In this article, THEMIS’s Lead Clinical Partner, TMLEP, discusses the significance of leaving wound packing inside a patient.
A Case Example
A patient underwent an operation, following which the wound was packed. When the time came for the wound to be cleaned and re-packed, the original packing was not removed but instead, retained along with the new packing. The patient then developed fever, wound tenderness and infection.
Independent Recommendations to Improve Healthcare Standards and Patient Safety
Wound Packing Complications
In cases such as the one above, when a patient requires specific wound cleaning and aftercare, clinicians must remember to review the patient’s case file, to determine exactly what they require, to make sure that the appropriate level of care is given.
Packing wounds is integral to the patient’s healing and should be thoroughly monitored throughout the aftercare period, adhering to the guidelines. The failure to remove packing on a regular basis, as and when needed, can be detrimental to the patient, because the packing obstructs the pus from leaving the cavity.
This in turn, can lead to the patient suffering prolonged pain and delayed healing, and can cause wound tenderness, fever and infection. Additionally, in some cases, the infection can become severe if the packing is not removed and replaced, requiring further washouts of the wound and an extended care pathway.
There are some preventative measures and checks which can overall reduce the risk of a patient inadvertently retaining packing when new packing is being administered, which include actions such as note-keeping and exploration. The measures can lessen the chance of infection and can limit wound complications:
- Using the Operation Note
In the first instance, reviewing the operation note can inform the reader exactly what was carried out and used. This can allow an assessment to be made of what packing was used, if dressing needs to be changed and how many pieces of packing are in situ.
When changing packing and dressings in a patient, the wound should be fully explored (with analgesia if necessary) as the wound opening can be smaller than the cavity underneath. This can prevent any foreign bodies from being left inside the patient, when the new packing is put in place.
Packing can become rather difficult to remove - if it is dark/covered in blood, this can make it difficult to identify, making removal challenging.
Moreover, if the packing is covered in blood which has thickened around the wound, this can create an ‘adhesive’ environment, making it troublesome to remove. Precautionary measures should therefore be borne in mind, consisting of note-keeping being up-to- date, for the next time the packing needs to be removed and replaced. By keeping a log of the amount of packing used, this limits the risk of any being retained.
- Packing Alternative
Packing can be biodegradable, which makes the wound check easier, however in those circumstances where the packing used is non-biodegradable, a careful record should be used. To minimise risk of inadvertent retention of the packing by the body of a foreign object, long ribbon packing can be used, rather than individual pieces, to further limit the risk of the patient retaining the packing.
TMLEP’S independent clinical recommendation is that when treating patients with wound packing in situ, clinicians should bear in mind some of the above preventative measures to make sure that the risk of packing-retainment is limited, which therefore aids in reducing the chance of infection.
By raising awareness of the above issues, THEMIS aims to assist in developing awareness of difficulties in dealing with wound packing and the advice to limit inadvertent retainment, thereby improving clinical care and reducing litigation risk.