Troubleshooting Wound Dressing: What to Do When Something Goes Wrong
Despite how exquisite your wound dressing is when you’ve completed it, there’s always the possibility of something going wrong. Perhaps the patient complains about the wound itching under dressing layers, or they could have an unanticipated skin reaction. It’s important to be prepared to deal with a wound dressing mishap so you can provide the best protection for the wound and minimise the distress or discomfort of the patient.
If you want information on dressing different types of wounds, take a look at our article A Complete Guide to Wound Dressing. This article will cover the most common wound dressing problems and how to handle them.
An Allergic Reaction to Wound Dressing Materials
Many wound dressing products are described to be hypoallergenic today. But if you’ve read our article on how to tell if a product is hypoallergenic, you’ll know that there’s no regulated standard or test to determine hypoallergenicity.
The best way to minimise the chance of allergic reaction to wound dressing treatment before applying the dressing is to find out from the patient if they have any known allergies. Known allergies from materials in wound dressing include:
- Latex
- Rubber
- Lanolin
- Acrylates
- Parabens
- Some adhesives
- Some detergents
- Topical antibiotics
Even if the patient has no known allergies, repeated removal and reapplication of a dressing can disturb the skin's natural environment and produce irritant contact dermatitis, a type of eczema.
Read our article Equipment Needed for Wound Dressing to see what other supplies your patient might be allergic to.
An allergic skin reaction to wound dressing most often shows itself as skin that is
- Red
- Flaky
- Swollen
- Cracked
- Blistered
- Thickened
You might also see something that looks like a rash from wound dressing, such as red blotches or bumps, or the patient could complain of an itchy wound dressing. A sure-fire sign that the skin irritation is from wound dressing is that these visible signs will follow the shape of the dressing on the skin where it comes into contact.
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How to Treat an Allergic Reaction to a Wound Dressing
Treat an allergy to wound dressing by first removing the dressing causing the problem. This should be done as soon as possible but take care and work slowly to ensure minimal trauma to the inflamed area. Here are some ways to deal with wound dressing allergic reactions.
- Discontinue the use of the current wound dressing materials and find a substitute.
- Reassess the exudate coming from the wound and how many dressing changes are necessary. If you can switch to a different dressing to reduce the frequency of dressing changes, the skin will be less disturbed and less prone to irritant contact dermatitis and skin stripping.
- Check whether the dressing retention tape used is hypoallergenic. Dressing tape is often the root of wound dressing allergies. Choose a hypoallergenic tape if possible, like Sterofix Dressing Retention Tape.
- If the injury is on an extremity, use a tubular bandage to hold the dressing pad in place. This removes the need for adhesive or dressing retention tape.
- Use medical adhesive remover when removing the dressings to reduce skin stripping.
The Wound Dressing Smells
Sometimes called ‘malodour’, an unpleasant smell coming from a wound dressing can signify two things: bacterial growth in the wound or the presence of necrotic tissue. The smell comes from the metabolic processes of the present anaerobic bacteria, releasing compounds that smell unpleasant.
A smelly wound dressing doesn’t necessarily mean something bad has happened. It can signify that something is slowing, or presenting a barrier to, wound healing. A bad-smelling wound dressing also has a negative psychological effect on the patient and their caregivers, so it’s a good idea to resolve it quickly.
- Regularly clean the wound and change the dressing. Reassess the frequency of cleaning and changing the dressing as necessary.
- Debride the wound if necessary to remove necrotic tissue.
- Educate and train the patient or their caregiver on how to clean and dress the wound appropriately and how often this should be done.
- Use biocidal cleaning agents when cleaning the wound designed to kill odour-causing bacteria.
- Change bedding and clean the environment regularly.
- If possible, swap to looser-fitting bandages such as white open weave bandages to help circulate air to the wound site.
- Healthcare practitioners widely find metronidazole gel or powder to be the most effective at treating anaerobic bacteria at the wound site.
If you are looking after your wound at home or providing care to someone else and you notice a bad smell, consult your GP for advice on what to do to ensure you’re doing the right thing.
An Infected Wound Dressing
A foul-smelling dressing isn’t always a sign of something bad happening, but it’s important to be sure that it’s not the result of an infection. Symptoms of a wound infection include:
- New pain or pain that doesn’t start to get better.
- Erythema (a skin rash that affects the blood capillaries).
