Good morning, Mr. Fox.
I'm here to do a dressing change today.
First I'm just going to check your patient ID.
And I do see, in fact, that you are Mr. Allen Fox.
First I'm going to start by just removing your old dressing,
and having a look at your incision, if that's all right with you.
Perfect.
So now I'm just going to raise the height of the bed a little bit,
just so it's more comfortable for me,
at a more comfortable work level.
I think that's great.
Before I start, I'm just going to sanitize my hands,
and I'm going to apply some clean gloves.
Alright, so if you don't mind,
I'm just going to lower your gown up here slightly
so I can have a look at the dressing.
I'm going to go ahead and remove the dressing, Mr. Fox,
and I'm also going to be assessing the site here.
I can see that there's a moderate amount
of serosanguineous discharge that's coming out,
so I'm going to be sure to record that in your chart.
I'm going to dispose of that.
And I'm going to look at the incision itself.
When I'm assessing the incision,
using the tool REEDA is very useful.
This is a tool that can be applied to any incision,
anywhere on the body.
So what I'm assessing for-- REEDA, is R-E-E-D-A.
"R" stands for redness.
The first "E" stands for edema,
then ecchymosis, discharge, and then approximation.
This is a fresh incision,
so I can see that there's a little bit of redness
around the incision area.
I don't see any edema or ecchymosis present.
There was some discharge that I did mention,
and it seems like the wound edges are well approximated.
So everything seems to be looking good, Mr. Fox.
I'm just going to now get my supplies ready
and we'll go ahead and redress that for you.
So today we're going to be setting up a sterile field,
and I'm going to be going through that with you.
I just want to let you know that I've gathered the equipment,
and I'll be reviewing the equipment that I've gathered.
But before I do that,
I have gone ahead and I have Viroxed my table,
so my environment is nice and clean.
Now I will go over the equipment that I have gathered.
In this case, I'm going to be doing a simple dressing change,
so I've gathered a dressing tray.
If you're not sure what equipment you need
in terms of the dressing that you're completing,
because there are various trays that are available,
the supplies are listed on the dressing tray itself.
So feel free to read that, and then see if there's anything else
that you might need to add to your tray.
The other thing, when grabbing a dressing tray,
is to make sure that the tray is intact,
and also checking the expiry date
to make sure that you're still able to use it.
The other thing-- I mentioned that I needed to add a few supplies,
so I'm going to add a 2x2 and a 4x4,
so I've gathered those supplies as well.
This particular dressing tray
does not come with a pair of sterile gloves,
so I have grabbed a pair of sterile gloves that I will need to don afterwards.
I have grabbed some solution
that I will need in order to clean the wound,
and I've noticed that this solution has been opened before,
but it has been dated and timed.
It's still within the 24 hours, so I'm okay to go ahead and use it.
I'm also going to check the expiry date,
just to make sure that the solution itself is still--
I am still able to use it.
And I'm also going to look at the solution
to make sure that it's clear--
that there are no sediments, that it's not cloudy or looks funny.
And then I'm going to have some tape,
so I have my tape here.
Before I start opening up, I'm going to sanitize my hands.
Okay, so I'm going to start by opening up my dressing tray.
There's a perforated edge at one end,
so that's the edge that I'm going to tear off,
and it just opens quite nicely.
When I start opening my tray,
I always want to start by opening it away from me,
and I'm going to be doing so gently,
because I don't want to dislodge the forceps
that are actually tucked underneath here.
I'm also going to be cognizant of the one-inch border
that's considered contaminated,
so not to put my hands in the tray itself,
causing contamination.
I've now grabbed the forceps that are considered sterile.
The tips of these forceps are considered sterile.
What I like to do is I like to square out my field,
like so.
And I can rearrange or organize my container
so it's better for me.
Then I'm going to place my--
Actually, before I do that, I'm going to remove some of the items.
I have a plastic garbage bag here,
so I can use it, or I can discard it.
I have my drapes that I'm going to remove,
and I have a couple of pairs of tweezers in here.
As mentioned before, I'm going to add a couple more items,
so I'm still going to need to use these tweezers.
The tips are still sterile, so I'm going to make sure
that I place the tips beyond that one-inch border
so that they remain sterile for further use.
I'm going to add my 2x2.
Using the sterile tips,
I'm going to withdraw the sterile 2x2
and place it in my tray.
Now I'm going to add a 4x4.
The inner package of these is considered sterile,
and my tips are sterile.
Then I'm going to place it in there.
And now I'm going to add my solution.
I've already checked the solution,
and I know that it's been opened within the 24 hours,
so I'm able to use it.
I'm going to unscrew it here.
I want to make sure that the label is palm up.
I'm going to discard some of that solution into my garbage,
and I want to be sure that when I'm adding the solution
that I'm not splashing it all over;
that I'm doing it in a controlled manner.
So now my solution is added, all my supplies are added to the tray,
and now I'm ready to do the sterile dressing change
on my patient.
It's very important that when you're opening your tray
you only do it right at the moment
when you're actually ready to do the procedure.
Otherwise your field will become contaminated,
related to prolonged exposure to air.
Okay, so now I'm ready to dress Mr. Fox's wound.
I've set up my sterile field with all the supplies that I need.
I've also placed my garbage right here,
so that way I don't have to turn my back.
You can have a garbage on the bed,
or you can have a garbage on the floor--
it's whatever you prefer,
as long as you're not turning your back to your sterile field.
I've also elevated the bed
so that it's a comfortable working level for me,
and I've made sure that my bedside table
is in a position related to the patient,
where I don't need to turn my back in order to gather my supplies.
So before I go on to clean the incision,
I'm going to place this drape.
And I find if I grab the corners
with my thumbs, like so,
when I put it down on the patient
my hands are not going to touch the patient,
so my hands still remain sterile.
And now I'm going to go ahead and clean the incision.
So I'm going to use the 2x2s
that I've added my cleansing solution to,
and I'm just going to wring them out.
I'm going to start by going down the center of the incision.
And as I go down the center,
I can roll my gauze
to get any debris that might be there.
In terms of Mr. Allen Fox, his incision is quite clean,
but if it wasn't, that could be something
that you might have to do a couple of times.
I'm going to grab another 2x2,
and wring that one off.
And I'm going to proceed by cleaning each side,
so I'm going to down the furthest side,
top to bottom, and then discard.
And then the last one,
I'll go down the side that's closest to me,
top to bottom, and then discard.
So now his wound has been cleaned,
and I'm going to go ahead and add the 4x4s,
because that's what the order is for,
to add some 4x4s and then an ABD pad.
So I'm just going to set the 4x4s down there.
It looks great.
Put that there.
And now I'm going to take my abdominal pad,
and I'm going to place it over here.
So now that the wound is covered I can move that down slightly,
because I don't need to keep my hand sterile.
The last thing I'm going to do is add the tape.
So that's all taped,
and now I'm just going to remove my sterile gloves here.
I'm going to Purell my hands,
and I'm going to clean up my work area
and get rid of some of these supplies.