How long can you leave that dressing on?
February 1, 1998 5 minutes read
How long can you leave that dressing on?
By Liza G. Ovington, PhD, CWSPresident, Ovington & Associates
Dania, FL
How long can I leave this dressing in place? How often does this dressing need to be changed? Can this dressing stay on longer than 48 hours?
These are only a few questions about changing wound dressings that may be posed by nurses, physicians, physical therapists, patients, caregivers, or anyone faced with the responsibility of wound care. Such questions are quite reasonable to ask, but are not so easy to answer.
Unlike pharmaceuticals, which have specific dosing instructions such as two tablets every four hours or one capsule three times a day with meals, wound dressings have no uniform rules for their dosing or changing. There is no easy or consistent answer in terms of a specific number of hours or days that should pass before a particular type of dressing should be changed. It is very difficult to make general recommendations, such as changing a foam dressing every 48 hours or changing a hydrocolloid dressing every three days.
The key to knowing when to change a dressing lies in the accurate assessment of the specific wound dressing and patient in question. There are two areas in particular that should be assessed in making the decision to change any type of dressing:
• absorptive capacity of the dressing;
• the integrity of the dressing in regard to structure and attachment to the patient and the wound.
Two other circumstances warrant dressing change, regardless of other variables:
• contamination of the dressing;
• clinical signs of infection in wound area.
Absorptive capacity of the dressing
Perhaps the most likely reason to change a wound dressing is that its ability to contain wound drainage has been almost reached, reached, or exceeded. Different types or categories of dressings have different fluid absorption abilities. For example, foam dressings usually have a higher capacity for absorption of wound fluid than do hydrocolloid dressings. Manufacturers may even publish the absorptive capacity of a dressing in terms of grams or milliliters of fluid it has been shown to hold in a laboratory test. But how much fluid any type of dressing absorbs is dependent on how much fluid is being generated by the wound it covers. A foam dressing placed over a minor laceration may never reach its absorbent capacity, whereas a foam dressing placed over a skin graft donor site may reach its absorbent capacity in less than 24 hours.How do you tell when a dressing has reached its absorptive capacity? You must examine the dressing for clues. Some types or brands of dressings may be transparent or translucent, and you will be able to distinguish fluid-saturated portions of the dressing from unsaturated portions. You may see the saturated areas as darker-colored areas or opaque areas. Usually, it is time to change a dressing when about 75% of its surface area is saturated with wound fluid. Because you should usually use a dressing size that extends beyond the wound margins, more than 75% saturation may lead to periwound maceration. If you are using a dressing that does not have a waterproof top coating of some sort (such as plain gauze or some foams), and wound fluid strikes through or comes through the top of the dressing, the dressing must be changed.
There is one dressing on the market that is specifically designed to have a visual indicator for when it should be changed (SignaDress by ConvaTec). It is a hydrocolloid dressing with an indicator line drawn around its perimeter. As wound fluid is absorbed, the dressing becomes opaque. When the opacity reaches the indicator line, it is time for a dressing change.
If a dressing becomes compromised in terms of its structure or attachment to the patient’s wound, it is time to change it regardless of its saturation level. An unattached dressing compromises the optimal wound environment by potentially allowing the wound to dry out or become contaminated by exogenous bacteria or foreign material.
For example, if a hydrocolloid dressing is placed over a wound, and 30 minutes later you find one corner lifted up, exposing the wound, the dressing should be changed.
How do dressings become compromised? It may be that the edges of the dressing have adhered to the patient’s sheets, and then when the patient changes position, the dressing is pulled off. If a dressing is applied over an anatomical area subjected to high friction or flexion, it may develop wrinkles or channels such that an entry point for exogenous bacteria or dirt is created and the risk for infection exists. The surface of a dressing may be torn or punctured by contact with shoes or clothing, a wheelchair, or something in the patient’s environment. Whenever an adhesive dressing becomes unattached at any point, it should be changed. If the dressing has no adhesive component but is being attached to the patient by some other means (such as a tubular netting or a self-adherent wrap), and it becomes unattached, it should be changed.
Dressings that have become contaminated with urine, feces, dirt, or foreign material on their surface or edges should be changed even if they have not become unattached.
Clinical signs of infection in wound area
Finally, the dressing may be in perfect condition, unsoiled, in place, less than 25% saturated with wound fluid; but you notice a reddened, swollen area around the wound that is warm to the touch, and the patient complains of pain when you touch the periwound area. The dressing should be removed so a thorough assessment and diagnosis of wound infection can be made. If the wound is determined to be infected, it may affect your choice of dressing to be reapplied after the infection has been addressed.While there are no consistent answers to questions about how often dressing A, B, or C should be changed, with experience you may develop a "feel" for how long a particular type or brand of dressing may stay in place in a particular anatomical area, or absorb fluid under particular wound drainage conditions. It is important to remember that other factors, such as the external environment or patient care setting and performance characteristics of the dressing material, may also affect dressing changes.
An ambulatory patient may subject a dressing to more potential for compromise than a bed-bound patient. It is also important to select the right dressing for the wound initially. If a thin hydrocolloid dressing is placed on a moderately to heavily draining wound, it may require more frequent dressing changes than if a more absorbent alginate dressing had been selected. Next month we will discuss strategies for selecting the right dressing the first time, and making appropriate adjustments based on the progress of the wound.
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