Embarrassed to ask......

I got my 2nd PM this past Thursday. I have an appt this Thursday to remove staples. I have reread the hospital instructions for wound care, but it was left blank. I don't know if I am supposed to remove the dressing and change it myself daily or wait until the appointment? It seems like good hygiene would be to change it daily, but I also got the impression in my post sedated state that I leave it on - no bathing - until my appt?
Thanks for any info!

11 Comments

PM Site Care

by Bill-2 - 2009-01-11 06:01:24

Don't remove the bandage. Don't even fool with the site . You can bathe but no shower as you should not get the bandage wet. If it is oozing anything, call your Dr. at once.

Wound care

by maryanne - 2009-01-11 06:01:33

Generally the dressing to the site can be removed 24 hours post op. You may shower...and cleanse with warm water and mild soap.....no creams on surgical site. It's best to leave the wound open to air...if there is any oozing then by all means you can put a dressing on it. But generally that is not the case. Watch for any increased reddness or swelling at the site and excessive drainage as those can all be signs of an infection.

No tub baths until the site is healed that would include no hot tubs or swimming...you would put yourself and increased risk for infection.

Hope all is going well.....and you shouldn't feel embarrassed....all questions are good questions.

Cheers......Mary Anne

instructions

by Tracey_E - 2009-01-11 07:01:26

If you weren't given instructions, I'd leave it alone. If the tape is bothering you, it's probably ok to take it off. A shower is fine. I've been told to leave the dressing on as Bill was told, another time (same surgeon!) I was told as Mary Anne was, take the dressing off and expose it to air. As long as it's clean and you don't go swimming or soak in the tub, I really don't think it matters.

hmmm

by candi51 - 2009-01-11 07:01:41

My instructions were to take the bandage off after a week and not to shower for a week or 10 days to avoid getting the site wet.
That being said I didn't have staples. I had stitches and steri-strips under my bandage. It took a full 2 weeks for the steri strips to work their way off.
I would definitely call the Dr. and see what they say about your individual case.
Good Luck-
Candi

Let it be

by CarolL814 - 2009-01-11 07:01:42

I have had 3 surgeries and for each I was told to leave the bandages alone and not to get the site wet.
From the mixed response I would definitely call your cardio. Seems like every case may be different.

stitches

by Tracey_E - 2009-01-11 08:01:32

Stitches can't get wet. I don't think it matters for staples.

I had the tape last time. I didn't get it wet and it peeled off all by itself. Way cool! I had no idea there were no stitches there until the tape came off and there was nothing there, lol.

Now I'm embarrassed to admit that...

by failed ablation - 2009-01-12 02:01:03

I WAS given discharge instructions which I just found away from the rest of the info. I think my brain needs pacing sometimes!! Thanks to all who counseled me on this topic!! My first implant was almost 11 years ago and I do not remember the protocol, although I did not have staples, I don't think. I mentioned to the surgeon that my scar had stretched and the PA told me to wear a good support bra to help this time. The surgeon said he would use staples, also, which should help to keep my scar from being so big. Anyway, if you're interested, my directions say "The dressing should remain on until your first appointment. Do not get it wet for 1 week. Notify them immediately for any redness, swelling, fever, drainage or foul odor from the incision. Mystery solved~~ and again, thanks for all the comments.

Wound Care....

by maryanne - 2009-01-12 04:01:07

I am sorry but I have to totally disagree with Bill-2. Wound care management has become a specialty of it's own. There are many many different types of wounds and many things influence the care and healing time of a wound. Such things as age, skin turgor, procedure preformed and Surgeons preference. There is also a Standard of Practise which from a nursing stand point guides healthcare professional in how to care for wounds and how to direct care for wounds.

Now assuming all things are equal..ie. we are talking about a PM generator preplacement only then there is a standard of care protocol which dictates care. In the three Critical Environments in which I have worked and the standard of practise has been the same.

Being a Critical Care Nurse myself and one who has experienced 5 PM's. I have always been instructed to remove my bandage 24 hours post op unless given specific instruction to keep on. Never Never Never...bathe until your site is healed You significantly increase chances for infection. Reason for is that when bathing in warm water bacteria builds up in the water this create an environment where bacteria can infiltrate into the wound beds....with showering the water runs off and keeps the sight clean.....Again if you shower us warm water and mild soap. If you note oozing at the site then by all means cover it...as I said above.