- An area around the wound that feels swollen, hard, hot, or a combination of these.
- Malodour
- Presences of abscesses, pus, or bleeding.
- Increased exudate.
- Discolouration.
- Delay in normal healing time.
Avoid using a dressing that will stick to your wound, such as a wet-to-dry gauze dressing, to minimise the chance of infection.
An infected wound usually requires a course of antibiotics to eliminate the infection completely. Antimicrobial dressings can be used to stem the spread of bacteria at the wound site. These work by either releasing a microbial agent into the wound on contact or drawing out bacteria contained in exudate and eliminating it in the dressing bed. Here are some common antimicrobial dressings
- Honey: used for centuries as a wound management device. Medical-grade honey is now available that offers antimicrobial and anti-inflammatory benefits. It can also help to treat malodour.
- Iodine: one of the most effective substances for clinical infection with broad-spectrum efficacy.
- Silver: a sustained slow release of positively charged ions effectively kills bacteria.
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An Over Granulating Wound Dressing
Over granulation sometimes occurs when granulation tissue in a wound left to heal by secondary intention. Granulation tissue fills the wound bed to a point where it comes above the surface of the epithelial tissue, preventing epithelialisation (the knitting together of the top layer of the skin).
It is thought that the efficiency of wound dressing today can sometimes prevent the start of epithelialisation, but many different circumstances can cause over granulation.
When signs of over granulation are present, stop using any wound dressings that promote granulation as soon as possible. A dressing that creates a warm, moist environment will promote epithelialisation and reduce over-granulation. A low-adherent foam dressing is a good choice. It's also important to be sensitive to the signs of infection. Using an antimicrobial dressing will head off any chance of infection while the wound heals.
How to Remove a Dressing Stuck to Wound Tissue
The dressing can become stuck to the tissues as exudate is drawn out of a wound. This is especially true of gauze, which has wicking properties. When you remove a dressing stuck to wound tissues, skin-stripping or pulling off a scab can expose layers underneath, which become prone to infection.
Because of this, removing a dressing sticking to wound areas should be done with extremely high levels of hygiene. Ensure your hands are clean, and you wear disposable gloves if possible. Keep the space around you clean, and ensure you have all the necessary tools and supplies before you start. This could include getting supplies ready using the aseptic non-touch technique.
A wound stuck to dressing can be painful for the patient so remember to work slowly and encourage them to communicate with you while you do it to ensure they are not distressed.
Here’s what to do if dressing is stuck to wound tissue.
- Place one hand firmly on the area above the dressing where you plan to begin peeling it.
- Grasp the edge of the dressing and begin to pull it in the direction of hair growth slowly.
- When the dressing won’t come away without tearing the skin or causing pain, soak the wound dressing in either clean water or a saline solution.
- When the dressing area has softened, try to remove the dressing again. Stubborn scabs may need to be soaked a few times.
- Once removed, clean and inspect for any stuck fibres. You may be able to remove them with tweezers carefully.
- Allow the wound to air dry thoroughly and apply a fresh dressing.
But this isn’t the only way to remove a dressing stuck to wound tissue. If you used a gauze wet-to-dry dressing, then you can expect it to be completely stuck to the wound by the time you need to change it. With a wet-to-dry dressing, the aim is to remove dead tissue as you remove the dressing, so this will cause the patient pain and discomfort. You may want to offer them pain relief and medicate the wound area.
If a wound bleeds during dressing change, this isn’t something to cause concern, especially if it’s a wet-to-dry dressing. Keep an eye on the bleeding; if it doesn’t stop or gets worse, the wound will need to be inspected further.
How to Prevent Dressing From Sticking to Wound
When considering how to remove sticky wound dressings, it’s a good idea to think about how to stop dressing sticking to a wound in the first place.
Stop a wound sticking to dressing material by maintaining a moist environment that won’t dry out. You can do this by soaking gauze in substances like vaseline and other ointments. Check that it’s safe to use the product directly on your wound is safe before applying it.
Another reason a dressing keeps sticking to a wound is that it needs to be changed more frequently. Ensure you check the dressing regularly and apply a fresh one when needed.
Browse all the most commonly used wound dressings from Steroplast. We supply NHS trusts across the UK with wound dressing supplies, including ambulance dressings, adhesive and non-adhesive dressings, waterproof dressings, eye pads, and wound closures.
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