The Perioperative Patient for Registered Nurses

Dressings

After a surgical incision is closed, a dressing is applied to:

  1. Cushion and protect the wound.
  2. Absorb any exudate. 
  3. Aid in wound debridement.
  4. Help to immobilize or support the body part and incision.  
  5. Help with hemostasis and control edema, if it is a pressure dressing. 
  6. Provide comfort to the patient and produce a clean appearance. 
  7. Help to ensure a moist environment in dressings that are meant to be moist. 
  8.  Hold medications placed within a dressing or dressings that have medications impregnated.
Dressings are Categorized as Primary or Secondary

PRIMARY – These dressings are placed directly on top of a wound. Their main function is to absorb drainage and keep it away from the edge of the wound.

SECONDARY – These dressings provide additional compression. They are placed over the primary dressing and can be used to absorb any leaking fluid.

(Bak, 2019)

Selecting a Dressing

When choosing an appropriate dressing, the perioperative team must consider its purpose.

Is it to absorb drainage? Provide splitting or support? Ensure moisture management. Other considerations:

  1. Does the patient have any allergies or sensitivities?
  2. What is the patient’s current skin condition?
  3. How large is the wound? What are the other characteristics of the wound?
  4. How much drainage is anticipated from this wound?
  5. What is the surgeon’s preference?

ORNAC standards clearly note that radiopaque sponges SHALL NOT be used for postoperative dressings. This is a safety mechanism in case the patient needs to come back to the OR, or if imaging needs to be completed.

(ORNAC, 2021)

Adding Dressing Supplies to the Sterile Field

Post-operative dressings should not be added to the sterile field until the final count is complete. This is to prevent the risk of a non-radiopaque sponge being retained in the wound. With the increased use of sterile custom packs, dressings are often included. These dressings must be clearly isolated within the pack and remain isolated until the final count has been finished.

(ORNAC, 2021)

📁Documentation Highlight

The circulating nurse must ensure that the following information is documented related to the dressing:

  1. Type of dressings used
  2. Location of the dressings
  3. Method of securing (ie. taped in place)

It is vital that this information is provided in report to the post operative care nurse during handover.

(ORNAC, 2021)