Editing Nursing Skills and Procedures (section)

=== Step sequence for a sterile dressing change ===
# Verify the order, assess pain, and premedicate so the analgesic peaks during the change.
# Perform hand hygiene, don clean gloves, and remove the old dressing, moistening it with sterile saline if it adheres so granulation tissue is not stripped.
# Assess the old dressing for amount, color, odor, and consistency of drainage, then discard it and the gloves and perform hand hygiene again.
# Set up the sterile field, open supplies onto it, and pour solution without reaching across the field.
# Don sterile gloves. Assess the wound bed, measure length, width, and depth, and probe for undermining and tunneling using clock terminology with 12 o'clock toward the patient's head.
# Clean from least contaminated to most contaminated, moving from the incision outward, using a new gauze for each stroke. Never return a used gauze to the wound.
# Pack loosely if ordered. Overpacking raises pressure and impairs perfusion. Packing is counted in and counted out and documented.
# Apply the new dressing, secure it, and label it with date, time, and initials.
# Reassess the patient and document findings and tolerance.