The Royal Marsden Hospital Manual of Clinical Nursing Procedures - Lisa Dougherty [103]
9 Loosen the adhesive or tape on the existing dressing. To make it easier to remove the dressing. E
10 Clean hands with alcohol handrub. Hands should be cleaned before any aseptic procedure (WHO 2009). Using alcohol handrub avoids having to leave the patient to go to a sink. E
11 Open the outer cover of the sterile pack and, once you have verified that the pack is the correct way up, slide the contents, without touching them, onto the top shelf of the trolley. To minimize contamination of the contents. E
12 Open the sterile field using only the corners of the paper. So that areas of potential contamination are kept to a minimum. E
13 Open any other packs, tipping their contents gently onto the centre of the sterile field. To prepare the equipment and, in the case of a wound dressing, reduce the amount of time that the wound is uncovered. E
14 Where appropriate, loosen the old dressing. To minimize trauma when removing the old dressing. E
15 Clean hands with alcohol handrub. Hands may have become contaminated by handling outer packets or the old dressing (Pratt et al. 2007, C).
16 Carefully lift the plastic disposal bag from the sterile field by its open end and, holding it by one edge of the open end, place your other hand in the bag. Using it as a sterile ‘glove’, arrange the contents of the dressing pack and any other sterile items on the sterile field. To maintain the sterility of the items required for the procedure while arranging them so as to perform the procedure quickly and efficiently. E
17 With your hand still enclosed within the disposal bag, remove the old dressing from the wound. Invert the bag so that the dressing is contained within it and stick it to the trolley below the top shelf. This is now the disposal bag for the remainder of the procedure for any waste other than sharps. To minimize risk of contamination, by containing dressing in bag. E
To ensure that any waste can be disposed of without contaminating the sterile field. E
18 Pour any solutions into gallipots or onto indented plastic tray. To minimize risk of contamination of lotion. E
19 Put on gloves, as described in procedure guideline 3.3 or 3.7. The procedure will dictate whether gloves should be sterile or non-sterile. Gloves should be worn whenever any contact with body fluids is anticipated (Pratt et al. 2007). Sterile gloves provide greater sensitivity than forceps for procedures that cannot be carried out with a non-touch technique and are less likely to cause trauma to the patient. E
20 Carry out the relevant procedure according to the guidelines.
Postprocedure
21 Make sure the patient is comfortable. To minimize the risk of causing the patient distress or discomfort. E
22 Dispose of waste in orange plastic waste bags. Remove apron and gloves and discard into orange waste bag. To prevent environmental contamination. Orange is the recognized colour for hazardous infectious waste (DH 2006a, C).
23 Draw back curtains or help the patient back to the bed area and ensure that they are comfortable. To minimize the risk of causing the patient distress or discomfort. E
24 Check that the trolley remains dry and physically clean. If necessary, wash with liquid detergent and water or detergent wipe and dry thoroughly with a paper towel. To remove any contamination on the trolley and so minimize the risk of transferring any contamination elsewhere in the ward (Pratt et al. 2007, C).
25 Clean hands with alcohol handrub or soap and water. Hands should be cleaned after any contact with the patient or body fluids (WHO 2009, C).
26 Document the procedure clearly, including details of who carried it out, any devices or dressings used, particularly any left in situ, and any deviation from prescribed procedure. Fix any record labels from the outside packaging of any items used during the procedure on the patient record form and add this to the patient’s notes. Provides a record of the procedure and evidence that any items used have undergone