Written by Janis Harrison, RN, BSN, CWOCN, CFCN
Gauze has been around since before the pink princess phone and is viewed by some as the least expensive and most cost-effective dressing.
Is it really cost effective?
To answer honestly, you must figure in the labor costs of the highly educated and trained nursing staff you have performing these changes.
Like the pink princess phone, this technique will still work but it has a short cord. The "cord" in this case is that the gauze dressings must be changed 4 to 5 times per day, whereas many of today's dressings only need to be changed every three days.
I'll leave the math to you....
The disadvantage of this technique or using any dressing that requires an increased number of changes is the increased opportunity for infection.
Here's the thing - gauze can do the job, but it can hurt. By nature, gauze adheres itself to the wound as it dries, forcing the provider to peel it from the wound bed.
Now imagine doing this four to five times a day... ouch
To be clear, this is not a rant against gauze but rather a loud call to bring attention and appreciation for the labor-intensive nature of this technique. Especially if it is to be effective and not cause patients needless discomfort.
Case In Point
My husband was a patient in a highly regarded teaching hospital where a surgeon had opened him from the bottom of his sternum to as far south as the scalpel would go. Shortly after the surgery, a resident in his final year came in to change his dressings.
After patting the wet-to-dry dressing like he was driving a symphony piano to the point of crescendo, my husband made his point of view known regarding the level of pain the good doctor was inflicting.
This must have hurt the doctor's feelings because he turned on his heel and left the room mumbling something about knowing how to use a pink princess phone better than we did.
Next came three fine residents in training. The senior resident ordered number two to change the dressings. You could see it in her eyes - she had no idea what to do and I could already feel the pain in my husband's eyes. He knew the pain that was about to be wreaked upon his abdomen. But then this resident turned to number three and charged her with the task before quickly slipping out of the room.
Poor number three looked like a deer in the headlights.
I am a CWOCN, CFCN and my husband is an educator. We are compassionate people so I asked the young surgeon-to-be if she would like me to teach her how to pack the dressing. She happily took me up on the offer.
Soon after, the Head of Surgery of this prestigious private teaching hospital came in and asked us how we were doing. This prompted an educator to educator discussion on what had transpired with a focus on the fact that none of his students knew how to pack a dressing or perform the dressing change.
The point being that is that to this day many surgeons don't know why or how to use wet-to-dry dressings because it wasn't taught to them. It's a technique that has been handed down like a pink princess telephone that everyone is just supposed to know how to use.
More on Gauze Dressings
Gauze dressings come in a variety of weaves, sizes, impregnated, sterile and non-sterile, and different thicknesses, and since they are labor-intensive they often require more pain medication to help with patient discomfort.
Gauze does not maintain a moist wound environment and can easily necessitate frequent changes throughout the day, depending on the amount of exudate from the wound. The frequency of change can also increase the bacterial dispersal into the wound.
Non-adherent dressings may be placed instead to decrease patient pain and increase patient compliance. Using petrolatum based gauze over the loose weave gauze can help keep the wound moist but healing time is slow and it is still labor intensive.
Gauze Application Tips
Loosely fill dead space to avoid pressure on the wound
Use a single piece or roll of gauze when filling dead space
Use tightly woven gauze for minimally exudative wounds
Use loosely woven gauze for highly exudative wounds
Do not allow dressings to completely dry out as this leads to painful removal and tissue desiccation.