Perform Wound Cultures (Nursing)

00:04 Hey guys, welcome to the scale, How To Culture a Wound.

00:08 When we talk about culture, all that means is we're gathering a sample from the wound that's either tissue or drainage or exudate, or even all of those things.

00:18 We're really just testing to see if there's infectious organism that's causing a delay in our wound healing.

00:25 So how we start to culture is the first thing we got to do is check the providers order.

00:31 Just know there could be some variation in order, so you want to make sure we start there first.

00:37 Now, here's the key thing, anytime you go to expose a wound bed to culture, gather all your supplies first.

00:44 So you got to remember, we want to clean the wound, because we've got to clean before we culture the wound bed, get all your cleaning supplies, get all of your supplies for obtaining the specimen, and also all the supplies you need to redress the wound.

01:01 Once we've gathered all of our supplies, we'll enter a patient's room and of course, provide privacy.

01:06 Now, it's really important when we're culturing a wound, that we get the right patient, so confirm their identity.

01:13 We want to explain the procedure to the patient and put them in the optimal position for us to gain our wound culture.

01:20 We can perform hand hygiene, put on our gloves, and with the old dressing, make sure to remove that.

01:27 Then we're going to dispose of our dirty gloves and perform our hand hygiene.

01:32 Now is a good time to assess the wound and surrounding tissue.

01:36 So we can go ahead and arrange our supplies on our sterile field and get ready to culture.

01:41 We now want to put on clean gloves and this is the time we're going to irrigate or cleanse the wound.

01:47 Most of the time, we're going to use sterile saline solution.

01:51 So just remember, anytime we culture a wound, make sure we irrigate or cleanse first, then we culture.

01:59 Now that we've done this and performed our irrigation, we can remove our gloves before more hand hygiene and put on clean ones.

02:07 Now when we're collecting the specimen itself, we want to take the swab in the wound and gently rotate it and this could be either a sterile calcium alginate, or rayon swab, for example.

02:20 And again, we're taking that swab, we're putting it in the wound bed, then we're going to swab the wound from margin to margin and like a 10-point zigzag fashion.

02:32 So here's the thing about culturing a wound, not very fun for your patient, this can be uncomfortable.

02:37 And many times when you're swabbing the wound, you need to put enough pressure to express some of the fluid in the wound bed.

02:45 And you can imagine that's not very comfortable.

02:48 But that's important to make sure we get all of the tissue, the fluid and the exudate for sampling and testing.

02:56 Now, once we've cultured our wound, we can take the swab and put it in the culture medium.

03:02 So just know many times when you use a wound culture, there's the swab that comes with and there's a little bit of medium that you stick it back in to send it to lab.

03:12 Now when you send it to lab, make sure you label it accordingly to the facility's policies and procedures and send this off as soon as possible.

03:21 Now that we've cultured our wound, we want to redress it as ordered, we can take off our gloves and perform hand hygiene.

03:28 And of course, make sure you document, you're also going to document your assessment findings of the wound and the patient's response.

03:37 When we're talking about culturing a wound, here's a few points that you want to make sure we do not do.

03:44 So you don't want to take the specimen from the exudate meaning just the drainage itself, or eschar of a wound.

03:52 When you hear the word eschar, this is the black stuff that setting inside the wound.

03:58 Many times we're not getting to the wound itself.

04:01 So this is where we don't want to take the specimen.

04:04 We also don't want to use just the cotton tip swab.

04:07 There are special wound culture tubes that we're going to use for this.

04:11 So make sure you check with your facilities equipment.

04:14 Now it's also really important here that we don't contaminate that swab.

04:20 We want to only make sure we're getting in the wound bed.

04:23 And we don't want to let that once we've cultured that swab to touch my fingers or the bedside table, for example, because this will skew or misinterpret our results.

04:34 And don't culture a dirty wound.

04:37 Just remember and this is one thing that nursing students really struggle with, make sure that you irrigate or cleanse the wound first, then you're going to culture the wound.

04:47 So clean and then culture.

04:54 Hey guys, welcome to the live demo of how to culture a wound.

04:58 So what I really mean by this is taking a sample of inside the wound, we're usually doing this because the wounds not looking too great.

05:07 There may be signs and symptoms of infection.

05:09 And we're going to sample this and send this off to see what potentially could be growing inside there.

05:15 So let's take a minute and talk about our supplies, we're going to need the appropriate swab for example.

05:21 Now usually, we're going to use something like this called a calcium alginate swab.

05:27 But just know you may want to triple check with your lab department to make sure you have the appropriate one for culture.

05:33 Also we're going to swab, here's the kicker, this is kind of confusing for students, but make sure that you cleanse the wound.

05:43 And then culture, I'm going to say it again, cleanse the wound and then culture and you may be thinking, "Okay, well, that kind of seems backwards?".

05:51 But just think about all the extra debris and maybe other microbes that if we culture it, we could pick up the wrong stuff, right.

05:59 So we want to get to the wound itself.

06:02 So make sure you when you go into the room to collect your sample, bring your irrigation supplies, and obviously, we're going to need to redress that wound.

06:10 So make sure you bring those supplies as well.

06:13 Now to start off, don't forget to review the health care providers order for obtaining the culture.

06:19 There could be some variations here.

06:21 So pay close attention before you go into the room.

06:24 And of course, gather those supplies to irrigate and cleanse that wound, obtaining your specimen so that's usually your swab, and also those to redress the wound.

06:35 And obviously, we're always going to provide privacy for our patients.

06:39 Sometimes those wounds can be on a lot of personal areas, it could be on the patient's buttocks, for example, or their abdomen.

06:46 So make sure you provide privacy for them and confirm the patient's identity.

