Opatrywanie ran przewlekłych jest procesem złożonym, podczas którego należy przede wszystkim zachować odpowiednie warunki higieniczne. Istotne jest również prawidłowe oczyszczenie rany i zabezpieczenie skóry wokół rany. Jakie są podstawowe zasady opatrywania ran?
Przed przystąpieniem do założenia lub zmiany opatrunku należy starannie umyć i zdezynfekować ręce, założyć rękawiczki jednorazowe oraz przygotować stanowisko do zmiany opatrunku i niezbędne materiały.
Jak prawidłowo zmienić opatrunek?
Przy zmianach opatrunków w domu oprócz opatrunków specjalistycznych niezbędne są m.in.: serweta jednorazowa, opaska samoprzylepna i plaster do mocowania opatrunku, nożyczki dedykowane do zmiany kształtu opatrunku, rękawice jednorazowe, preparat do mycia i dezynfekcji rany (sprawdź zestawienie nowoczesnych opatrunków na rynku), 0,9% NaCl (roztwór soli fizjologicznej) lub płyn Ringera, worek na zużyty materiał.
- Zdjęcie opatrunku
Gdy opatrunek jest przesuszony i przylega do rany, nie należy używać dużej siły w celu jego usunięcia. Wskazane jest namoczenie materiału opatrunkowego płynem antyseptycznym, np. za pomocą wacika. Gdy opatrunek nasiąknie płynem, możliwe będzie jego bezbolesne usunięcie.
- Oczyszczenie rany
Opatrunek wykonuje się zawsze po dokładnym oczyszczeniu rany. Należy usunąć resztki opatrunku, luźne tkanki martwicze i zalegającą wydzielinę, np. za pomocą gazika nasączonego preparatem do mycia rany (płyn Ringera, roztwór z soli fizjologicznej). Należy uwzględnić również dno rany, kieszenie i przetoki (przetoki można oczyścić za pomocą patyczka do ucha zamoczonego w antyseptyku). Ranę zawsze należy oczyszczać od zewnątrz do jej środka.
Ranę można również opłukać pod strumieniem letniej wody. Nie jest jednak wskazane jej moczenie. Jeżeli widoczne są objawy infekcji rany, można ją oczyszczać łagodnym antyseptykiem (zobacz także: Metody oczyszczania ran).
Po oczyszczeniu na ranę należy zastosować wilgotny (nie mokry) gazik z antyseptykiem i pozostawić go na 10 minut przed założeniem nowego opatrunku (w przypadku objawów infekcji przymoczkę z antyseptykiem można zostawić dłużej, do 20 minut). Po tym czasie antyseptyk należy zmyć roztworem z soli fizjologicznej i osuszyć ranę jednorazowym ręcznikiem. Wyjątkiem są specjalne antyseptyki, które można pozostawić w łożysku rany, bez konieczności zmywania.
- Zabezpieczenie skóry
Przed założeniem opatrunku należy odpowiednio zadbać o okolicę rany, szczególnie w ranach z wysiękiem. W tym celu można zastosować kremy i maści nawilżające, natłuszczające skórę, np. maść cholesterolową, białą wazelinę, maść witaminową, maść nagietka. W przypadku stosowania opatrunków samoprzylepnych – kremy i maści należy nakładać po założeniu opatrunku, inaczej warstwa samoprzylepna nie przyklei się do skóry.
- Założenie opatrunku
Opatrunek specjalistyczny należy wyjąć z opakowania, chwytając go za brzegi i rogi. Jeżeli jego rozmiar jest odpowiedni do rozmiaru rany, można od razu nałożyć go na skórę. Jeżeli jest za duży, można przyciąć go nożyczkami, ale tylko takimi, które służą do tego celu.
Opatrunki żelowe mogą być nieco większe od rany (1-2 cm), ponieważ w kontakcie z wysiękiem żelują i zmniejszają rozmiary. W przypadku opatrunku piankowego należy pamiętać o usunięciu pokrywającej go folii przed nałożeniem na ranę. Do zaopatrzenia przetok mogą służyć jako sączek opatrunki antybakteryjne w postaci siatek, tkanin lub taśmy.
- Założenie opatrunku wtórnego
W przypadku ran z poważnym zakażeniem czy silnie sączących się zalecane jest dodatkowe zabezpieczenie rany opatrunkiem wtórnym/wierzchnim. Kolejne warstwy opatrunku powinny być zakładane luźno, w taki sposób, by nie uciskały rany.
- Zabezpieczenie opatrunku
Na opatrunek należy założyć bandaż, a jego koniec zabezpieczyć plastrem lub specjalną siatką. Bandaża nie można wiązać na supeł oraz zabezpieczać żabką metalową, ponieważ może to doprowadzić do zranienia naskórka, niedokrwienia lub powstania odleżyn spowodowanych uciskiem supła. Cały opatrunek nie powinien być zaklejony plastrem, można nim wzmocnić jedynie brzegi opatrunku.
Po zmianie opatrunku należy zdjąć rękawiczki i wyrzucić je do specjalnego worka na zużyte materiały opatrunkowe. Konieczne jest również dokładne umycie i zdezynfekowanie dłoni.
Źródło: Grupa Robocza ds. Praktyki Stowarzyszenia Naukowego Leczenia Ran, „Stanowisko w sprawie postępowania w ramach leczenia i opieki nad raną trudno gojącą się w okresie epidemii COVID-19 wywoływanej przez wirus SARS-CoV-2”, Forum Leczenia Ran 2020;1(1): 1-10
Przeczytaj także: Jakie rodzaje opatrunków są dostępne na rynku i w jaki sposób dobrać opatrunek do rany?
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