Wound Pouching

  Procedure for applying and reapplying wound pouch

  1. Wash hands, and don clean gloves and personal protective equipment.
  2. If current drainage pouch has external opening, drain and measure content volume and discard.
  3. Gently remove old drainage pouch; support underlying skin with fingertips while drainage pouch is being removed; dispose of pouch.
  4. Using wet 4 x 4 gauzes, gently clean wound site from area of least contamination to greatest; clean and dry surrounding intact skin.
  5. If ordered, irrigate wound/fistula or traumatic wound as indicated with NS or water until drainage is clear.
  6. Using wrapper from wound drainage pouch or wafer, draw (measure) wound or fistula edge onto wrapper; cut out the center of the pattern on the wound skin barrier and drainage pouch (cut the pattern slightly larger than the tracing).
  7. Apply skin barrier (wafer, liquid, paste, sealant).
  8. Remove adhesive paper from drainage pouch; apply drainage pouch over wound and, using gentle, even pressure, secure pouch edges to skin barrier.
  9. Close drainage pouch; wound drainage may be allowed to collect in pouch or suction may be attached to end of pouch to pull fluid away from wound into a more distant collection container.
  10. Document in patient record.