By: Nancy Morgan, RN, BSN, MBA, WOCN, WCC, CWCMS, DWC
In the modern world of wound care, there are many treatment options. Surprisingly though, we are still seeing orders for those dreaded wet-to-dry dressings. Using a wet-to-dry dressing involves placing moist saline gauze onto the wound bed, then allowing it to dry and adhere to the tissue in the wound bed. Once the gauze is dry, the clinician removes the gauze, with force often required. This has to be repeated every 4 to 6 hours. Wet-to-dry dressings are a nonselective debridement method that harms good tissue as well as removes necrotic tissue. It keeps the wound bed at a cool temperature and it at risk for bacterial invasion, as bacteria can penetrate up to 64 layers of gauze! It’s one of the most painful procedures for our patients, and this was one treatment that as a nurse I never wanted to do. In fact, I have heard of nurses who would remoisten the gauze before removal to make the treatment more bearable for patients.
Are you seeing a lot of these dressing still used in current practice? What types of settings are they still being used in consistently? How are you dealing with the prescribing clinicians who continue to order this treatment even though it’s considered a substandard practice for wound care?
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DISCLAIMER: All clinical recommendations are intended to assist with determining the appropriate wound therapy for the patient. Responsibility for final decisions and actions related to care of specific patients shall remain the obligation of the institution, its staff, and the patients’ attending physicians. Nothing in this information shall be deemed to constitute the providing of medical care or the diagnosis of any medical condition. Individuals should contact their healthcare providers for medical-related information.
I am a new RN. This was the only technique we were taught in nursing school. It was not widely used, as far as I observed, on the hospital ward.
Wet-to-dry dressings continue to be used in our hospital setting.
In reply to Naomi Roberts.
Hi Naomi……”I hear you!” many of the nursing schools are still teaching this old tx and that includes med schools as well. Its gonna take all of us to spread the education out on this and kick wet to dry dressings out the door! Thanks for your post and congrats on getting your RN that is awesome!
In reply to imawcc2.
:(……not good its time for them to update their policys and get w/ the times ! Thanks for your post!
I have seen nurses use AG silver like a wet to dry. First layer of absorbent silver on cellulitis wet than dry over it. Could someone comment on this practice.
In reply to Mary Lou Hedemark.
Hi Mary Lou–good post! Its not “customary”.. why? Because- Absorbent Silver such as foam or alginate is to be put on for extend period of time. Unless otherwise “specified” By wetting the product first before putting it in place brings up a few potential problems 1-its suppose to absorb so why add moisture to it as it defeats the purpose of the product and decrease the wear time. This shouldn’t be changed every 4-6 hrs like a wet-to-dry as its suppose to be in place for extended period of time. 2-if using silver there are some products (not all) where you are not suppose to use saline w/ silver. I would question that and read product instructions to make sure its being used correctly.
My thought is maybe they are using this to calm down the inflammation locally if this is the case ……its common to use domboro soaks to the affected area that will assist in decrease the inflam and is soothing to the site.
Aquacel AG is diff product where in the product insert says you can wet it first prior to applying but then again there is no need to change this every 4-6 hrs as its a product that is used to stay in place for extended period of time.
I hope that helps clear some things up thanks for your post!
Hello my name is Emily and I am the wound care specialist with a home care agency in Montana. We have wet to drys ordered quite frequently in the home care setting simply because most of the MDs don’t know any better. They were taught this method for wound care in med school, as were most nurses, and have remained ignorant to the advancements in wound care. Most of the older physicans are the ones that have problems listening to my recommendations and in fact, had one tell me that he didn’t care what the standard of care was, this is the way his pt was going to have it done. I, unfortunately, have refused to admit these pt’s to my service because it is my responsibility to provide the best care possible. I have found that article by Liza G. Ovington, PhD, CWS ” Hanging Wet-to-Dry Dressings Out to Dry” has been my best weapon with the doctors.
In reply to Emily.
Emily, that article is a good one yes!
Thanks for your post!
In reply to Emily.
I am in the same predicament, where can I locate a copy of that article?! A few of my MDs have gone along with my suggested alternatives just because it was suggested but I do have some where I’m sure the article would help. Thank you
I have two MDs’ that request scientific research articles published by physicians as to the reason we do not do wet to dry dressings. They have point blank stated that nursing journals is not enough.
We are right now using wet-to-dry treatment for spider bite. We are on 4th day and it seems to be working well.
In reply to Dora fujinami.
hey I found the link in case you were still looking..
http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.614.7548&rep=rep1&type=pdf
A wound vac works best for me for my ulcers but a wet to dry dressing also works in the interim between hospital and home health or vice verse. Quadreplegic 38 years
I take it back, I finished reading the description of your wet to dry dressing, oooch. Moist gauze placed on wound bed then covered with dry gauze and taped over with gauze tape changed daily. That’s what they used at the hospital, rehab facility and the home health agency.
