Changing a dressing on stitches, or sutures, is a common task after a surgical procedure. The dressing protects the incision from contamination and absorbs drainage, creating an optimal environment for healing. It acts as a barrier against external germs while maintaining a moist, temperature-controlled space for tissue repair. Always follow the detailed instructions provided by your healthcare provider regarding the type of dressing and the frequency of changes. Maintaining a meticulously clean environment during every dressing change is the most important step for preventing a surgical site infection.
Essential Preparations and Supplies
Before touching the dressing, assemble all necessary materials to ensure the procedure is seamless and clean. The required supplies typically include sterile gauze pads, an adhesive dressing or medical tape, sterile gloves, a cleaning solution (like normal saline), and a sealable plastic bag for waste disposal. Prepare a clean, uncluttered surface, such as a disinfected counter or table, and cover it with a clean towel or paper to serve as your workspace.
First, wash your hands thoroughly with soap and water for at least 20 seconds, scrubbing between fingers and under nails. Open the packaging for the new dressing and gauze, letting the items fall onto the clean workspace without touching the inner surface that will contact the wound. Check the expiration dates on all sterile products, as compromised sterility can introduce pathogens to the healing site. Position your cleaning solution and the waste disposal bag within easy reach before you begin the dressing removal.
Step-by-Step Guide to Dressing Change
Removal
Begin by putting on a pair of clean, non-sterile gloves to protect yourself from wound drainage. Gently lift the edges of the old adhesive dressing, pulling the tape back parallel to the skin surface rather than peeling straight up. This low-angle technique minimizes stress on the skin and prevents painful skin tears. If the dressing is stuck to the stitches due to dried drainage, gently soak the area with a small amount of approved saline solution to loosen the bond before continuing removal.
After removal, carefully inspect the wound and the used dressing for any signs of infection, noting the amount and appearance of drainage. Immediately fold the contaminated dressing inward, place it into the plastic disposal bag, and seal it. Remove the used gloves and perform hand hygiene again before moving to the cleaning phase to prevent the transfer of bacteria to the wound.
Cleaning the Wound
With a fresh pair of gloves on, moisten a piece of sterile gauze with the prescribed cleaning solution, which is usually normal saline. The cleaning motion must be gentle and precise, starting directly over the incision line and moving outward away from the stitches. Use a fresh piece of moistened gauze for every swipe to ensure you are removing contaminants and not pushing them back into the wound or surrounding clean skin.
Avoid forceful scrubbing, as this can damage the delicate new tissue forming beneath the sutures and increase inflammation. After cleaning, gently pat the incision area dry with a clean, dry gauze pad, using the same single-pass, center-to-outward motion. The surrounding skin must be completely dry before applying the new dressing to ensure proper adhesion and prevent skin breakdown.
Application
Open the packaging for the new sterile dressing, handling it only by the edges or the non-wound-facing side. Place the sterile pad directly over the incision, ensuring the entire wound and surrounding stitch line are fully covered. The surface of the dressing that will touch the wound must not be contacted by your fingers or any non-sterile surface before placement.
Smooth the adhesive edges of the new dressing down firmly onto the dry surrounding skin. Ensure the dressing is secure but not so tight that it restricts circulation. A properly applied dressing should lie flat and create a sealed barrier against the environment. Once the new dressing is secured, remove the gloves, dispose of them with the rest of the waste, and perform a final hand wash.
Monitoring the Wound and Warning Signs
Monitoring the surgical site is an ongoing responsibility that occurs between dressing changes. Mild redness, swelling, and tenderness are normal during the initial healing phase, but these symptoms should gradually decrease over the first few days. An increase in localized pain disproportionate to the stage of healing, or persistent, spreading redness extending beyond the stitch line, can signal a potential infection.
Wound drainage should be thin, clear, or slightly pink, and its volume should rapidly diminish after the first day or two. Thick, cloudy, or discolored discharge (yellow or green), especially if accompanied by a foul odor, is a sign of bacterial proliferation and warrants medical consultation. A serious complication is wound dehiscence, which is the partial or complete separation of the wound edges, typically occurring five to eight days post-surgery.
Immediate medical attention is required for any visible opening of the incision, persistent bleeding that soaks through the new dressing, or a sudden onset of fever (above 101°F or 38.4°C). Red streaks radiating from the wound and a feeling of heat or warmth at the site are also signs of a spreading infection. If you observe any of these symptoms, contact your healthcare provider immediately.