How to Pack a Wound
If you or someone you know has a deep wound, you may need to pack it with gauze to help it heal properly. To pack a wound, it's important that you protect the wound from possible infection. Wherever you plan on doing the dressing, wash and disinfect the surface with disinfectant cleaner so you can work in a sterile environment. Wash your hands thoroughly with soap and water, scrubbing up to your elbows. Dampen a length of gauze with saltwater or saline solution and then gently work the gauze into the wound. Don't force the gauze into the wound and place any excess material neatly on top of the wound. Take sterile gauze sponges and layer them on top of the wound to cover it completely. Then, tape the outer dressing with medical tape so it's held in place.
Assemble the necessary materials. If you're caring for an open wound while it heals, you'll need a large supply of the following materials readily available. To change out the dressing once or twice a day, you'll go through a lot of gauze and saline, so prepare accordingly and you won't have to make multiple runs to the store. You will need the following items: Sterile wetting solution. You may need a prescription to get saline at the drugstore, or you can make your own by boiling 1 tsp. of salt in at least a quart of water for five minutes. For packing the wound, you'll need sterile gloves, clean towels, a clean bowl, and scissors or tweezers that have been sterilized in boiling water. For dressing the wound, you'll need packing gauze, bandages for the outer dressing, medical tape, and cotton swabs or Q-tips. Clean the area where you will set out your dressing supplies. Wounds need to be packed in a clean, sterile environment. If you're working at home, dusty kitchen tables and TV trays are covered with germs that could cause infection. But you've got to work somewhere, so wherever you plan on doing the dressing, you need to wash and disinfect the surface thoroughly with disinfectant cleaner before you attempt to pack your wound. Wash your hands thoroughly with soap and water to get started. Scrub up to the elbow on both hands, and keep your fingernails neat and trimmed. Prepare the packing. After cleaning your work surface and getting ready to pack the wound, put a clean towel over the area. Pour enough salt water or saline solution into a clean bowl. You won't need a lot, just enough to gently moisten the packing material. Open the outer dressing material–bandage and tape–as well and place it on the towel. Keep it away from the bowl, and don't get it wet. Cut off a length of packing material and carefully wet it with the saline. Never soak packing materials in the packing solution, just dampen it slightly. If saline is dripping from the packing material, it's too wet. Many nurses and home dressers find it effective to cut pieces of tape to the desired length, then hang them on the edge of the table for later, so you won't have to work with digging at the tape roll when you want to be finishing the wound dressing. Organize your space however works best for you. Wash your hands thoroughly again. You can never be too careful with the hand washing, especially if you're dealing with a deep and significant open wound. Infection can be deadly. Keep your hands clean using soap and water, then put on latex medical gloves for added protection. Gently put the packing material into the wound. Squeeze the packing material to wring out any excess saline solution in the sterilized gauze. The packing should be moist, but not dripping. Use enough of the packing to fill the wound space completely, but not tightly. Gently work the material into the wound, using a cotton swab or a Q-tips to guide it in. Although the packing should fill the wound, it should not be forced tightly into the wound. Any gauze ends that do not fit into the wound should be neatly placed on top of the wound, then wrapped in the outer dressing to secure everything safely. Be gentle and swift. There's no big secret to getting the gauze into the wound–you just have to work it in there as gently as possible. Depending on the size and shape of the wound, it may be very easy or it may take some negotiating. Watch the patient closely and communicate to make sure you're not packing it too tightly, causing discomfort. Dress the wound on the outside. Outer dressings should be made up of squares of gauze sponge, to cover the packing, the wound, and seal everything up tightly and comfortably, protecting the packing from the outside. Layer sterile 4 x 4 gauze sponges over the wound, using enough to cover the entire site, with some extra around the outside for security. Tape the outer dressing in place, at least an inch or two beyond the diameter of the wound's edge, using the medical tape you hung off the corner of the table earlier. Always pick up the gauze by the edges, being careful not to over-handle it and risk infection. Remove the outer dressing. Start by removing the tape of the outer dressing and gently pulling back the gauze sponge of the outer dressing. Use one hand–clean and gloved–to hold the skin around the wound steady, and use the other hand to pull the outer dressing free. Be especially careful to look for any