Dispose of soiled dressings in accordance with facility infection control protocols.

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Types of dressing: Gauze (woven and unwoven) 

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Types of dressing: Gauze (woven and unwoven) 

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Discription

woven, made from cotton, yarn, or tread that is woven like fabric.

unwoven, made from synthetic fibers presses together.

Advantages

can be used on infected and uninfected wounds of any shape, size, depth, and eitology.

economical choice , inexpensive for one time or short term use.

Disadvantages

If allowed to dehydrate, they will adhere to the wound bed, causing trauma upon removal.

Procedure - pg 172 box 7-13

Prepare the patient and environment

Hand hygiene

Apply clean gloves

Remove old dressing

Assess wound

Clean the wound

Apply new gauze dressing

Document

Medical asepsis

Use clean gloves (sterile gloves not required unless wound is highly susceptible or ordered)

Clean wound using standardized technique (inside to outside)

Do not touch gauze that goes directly into the wound bed with bare hands

Avoid contaminating the gauze or wound area by maintaining a clean field

Properly dispose of soiled gauze and sanitize hands after procedure

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Description - pg 187

Impregnated gauze dressing into which materials such as petrolatum, hydrogel, saline, bismuth, or zinc have been incorporated.

These dressings are designed to deliver medication to the wound or maintain a moist wound environment without adhering to the wound bed.

Advantages- pg 187

Maintains a moist wound environment

Non-adherent, reducing pain with dressing changes

May deliver antimicrobial agents directly to wound bed

Can be used under compression or in combination with other dressings

Disadvantages pg 187

May require a secondary dressing to secure in place

Can retain exudate, potentially leading to maceration if not monitored

Needs frequent dressing changes depending on the level of drainage

Procedure pg 187-188

Perform hand hygiene and apply gloves.

Cleanse wound using appropriate wound cleansing protocol.

Select and prepare impregnated gauze dressing.

Place directly onto wound bed, ensuring full contact with the wound surface.

Apply secondary dressing if required to manage exudate and maintain placement.

Secure dressing with tape, wrap, or compression as indicated.

Document dressing application, including product type, lot number (if applicable), and wound status.

Medical Asepsis pg 187-188

Use clean technique unless otherwise directed (e.g., surgical or acute care settings may require sterile technique).

Maintain non-touch technique when handling dressing that contacts the wound bed.

Always dispose of old dressings properly and clean the surrounding periwound skin before application.

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1. Wet-to-Dry Gauze , pg 99

Contraindicated for clean granulating wounds because the nonselective removal of tissue can damage healthy granulation tissue and delay healing .

2. Gauze (Woven and Unwoven), pg 147

Avoid using as the primary dressing for wounds with exposed tendon, bone, or delicate structures unless appropriately moistened and monitored .

Woven gauze may require more force to remove than non-woven gauze, potentially traumatizing the wound

bed. Additionally, woven gauze may leave a residue

or lint within the wound bed. The body may respond

to this foreign material by forming a granuloma.

Therefore, clinicians would be wise to use nonwoven

gauze with a fine weave on wounds that are not 100%

necrotic. If gauze dressings are allowed to dehydrate, that will adhere to wound bed, causing trauma upon removal.

3. Impregnated Gauze, pg 147

There are timeswhen impregnated gauze dressings may be inappropriate. Xeroform gauze is impregnated with a combination of bismuth and petrolatum. Bismuth has mild antimicrobial properties and has been used prophylactically to prevent wound infection. However, bismuth is also cytotoxic to inflammatory cells and may be a sensitizing agent, that is, it may cause irritation, dermatitis, or an increased inflammatory response. Patients with venous insufficiency ulcers are particularly prone to such responses.20 Clinicians must weigh these poten-tially adverse responses against the potential benefitsof bismuth’s antimicrobial properties. Similarly, iodine-impregnated gauze packing strips are cytotoxic to human cells and only mildly antimicrobial.

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Selection Considerations (pg. 167-171 wound mgmt) 

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Selection Considerations (pg. 167-171 wound mgmt) 

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1. Location of Wound

Wounds located on joints or high-movement areas (e.g., fingers, knees) benefit from flexible, conformable dressings

Distal extremity wounds may require securement with wraps or tubular bandages to maintain placement

2. Wound Stage/Type (Table 7-3)

Granulating Wounds: Require protection and moisture maintenance (e.g., hydrocolloids, hydrogels)

Necrotic Wounds: Require moisture-retentive or enzymatic dressings to promote autolytic debridement

Draining Wounds: Require absorptive dressings such as foams or alginates

Dry Wounds: Require dressings that provide moisture like hydrogels

3. Cavities, Tunneling, and Undermining (Fig. 7-12 pg. 170)

Deep wounds require light packing to prevent absecc formation. Light packing using gauze strips or calcium alginate ropes is indicated

Overpacking should be avoided to prevent ischemia and delayed healing

4. Necrosis (Table 7-3)

Necrotic tissue presence necessitates debridement through autolytic (e.g., hydrogel under occlusion), enzymatic (collagenase), mechanical, or surgical means. Knowing the type of debridement used will help determine the most approrpiate wound dressing.

