 Welcome to nursing school explained and today's video on how to change a sterile dressing. Most of all keep in mind that you always want to gather your equipment first because once the old dressing has been removed you want to make sure that you have all the supplies that you could possibly need right there at the bedside so you don't have to leave the room or call for help and have some supplies brought in. So what I like to do and it'll depend on the facility that you work at. I like to bring either a dressing change kit and then also maybe some extra gauze. This gauze here is nice because on the side it has a little tip measure so you could use the wrapper of the gauze to measure the wound if that's needed and then I also like to maybe bring an extra pair of sterile gloves as well as some cleaning swabs just in case something happens or the kit doesn't supply everything that I need. Keep in mind if you're using a kit it usually has all the contents of the kit right there for you so that you can know what's in the package and then you can gather any other supplies that you might need. Once I uncover the patient and their dressing I can basically get ready to set up my sterile field and also assess the wound and I will do this by performing hand hygiene and then putting on just clean gloves and removing the patient's dressing but before I want to do that I note here that this patient has paper tape that they use so in order to prepare myself better I will again also use paper tape and I can measure the length of the tape strips that I'll need but just measuring the length and tearing them off and then placing them at the bedside table or some other place where I can easily get to them later on. Another trick is to make a little tab at the end of the tape which later will help you once you remove the tape off the patient's skin it's much easier to come off when there's a tab otherwise you might have to really dig underneath that tape to get it off and that might not be good for the patient's skin nor might it be very comfortable when that happens and typically we want to form a window frame around the dressing which is what I'm doing here because this dressing was set up the same way before. Okay so now I'm ready to remove the dressing so I gently want to remove the tape. If the tape sticks too much to the patient you can always look for these tabs but if there is no tabs you can take a little alcohol and wipe underneath the tape which will help to dissolve the adhesive of the tape and then the dressing will come off easier. So I loosen it up all the way around first and then I will just remove the dressing and I can throw it right down into the trash that I set myself up with and then I can remove the rest of the dressing and this time I will see if there's any discharge, draining, any kind of fluid that's on the dressing so I can put that in my charting later on. I also want to take a look at the wound and we use the acronym READER so I want to assess for redness, ecomosis, edema, as well as drainage and approximation and the approximation means is the wound, are the wound edges approximate, are they together? In the case of this wound they are not really well approximated because I have this gap right here for this laceration so if they were approximated this would be if there were for example sutures or staples in place here and the two wound edges here were to come together. So now I can take off my clean gloves, I will perform hand hygiene again and then I can open up my sterile dressing kit and this particular kit comes with a nice sterile field so we'll also see how to set up a sterile field. I always like to just fold this over here. This particular kit comes with a trash bag you could set it up right here if you open up the kit before you remove the old dressing and then use this as your trash but in this case I already took off the dressing so I can't just get rid of this. So then everything in here is sterile so now I have to be careful and the sterile drape I'm going to set myself up with and I'm going to pick up one inch of the edge of that drape so I'm going to pick it up right here move the remainder of the box out of the way for now and then hold it at the edge let it unfold and then set it up right here. Now I have a nice sterile field and I can take the contents of the sterile dressing kit and just dump it on here being careful that they don't roll out to this one inch margin. My kit can go away if I were to use additional supplies if I were to use this gauze that I talked about earlier has this nice measure tape measure I could just again open up the wrapper away from the sterile field of course now touch the inside and then carefully just dump it on my sterile field. In this case I'm actually going to use the tape measure and I could use it to visualize and see the length of the wound in this case there's about 10 so this is about 11.5 to 12 centimeters long there's not really a whole lot of width maybe right there at the biggest diameter it's about 1 centimeter and then if there was any depth of the wound I would have to take a sterile q-tip and place it inside the wound gently and measure the depth and then keep that in mind for later so that I can chart that. So now that I got my sterile field all set up I'm ready to don my sterile gloves and I'm going to use those to that away from my sterile field I don't want to put anything on top I don't want to reach over it so I'm just going to look put them aside here careful not to overlap anything and then don my sterile gloves and I have a separate video on how to don sterile gloves properly and then I can just take the wrapper here and be careful stay away from the sterile field and throw it in my in my bin. Now everything here is sterile my sterile gloves I can touch everything here but again I'm going to be careful not to go within that one inch margin but there's a couple of things that I'm not going to need which are these four steps I'm probably not going to use these scissors either I don't wear any tape because I already got my paper tape ready really all I'm going to need on my cleaning swap sticks my gauze and my ABD pad which is what was previously on the dressing so this is fairly simple going forward now because I'm just going to use the gauze and place it over the wound actually first I need to clean it and so I tear this off and this can go in my trash or I can leave it here because it's all still sterile and it comes with these three swap sticks sometimes there can be some cleaning solution in there so you want to be careful not to place the wrapper on the sterile field where the fluid could leak out of the wrapper because then you have a wet sterile field and now it's contaminant because germs could soak through there so you want to either hold on to them remove them and get rid of this wrapper or keep it here but make sure that it doesn't go upside down and then we'll typically clean the wound with whatever the prescribed cleaning solution is just like we do on catheter insertion one wound edge throw that away second wound edge throw that away and then the third wound just down the middle depending on the orders and what the wound looks like then I'll let that just dry for a couple of seconds now I'm ready to put the gauze on remember the gauze is sterile so are my gloves so I don't want to touch the patient when I put the gauze on so I can either just come here and carefully place it on there or I can grab it in the middle and do it this way I'm going to take my ABD pad and place that on top now my sterile procedure is actually complete I could take off my sterile gloves now but since they're still clean I'm not contaminated there's no blood on it I can now use the tape that I have previously prepared here in the appropriate size strips and again I will use a tab here place it on one side here use the other long strip the other side and then my third strip is shorter so it'll go again in this window frame method with my tab and before I put on my last one because I want to label a date time and initial the dressing but now I'm not sure if the gloves touched anything before I reach inside my pocket and use my pen to do that I'm going to take up my sterile gloves and by now I can just discard all these contents here and I will do hand hygiene and then take my pen and label this last piece of tape because I don't want to write on the page that might be very uncomfortable so I'll write the date and the time I'll say it's 10 38 a.m. and I'll put my initials and then I'll put this last piece of tape right there and now I have concluded my sterile dressing change remember to chart everything that you've done to make sure that you take care of your patient give them the call light do all the appropriate things and then regarding the charting always include what the wound looked like so with the reader acronym also include what kind of dressing you did how what kind of addressing was it what supplies that you use as well as how the patient tolerated the procedure please also watch the other videos in my skills playlist regarding sterile technique for catheter insertion as well as donning sterile gloves thanks for watching nursing school explained see you soon