06:52 I know we learn this out the gate from nursing school but, just think about it this way that if we are sending off lab or excuse me, a specimen, we want to make sure it's from the right patient.

07:05 So confirm the patient's identity with your name and your date of birth, your two patient identifiers.

07:11 Now you want to thoroughly explain the procedure to the patient.

07:14 This sometimes can be a little bit uncomfortable, because we're working in that wound.

07:19 So make sure you keep this in mind with your patient.

07:22 Then once we're ready, we need to position the patient and drape if it's applicable.

07:26 So sometimes wounds are in different spots on the patient's body.

07:30 So we want to position them in the ultimate place to cleanse, grab the culture and also to change the dressing as well.

07:38 So now we can go ahead perform our hand hygiene, and then put on our gloves.

07:51 Okay, so once we've done this, we're going to go ahead and remove the dressing.

07:56 This is the old stuff here.

07:58 So we've got to get to the wound itself.

08:00 Let me go ahead and take this off.

08:03 And once I go ahead and take off the old dressing, this is when I'm going to dispose of this soiled dressing and my soil gloves.

08:15 Okay, and I've got my trash can, and I'm going to get rid of, it's a great idea to have that close by.

08:22 Now this is a great time to go ahead and assess the wound and the surrounding tissue.

08:27 More than likely we're culturing the wound because it's probably good chance or something going on.

08:33 So make sure that you assess this tissue as well.

08:37 So once we've done that, we want to arrange our supplies on our sterile field to prepare to irrigate.

08:42 So here we would put on our clean gloves, and then we perform our irrigation with our prescribed solution.

08:49 So just know it will be per physician order, but many times we're going to cleanse the wound with just a sterile saline solution.

08:57 So guys, as nursing students, I know we have lots of names for things that makes it kind of confusing, but if someone says normal saline, what we're really talking about is 0.9 sodium chloride.

09:10 So I know that seems confusing, but just know if you hear normal saline, we're talking about sterile 0.9% sodium chloride, but again, check your providers order.

09:22 So of course with irrigation, we'll use our prescribed solution.

09:25 It's also a great idea to have an irrigation tray that has a container and also a syringe to pull up the irrigant fluid.

09:34 Now once you've irrigated your wound, you're going to take some sterile gauze and just dab dry around that wound.

09:41 We don't want to leave that wound moist and all that moisture setting on the skin.

09:46 Now once we've completed our irrigation, we can remove our gloves before our hand hygiene and put on clean ones for the swab.

09:53 So, I'm going to do that now.

10:01 So once we put on our gloves, and we're going to collect our specimen.

10:05 So just remember to double check yourself that you're in the right patient's room, and the right name and the date of birth, and you're checking those identifiers.

10:16 And next also really important, we're using the right swab for the right lab test.

10:21 So check that as well.

10:23 And again, your lab is a great resource for that.

10:26 So I've got my swab here.

10:28 So I want you to take a look at this, make sure that this is in date, that's the other thing, we want an accurate result.

10:34 So make sure this is not expired.

10:37 So when you open this up, there's a little tab here that's got a little blue, typically a little cheat on where you're going to open up that swab package.

10:49 And there's two components typically with your swab.

10:53 So this is very important, what I want you to see, you will have the swab, and then you're going to have this other piece.

11:01 So what I like to do, let me pull these out for you.

11:06 It's really important that this swab doesn't touch anything else besides the wound, this has to stay sterile, we don't want it touching our hands or the table, for example.

11:17 So just be really diligent about keeping this away of anything that can contaminate it.

11:23 Now this is the medium that it's going to go to.

11:25 And this is going to look a little bit different depending on each swab and what your facility has.

11:30 So as you see here, this is sealed.

11:32 So I'm going to take this, crack that and just pull this top off, and I can just get rid of this.

11:39 So this swab is what we're using for the wound and it's going to go inside the tube to be sent to the lab.

11:46 So now that I've got my swab, we want to take this and gently rotate this in the wound itself.

11:52 So many times we're going to get into the deepest part of the wound to start, I'm going to put this in and gently rotate it.

12:00 Now as you can see here, many times we've talked about earlier about using a 10 point zigzag fashion depends on the size of the wound, right.

12:08 So really, you just want to know, you want to get all in the wound, you want to make sure that you're actually depressing and some of that fluid and some of that exudate and getting some of that tissue from the wound, all the good stuff, if you will, get all of that.

12:25 Now once you've done that, we're going to place this culture swab in the meeting itself.

12:30 So if at all possible, try to keep this without touching the sides so you don't lose all the good stuff.

12:37 Now, this is the hard part guys.

12:39 So we're going to see if I get lucky.

12:48 Okay, so you see that was a lot of concentration, but if at all possible, when you're grabbing this, you want to do your best not to push all of that stuff on the side of the tube, you want to try to go straight in as much as possible.

13:03 Now we can label it according to your facility's policies and procedure and send it to the lab as soon as possible.

13:10 So I'm going to take this and I'm going to send this off to our lab, but I'll set it aside for now.

13:16 So once we've done that, we want to make sure we of course, don't leave our wound open.

13:20 So I'm going to redress the wound.

13:27 And just depending on whatever use make sure you have sterile gauze, or I'm using an ABD pad here, and I'm going to cover my wound, and a lot of times I like to use what we call a window tape method, where I go around each corner and we make a little window.

13:43 So we're going to redress the wound.

13:45 And don't forget to put your initials, your date and your time so the next shift knows when this was redressed.

13:53 Take off my gloves and perform hand hygiene.

13:56 And don't forget to document your procedure.

13:59 Whatever your assessment findings were in the patient response.

14:02 Thanks for watching, guys.