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How should I take care of a scraped knee?

My daughter fell down and has a scraped bloody knee. How should I bandage it?
 

Care at home or hospital?

How to care for a road rash scraped knee at home

How do I clean my scraped knee?

Normal Saline Recipe

How do I dry my wound?

What do I cover my wound with now that it's clean and dry?

How do I apply Tegaderm?

How can I get the the Tegaderm to stick really well?

How long do I leave the Tegaderm on for?

Should I apply Bacitracin or antibacterial ointment to the wound?
  

Care at home or hospital?

First to decide is whether you need home care or a hospital / urgent care center. If only the skin is scraped, I can tell you how to take care of it at home below. If you see bone, muscle, tendons, nerves or fat, please visit a health care provider.

If you have not had a tetanus vaccine in 5 years, visit a health provider to get updated.

You can take care the left 2 images below at home. The right two images--there are serious injuries here and you need to see a health care provider to get the would numbed up, well-cleaned, stitched together possibly in photo 3, and in the case of photo 4--there is bone visible, it probably needs a skin graft. You cannot do this at home! Click on the images for larger pictures. Learn how to take care of wounds below the images.

hairy knee hairy knee bloody scraped knee scraped knee, bone

How to care for a road rash or scraped knee at home

If your wound looks like images #1 and #2, you can take care of this at home (read how below!). Image #3 has significant tissue damage and image #4 shows the knee scraped down to the bone. Please get professional help if your leg/elbow/body is as injured as the photos in pictures #3 or #4.

If you have a wound similar to image #1 or #2, first, see that both of these knees are surrounded by hairy skin. Please shave the hair off of surrounding skin so that the bandage can stick to smooth skin. Hair also collects bacteria, which can cause infection. It's best to get rid of it to keep your wound clean. You can either wet or dry shave, but both wounds need cleaning first, so wet might be easier. Keep hair out of the wound, or flush it out if some should fly in there.
 

How do I clean my scraped knee or skinned elbow?

Wash your hands.

In many countries, the water is probably clean enough to use straight out of the tap if the wound is not too deep. Many times I am at my kids' soccer games, and they or their teammates get a scraped knee and I do not clean it at all, I just put the dressing over the wound because it is not practical to clean wounds at a soccer match. But if the wound is deep, it would be best to clean it with sterile water with a little salt also known as "normal saline." If you live in a country where tap water is not drinkable, it is important to use normal saline.
 

Normal Saline Recipe

Water: 1 liter (or 1 quart or 4 cups)

Salt: 1 1/2 teaspoons (or 9 grams)

Heat this mixture until it boils for a full minute. Turn off the heat and
LET IT COOL!

LET IT COOL!
LET IT COOL!

Boiling kills organisms that are in water, so it is safer to clean a wound with this.

Never apply hot water to skin--wait for the water to cool to body temperature first. This might take 30 minutes, depending on how warm the air temperature is. If you are taking care of children, always test the temperature of the water on the inside of your wrist first to make sure it is a comfortable temperature before using the saline on children.

To wash the wound, you could use a bulb syringe, only if it is extremely clean, or pour water over the wound with a cup. Or you could wet gauze below and dab (lightly touch and very slightly brush) at the wound until the dirt is out. guazeIf you don't see any dirt, you can just rinse it by pouring from the clean pot--as long as the water has cooled off.
 

How do I dry my wound?

Let the wound air dry unless you have clean sterile gauze to use to pat it dry. Do not use those cotton makeup removers as they will leave cotton fuzz in the wound that will make healing more difficult.
  

What do I cover my wound with now that it's clean and dry?

TegadermNurses' favorite dressings are Tegaderm transparent dressings. (We do not get any funding for saying this!) I always carry about 30 of them in my purse in case I find someone in need, and I do, about once per week. The most affordable ones I can find are online here. We do not get any money for mentioning that either, we just want to share where we find them most affordable. In the drug store they can often cost 10 times as much as they do in packs of 100 online.

For most scrapes, you can use the small size (2-3/8" X 2-3/4"), but some will need more than one, or you can get the larger sizes (4" x 4 3/4").
 

How do I apply Tegaderm?

1) Wash your hands.

2) Remove the paper on the back of the dressing.

3) Apply the dressing to the wound so you can see the wound through the window.

4) Remove the window frame from the top that surrounds the film.

See an online video explaining more details here.
 

How can I get the the Tegaderm to stick really well?

Sunmark BenzoinTegaderm dressings can be a little pricey, so in order not to use too many, try to keep them stuck to the skin for as long as possible. This means applying a layer of tincture of benzoin to the surrounding healthy skin, never to the wound.

The kind I like the best is Sunmark because it is clear, doesn't smell too strong and doesn't discolor the skin, unlike some other brands. (We do not get any funding for promoting these brands, this is just what I like to use on our patients the best).

Its purpose is to make dressings stick to skin better so the dressings stay on for days instead of hours. So, you use a Q-tip, get it really wet with Benzoin and rub it on the intact, undamaged skin that surrounds the wound—do not get any benzoin in the wound, just put it where the edges of the dressing will be sticking to the skin. Don't get any into the wound or it will burn. Let the benzoin dry for about a minute, until the skin is sticky. (Do not put your fingers in the wound, only touch the healthy skin.)

Apply nothing to the wound.

This system is so much better than gauze or Bandaids, which stick to the wound and reinjure the wound when the bandage is changed. Tegaderm is the most comfortable dressing (perfect for kids who do not like to remove Bandaids) and provides moist healing which makes healing fast and reduces scarring.
 

How long do I leave the Tegaderm on for?

Try to leave the Tegaderm on until it falls off. This might be hours or it might be a week. Sometimes the wound gets a little goupy and this is the body getting rid of tiny bits of dirt and junk (hopefully you have washed out the larger pieces already). So when the dressing builds up some fluid, just remove the outer edges of the entire dressing first, then remove the center of the dressing that covers the wound. It almost never hurts. Dispose of safely. Wash your hands. Rinse the wound with normal saline or water, apply more benzoin to the outer edges of the skin (not to the wound), allow to air dry and you can apply a new dressing.
 

Should I apply Bacitracin or antibacterial ointment to the wound?

I usually do not use anti-bacterial ointment. Sometimes with a bad wound that is deep, I will apply the smallest dot of ointment to prevent infection. But it usually makes the dressing fall off quickly, so the amount has to be very small, about the size of 1-2 sesame seeds. Benzoin helps the dressing stay on. If it falls off, put the next one on without antibacterial ointment because some of the ointment will have remained in the wound and that is enough. The Tegaderm keeps out dirt, acts like a layer of skin and allows the body to heal naturally, so the body's immune cells will fight off infection. Best of luck with your wound care and I hope you heal up soon.


Author: Sandy Summers, RN, MSN, MPH, biography

 

 

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