If I am not mistaken you said you just had a PM generator(battery) replacement....You did not say whether you had dissolveable sutures or ones that needed to be removed or if you had staples. Sometimes if the surgeon has used non dissolving sutures (ones which are readibly visible)they would specifically indicate their instruction for care. But generally dissolving, retention, or staples may all be exposed to air.

There is tons of research out there to support this. As long as the wound is not oozing or open, then it should be left open to air whenever possible. The reason for this is two fold 1) you are able to observe for signs and symptoms of infection ie. increased reddness or swelling at the site, heat at the stie, purulent drainage at the site and of course increase temperature. Covering the wound keeps the wound beds warm and moist which promotes bacteria growth and ultimately infection.

After my surgery in December where I had not only retention sutures and staples on one side...i 50 staples down the middle of my chest, then chest tube sutures, and the new PM all dressing were removed 24 hours post. I have not had any infection I was instructed that I could have showered wihen I was in the hospital on day 3 post op but I opted to wait till I got home the next day to shower.

But don't take my word for it...when in doubt call your GP.

All the best....Mary Anne

Instructions

by Bill-2 - 2009-01-12 08:01:29

Mary Anne,

I'm sorry, but I didn't know we had such full blown experts on the subject on site. However, as someone said a few weeks ago, all of my advice comes with a money back guarantee so just tell me where to send it and my check will be in the mail tomorrow.

By the way, from what I read, my advice was not that far off the instructions Failed Ab. found that she had received which were: "The dressing should remain on until your first appointment. Do not get it wet for 1 week. Notify them immediately for any redness, swelling, fever, drainage or foul odor from the incision." She posted these just above your last comment.

My advice was: "Don't remove the bandage. Don't even fool with the site . You can bathe but no shower as you should not get the bandage wet. If it is oozing anything, call your Dr. at once." I didn't give a time frame because she was going back in one week and I was talking to Failed Ab." I'm sure her doctor didn't know what he was talking about either come to think of it.

But no matter, I can see I'm out of my league with you experts so hereafter I'll just be quiet, even when I know what I'm talking about.

Bill2

What Do I Do

by SMITTY - 2009-01-12 12:01:04

I'll add to what Carol said "EVERY surgeon has his/her favorite post-op wound care protocol."

Some of those instructions are good and some are bad, but like everything in life, we pay our money and take our chances. In my case I saw my incision within a few minutes after they completed the implanting and it had no bandage then or ever. I was sent home with it uncovered and just told to be careful. If it started to bleed I was to call them at once, but otherwise just be careful. For 3 days I was not to shower, but I could take a tub bath, just don't get water on the incision. There were no signs of stitches as they were all internal. I never had one minutes problem.

I think this is truly a case where one size does not fit all, so as others have said, see what your doctor has in mind before doing anything.

Good luck,

Smitty

Post-op Care

by Carol - 2009-01-12 12:01:48

Hi! I'm an RN with a PM and what I can tell you with certainty is that EVERY surgeon has his/her favorite post-op wound care protocol. This accounts for all the various responses you've received previous to mine.
In general, as it was in my case, it is OK to remove the dressing 48-72 hours post operatively. ( My EP used an antimicrobial gauze dressing over the incision which stayed in place to help avoid infection during that time). The dressing is then removed so you can visually examine the incision for any s/s infection i.e. redness, swelling, heat, and discharge- and of course report to your doctor if any of these things occur. Then you can put a clean gauze dressing back on to protect the healing incision from rubbing on your clothes and from causing any irritation. Change it daily and always check your incision for signs of any complications.
I would agree with one of the authors above that you should NOT feel embarrassed about contacting your doctors office and telling them you did not receive any written instr one way or the other and you'd like to do the right thing. I will guarantee you that as a nurse, I would gladly call you back with the correct instructions so as not to miss something. So, please, give 'em a call on Monday and then you'll know for sure what you should be doing!
Best Wishes, Carol

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