For cats’ open wounds, soft tissue infection incision and drainage, surgical incision infection, etc., due to local tissue pathological reactions, the wound surface will appear exudation, suppuration, necrosis or tissue defects, etc., and should be treated appropriately. This treatment includes inspecting the wound, removing pus and necrotic tissue, placing or removing drainage, replacing dressings and bandages, etc. This process is called dressing change, also known as dressing change or medicine application.

1. Purpose of dressing change

1. Observe the wound; 2. Remove necrotic tissue; 3. Clean the wound; 4. Smooth drainage; 5. Promote tissue growth.

Principles: 1. Aseptic principle; 2. Remove inactivated necrotic tissue; 3. Maintain and promote granulation growth; 4. Promote wound healing

2. Preparation before dressing change

1. Fully understand the wound, the size and depth of the wound, the number of gauze packing in the wound cavity, whether there is drainage and whether it should be removed or replaced, whether the wound needs to be expanded or flushed, whether stitches need to be removed or sutured, etc. First check whether the required dressings, equipment, drugs, etc. are all available. Special supplies should be prepared, such as antibiotic solution for wound surface coating, local anesthetic blades for widening wounds, long vascular forceps probes for deep wounds, replacement Special drainage tubes for suprapubic cystostomy, etc. The patient's mental state, general condition and possible situations that may occur during dressing change should be understood in detail and fully prepared.

2. Sterile preparation: Generally, dressing changes are required to be done half an hour after morning care or cleaning of the dressing room. It is best to change the dressing in the dressing room. Put on the mask and cap, invite the patient to the dressing room, observe the wound condition (remove the gauze in the direction of the wound, vertical removal will easily cause the wound to open again), evaluate the required equipment, and the number and type of dressings. Then wash your hands and prepare items for dressing. Generally, two sterile bent plates, two pairs of tweezers, alcohol cotton balls, etc. are needed. When clamping the instrument, the tweezers must face down and cannot be tilted up. In the order of clamping, clamp the tweezers first, place them in the middle of the bent plate, and cover them with gauze. Above, place the iodine and alcohol on both sides of the curved plate. Clamp the iodine cotton balls first and then the alcohol cotton balls (if you clamp the alcohol first, the remaining alcohol in the tweezers will dilute the iodine and affect the disinfection effect).

3. Operation: Take the outer auxiliary material with your hands, and then use tweezers to take out the inner layer. If it sticks, moisten it with a saline cotton ball and peel it off. Two tweezers, one touching the skin and one touching the accessories (never touch the two tweezers). Disinfect the wound and suture opening by gently dipping it, and then (for clean wounds) disinfect from the inside to the outside with alcohol at least twice, and the area should exceed the covering gauze. Cover with the smooth side of the gauze facing down, and cover with at least eight layers of gauze (usually four layers of gauze). The viscose cloth should be glued along the direction of the skin grain and vertically to the gauze. Generally, there are three strips, one on both sides and one in the middle. Wash your hands last (to protect yourself).

4. Sequence: clean first, then dirty, simple first, then complex. a patientThe same goes for multiple wounds.

3. Frequency of dressing changes

In principle, the dressing should be changed as soon as the excipients are wet

1. General wounds: within 24 hours for the first time, then every 2-3 days/time;

2. Special wounds: after breast surgery, 3-5 days/time;

3. After skin grafting: 7-9 days/time;

4. Gastrointestinal fistula: 2-3 days/time;

5. In summer, change it every day and apply alcohol gauze;

4. Dressing Selection

In the first few days, the growth of the wound is mainly the growth of granulation tissue, which requires a relatively humid environment, so several more layers of dressing can be used in the first few days to keep the wound surface relatively moist. In the later stages, the growth of the wound is mainly the growth of keratin. At this time, the wound needs a relatively dry environment, so the dressing should be as thin as possible while providing isolation. In addition to protecting the wound from external contamination, the dressing also has a certain drainage effect. Therefore, when changing the dressing, you should ensure that the dressing adheres closely to the wound, especially when the wound is lower than the surrounding area.

5. Things to note

1. When changing the dressing of a sterile primary wound, the local swelling and exudation should be observed routinely for 24 hours and 72 hours.

2. After open injuries, strive to change dressings for three consecutive days within 24, 48, and 72 hours. Pay special attention to hematoma or drainage situations that are prone to occur and it is critical to eliminate dangers in a timely manner.

3. Infected wounds are more common in orthopedic wounds, such as skin necrosis and bedsore wounds. Hypertonic saline is generally used at a certain period of time for wounds with severe infection and large amounts of exudation. It can quickly reduce the edema of the wound and granulation tissue, and reduce Oozing.

4. For reimplantation surgery or flap surgery with anastomosed blood vessels, it is best to use nitrofuracil solution that is close to body temperature for dressing change. Ring dressing gauze should be avoided on fingers, and it is best to fill the local area with rags.

5. For large-area wounds, first pay attention to debridement. Do not tolerate necrotic tissue, including necrotic tendon and vascular tissue. Try to resect decisively once the boundary is obvious during several dressing changes. Reluctantly leaving it behind will only delay the growth of granulation and even cause infection.

6. For wounds that have removed most of the necrotic tissue, pay attention to the growth of granulation tissue. The granulation tissue itself has the ability to resist infection. If there is no obvious leakage, do not use antibiotics or other medicines to change the dressing. Use only iodine. Disinfect the wound edge skin and cover it with wet saline gauze.

7. Do not place the oil gauze strips on the wound surface. They should be placed on the saline gauze to prevent the brine from evaporating too quickly.

8. For infected wounds, please do a bacterial culture + drug sensitivity before changing the dressing to avoid being infected in the future.move.