crusty blood or other seepage that may have formed, and stuck to the dressing. Use a Q-Tip moistened with saline to gently work the bandage off, if necessary. Go slowly and be extremely gentle. Put all discarded dressing materials into a plastic bag and dispense of them immediately, keeping them away from children and pets. Remove the packing. Use your sterilized tweezers or your fingers to pinch the corner of the packing and start gently pulling it free of the wound. Go extremely slowly and use caution. Stay focused on getting the packing free, keeping aware of any crust that has formed between the wound and the gauze. Use your Q-Tip to work it loose if necessary. Pull the entire packing free and inspect the wound to make sure that no gauze is left in the wound. If bleeding starts, apply pressure. Depending on the severity and the depth of your wound, removing the packing may result in some bleeding, especially the first time you replace the packing. If this occurs, use a gauze sponge to apply direct pressure, pressing firmly and uniformly for at least five minutes to give time for a clot to form and stop the bleeding. Move forward with the packing. If you cannot get the bleeding to stop, or the wound is still bleeding a day or two after getting your wound checked out by a doctor, you need to return to the hospital immediately and get your wound checked out. Check the wound for signs of infection. After you've removed the packing, you need to inspect the wound very closely for any signs of infection. Discoloration, excess seepage, or unpleasant odors are all signs of infection that should be addressed immediately by returning to the hospital and getting the necessary treatment. A doctor may need to administer antibiotics or alternative methods of dressing the wound. For more specific instructions regarding the care of open wounds, read the next section. Wash the area gently with soap and water. Use soap and water to wash the area around the wound very gently with soap and water. Use a clean sponge, warm water, and antibacterial soap to clean the skin around the wound. Don't soak the wound and don't soap directly in deep wounds. Wash around the perimeter. Replace the packing as directed. After removing the packing and cleaning the area, repack the wound immediately, as outlined in the first section, unless directed otherwise. Always following the instructions of your doctor and change the dressing according to the recovery plan for your wound. Some wounds will need to be packed a few times a day, while others will have different methods of recovery. Change the dressing once or twice daily. Always follow your doctor's instructions regarding the changing of an open wound. After the tissue begins to heal, most doctors will allow the wound to be changed out once a day, eventually dropping the packing entirely to allow the wound to begin healing more thoroughly. When enough tissue is built up, the external dressing should be enough to allow the wound to continue healing properly. Most wounds should never need to be packed for more than 10 days. Always pay attention to symptoms and common sense–if it seems to be healing improperly, call your doctor. If it seems to be taking too long, call your doctor. Recognize the warning signs of infection. While you're changing out the wound, it's very important to keep a close watch for any of the following signs of infection. Call your doctor immediately if the patient experiences: Temperature over 101.5 °F (38.6 °C) Chills Wound tissue that changes from pink to white, yellow, or black in color Foul-smelling drainage or fluid from the wound Increased redness or swelling of the wound or skin around it Increasing tenderness or pain in or around the wound. Never soak the wound. While you're packing and caring for an open wound, it's critical to avoid soaking the wound or getting the area extremely wet. This can promote infection and keep the wound from healing properly. Let your body do the work of healing itself and avoid getting the wound wet. You may shower, keeping the wound free of water, after the first 24 hours. Usually, you can wrap the area in plastic, or simply keep your arm outside the spray of the water to keep it safe. Your doctor may have more specific instructions regarding cleaning the wound. Talk to your doctor about any questions or concerns. Caring for an open wound is serious business. If you have any hesitations or concerns about the healing process, you should call your doctor immediately. Don't wait and allow infection to become more severe. Blood infections and gangrene can result from wounds looked after improperly. 
Assemble the necessary materials. Clean the area where you will set out your dressing supplies. Prepare the packing. Wash your hands thoroughly again. Gently put the packing material into the wound. Dress the wound on the outside. Remove the outer dressing. Remove the packing. If bleeding starts, apply pressure. Check the wound for signs of infection. Wash the area gently with soap and water. Replace the packing as directed. Change the dressing once or twice daily. Recognize the warning signs of infection. Never soak the wound. Talk to your doctor about any questions or concerns. 