In our outpatient Primary Care/Urgent Care Clinic we are attempting to use the Newest Honey Calcium Alginate dressing with great success with every wound that needs debridement. Patients Love it; but when we receive outpatient surgical patients, surgeons still are ordering these dreaded Wet – Dry dressings and its 2014!
I am a non-medical professional who is being expected to do wet-to-dry dressing changes at home on my husband who had I & D surgery on his chest yesterday. I read the recommended article you referred to and will be providing my husband’s wound care professional this article tomorrow. Have you incurred problems with insurance covering the more advanced dressing supplies?
@Marcie-usually not a problem ……cause wet to dry dressings cost more (you have to do it several times a day) and now considered substandard of care in USA. Advanced dressings are to extend wear time (can leave it in place for several days), keep the wound bed temp closer to normal body temp as possible and also will assist in keeping the wound bed moist which will help a wounds heal much faster. Good luck!
please me help me to heal my wounds,my wounds is weting.im asking what medicine should i take?pls help me
Hi Joann,
It really depends on the type of wound, the tissue type in the wound bed, how wet it is and many, many more factors… Your best bet is to find a clinician who is wound care certified or utilize a wound clinic with certified wound specialists where they can assess your wound and give you the “expert” advice and recommend a treatment that you need to heal you up! Good luck!
Hi, I recently had a breast surgery (3 weeks ago), and my surgical incision has opened up (which is normal, I’m told). The opening is about the size of a quarter (getting bigger). Doctor told me to just put antibiotic ointment on it and place clean gauze over it a few times a day and it will (eventually) close up. That didn’t seem to be working well, so I was searching for some better, more aggressive treatment measures, as I’m not excited about getting an infection in there. I rinse it out a little with a saline solution, first. Then, I am trying the wet-dry method, but I only change the dressing 2-3 times a day. Although it bleeds a wee bit when I remove it, it really doesn’t hurt. I feel like it looks better (today is day 3 of this process) than it did before. It looks more “alive,” if that makes sense. I’m going to do more research as to whether or not I’m doing more harm than good, though. Thank you for all the great info!
@Kay I am glad this is helpful to you and I wish you much success in healing!
Why aren’t my wet to dry gauze dressings not dry in 10 -12 hr changes.this is for debriedment of a very large deep pilonidal surgery. The gauze is wet not soaked when placed in wound.
In reply to gail barton.
@Gail, there could be several reasons… you may have a lot of drainage that is saturating the gauze. An increase of exudate can be a sign of infection. Are you using an appropriate secondary dressing? Wet to dry dressings should be used with the open “woven” gauze pads. Maybe wet to dry dressings are the right fit for this patient and the treatment should be re-evaluated, especially if no necrotic tissue is visible in the wound bed any longer.
Good luck!
Actually at our wound care center we still use wet to dry as a treatment plan for particular wounds that fall neither under the chronic nor acute categories. They are surgical wounds, where a significant amount of tissue is removed and hence suturing the wound is not an option. these wounds need around 2-3 some 4-5 weeks o heal and we refer to them as complicated acute wounds. A good example would be pilonidal cyst ablation or a stoma secondary to a temporary colostomy. If these wounds are not infected, and the wound bed is healthy and shows good signs of granulation, wet to dry is therefore used as one of the treatment plan options. Dressings are changed q 24 hrs and thus it is done OD. As for the pain and non selective debridment, soaking the dressings with saline before removing them is an option.or advice the patient to take analgesics 30 minutes before presenting for wound dressings ( in order to manage pain). Another method which proved to be effective in managing pain or discomfort induced by removing the dresssings is to dissolve 3-5 cc of Lidocaine in the saline that the dressings will be soaked in prior to application on he wound bed.
As a South African occupational therapist treating upper limb wounds, I have never come across wet to dry dressings in my practice or hospital. It sounds dreadful.
At Rhona wet to dry dressing is considered substandard of care now in US. I would teach them newer dressings that are out there for debridement such as autolytic-using diff dressings which allows the body to break down necrotic tissue, enzymatic debridement-Santyl. Here is my email incase you want to chat further on this: [email protected] I can maybe narrow down some more ideas for you and provide some tools that will help. Nancy
I’m not a RN but I work on a Home Health Care. We have patients that have wound care and most of the doctors that send us orders still uses the wet to dry technique.
In hospital wet to dry bandage wrapped in my groin area 48 hrs i need easiest removal techniques.