5. Drainage

Heavy Exudate: Use alginates, hydrofibers, foams, or multilayer gauze

Minimal Exudate: Use hydrogels, transparent films, or hydrocolloids

6. Wound Edges (Wound care txtbook 4th ed. pg 134)

Macerated edges require absorbent dressings and periwound barrier protectants

Rolled or undermined edges may need debridement or edge approximation strategies

Distinctness. Look for how clear and distinct the wound out line appears. If the edges are indistinct and diffuse, there are areas where the normal tissues blend into the wound bed. Well-defi ned edges are clear and distinct and can be outlined easily on a transparent piece of plastic. • Attachment. Edges that are even with the skin surface and the wound base are edges attached to the base of the wound. This means that the wound is flat, with no appreciable depth. Edges that are not attached to the base of the wound imply a wound with some depth of tissue involvement. The wound that is a crater or has a bowl/boat shape is a wound with edges that are not attached to the wound base. The wound has walls or sides. There is depth to the wound

Thickness. As the wound ages, the edges become rolled under and thickened to palpation. Wounds of long duration may continue to thicken, with scar tissue and fibrosis developing in the wound edge, causing the edge to feel hard, rigid, and indurated. Hyperkeratosis is the callus-like tissue that may form around the wound edges, especially with diabetic ulcers

Color. The edge achieves a unique coloring with time. The pig ment turns a grayish hue in both dark- and light-skinned persons.

7. Epithelialization & Granulation

Support with nonadherent, non-traumatic dressings such as impregnated gauze, silicone contact layers, or thin hydrogels

8. Incontinence

Moisture-associated skin damage necessitates use of moisture barriers (zinc oxide creams, skin sealants) and absorbent dressings like foams or bordered gauze

9. Infection

Infected wounds require frequent dressing changes, often with gauze, silver-containing dressings, or iodine-based dressings

Occlusive dressings are avoided unless antimicrobial agents are integrated

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1. Gauze Dressings (Woven and Nonwoven)

Indications pg. 146:

Gauze dressings can be used on both infected and uninfected wounds of any size, shape, depth, or etiology. Although gauze may not be the best choice of dressing, gauze dressings can be modified to be safe with any wound type. For example, if used on a nondraining or minimally draining wound, a topical agent can be applied to the wound bed to help main tain a moist wound environment or the gauze may be premoistened with normal saline. Alternatively, if used on a highly draining wound, additional layers can be used to aid in absorption. Gauze dressings can be used alone or in combination with topical antimicrobials, enzymes, growth factors, amorphous hydrogels, algi nates, semipermeable foams, or semipermeable films. There are several scenarios in which gauze is the dressing of choice. If a wound requires daily or more frequent dressing changes, gauze is the most economical choice. Therefore, gauze is commonly used on infected wounds or wounds being treated with enzymatic debriding agents. Because roll gauze dressings avoid adhesives, they may be the most appropriate secondary dressing for patients with fragile integument. Patients with large wounds or wounds in irregularly shaped areas may be best treated with gauze dressings because gauze is inexpensive and can easily be secured in place. Gauze packing strips (see Figure 7–6) are commonly used to prevent premature closure and wick away exudate in tunneling or undermining wounds.

2. Wet-to-Dry Dressings

Indications pg. 99:

Wet-to-dry dressings are only indicated for wounds with 100% devitalized wound bed.

3. Impregnated Gauze Dressings

Indications pg. 147:

Petrolatum-impregnated gauzes may be used as a wound contact layer on granulating wound beds in combination with a secondary gauze dressing. They can be used with or without a topical agent, such as an amorphous hydrogel or antimicrobial. Impregnated gauzes may also help prevent exposed tendons or tendon sheaths from dehydrating or adher ing to the primary dressing. Because petrolatum impregnated gauzes allow pain-free removal, these dressings are commonly used on burn wounds. Before being placed on the burn, a topical antimicrobial, such as silver sulfadiazine, is typically applied to these dress ings to treat an existing infection.19

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Good Wounds Improve

G = Gauze (woven & nonwoven) → General use, versatile, absorbs

It's versatile for primary/secondary use, packing, or securing other dressings; low cost; requires frequent changes; may traumatize wound bed on removal.

W = Wet-to-Dry → Wipe out debris, nonselective, for necrotic tissue

For wounds with moderate to heavy necrosis, non-selective, not for clean granulating wounds

I = Impregnated Gauze → Infused with agents, keeps it moist, protects fragile tissue

Low absorption- needs secondary dressing

Ideal for burns, skin tears, donor sites, granulating/epithelializing wounds