Amputations

  Wound care procedure with amputated limbs partial and complete
Initial Assessment of the Amputation

   1. Perform hand hygiene and apply gloves.
   2. Verify the patient's identity in accordance with institutional policy.
   3. If the hand is injured, determine whether the patient's right or left hand is dominant.
   4. Determine whether the patient smokes or has diabetes or peripheral vascular disease.
   5. Consult with the replantation team as soon as possible to determine the feasibility of replantation and to               receive specific instructions regarding care of the amputated part and the patient.
   6. Remove all jewelry from the injured area.
   7. Obtain wound cultures before antibiotic administration. Send laboratory specimens for type and crossmatch as        indicated.
   8. Administer parenteral antibiotics, analgesia, and sedation, as prescribed.
   9. Administer tetanus prophylaxis, as indicated.
  10. Administer aspirin or low-molecular-weight dextran, if prescribed by the replantation surgeon.
  11. Obtain x-ray studies of the stump and the amputated part.
  12. Keep the patient warm to prevent vasoconstriction.

Complete Amputation

   1. Cleanse the stump and the amputated part by gently rinsing with normal saline solution to remove gross               contamination. Do not scrub or use antiseptic solution because this may destroy the delicate nerves and               vasculature that the replantation team will attempt to reconnect.
   2. Apply a soft-pressure dressing, and elevate the stump. Splint the stump, as indicated.
   3. Wrap the amputated part in gauze moistened with saline solution and seal it in a plastic bag; do not immerse        the part in water. Be sure to wrap the part well so that it is protected from freezing.
   4. Place the plastic bag or container on an ice bath in an insulated container.
   5. Label the bag or container in which the amputated part is stored so that it is not inadvertently discarded.

Partial Amputation

   1. Wrap the entire extremity in moist dressings per replantation team prescription.
   2. Splint and elevate the extremity.
   3. If there is evidence of arterial insufficiency, attempt to cool the distal part with ice packs. Cooling the extremity        may not be possible because it can be painful.

Post Procedure

    * Prepare the patient for transport if indicated.
    * Discard used supplies, remove gloves, and perform hand hygiene.
    * Document the procedure in the patient's record.



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