Lecture 13: Bandaging & Bandaging Techniques - SA

What are the goals of a bandage?

protect wounds and speed wound healing

What are the major potential bandage complications?

result in limb amputation or can kill your patient

What are the advantages to bandages?

• Provide wound cleanliness

• Control wound environment

• Reduce edema & hemorrhage

• Eliminate dead space

• Immobilize injured tissue

• Minimize scar tissue

• Make patient more comfortable

What are the disadvantages with bandages?

• Patient discomfort

• Patient mutilation of bandage & wound

• Bacterial colonization of wound

• Ischemic injury

• Damage to healing tissues

• Become GI foreign body obstruction

What are indications for bandages?

• typically used below elbow & stifle

• treating injuries - reduce pain, swelling, local tissue damage

• protecting wounds or devices

• for transport

What bandage technique immobilizes the limb, decreases/limits soft tissue swelling, and absorbs wound exudate, but the fracture MUST be below the elbow/stifle?

modified robert jones

What are the three basic layers of a bandage?

1. primary (contact layer)

2. secondary (intermediate layer)

3. tertiary (outer layer)

What is the function of the primary bandage layer?

• Debrides tissue

• Delivers medication

• Transfers wound exudate

• Forms occlusive seal

• Minimizes pain

• Prevents excessive loss of body fluids

What is the function of the secondary bandage layer?

• Absorbs & stores deleterious agents

• Retards bacterial growth

• Pads wound from trauma

• Splints wound to prevent movement

• Holds primary bandage layer in place

What bandage layer is this?

primary

What bandage layer are these?

secondary

What is the function of the tertiary bandage layer?

• Holds other bandage layers in place

• Protects against external bacterial colonization

• Cosmesis

What bandage layer is this?

tertiary

What are the four types of primary bandage layers?

• Adherent

• Nonadherent

• Occlusive

• Semi-occlusive

What is the primary/contact bandage layer selection based on?

• Phase of wound healing

• Amount of exudate

• Wound location & depth

• Presence of absence of eschar

• Amount of necrosis or infection

What type of primary bandage layer is used when wound debridement is require and may be wet or dry?

adherent

What type of primary bandage layer is used during repair phase or if no necrotic debris, retains moisture to promote epithelialization & prevent dehydration, and drains excess fluid and prevents maceration?

nonadherent

What type of primary bandage layer is impermeable to air and is used on nonexudative wounds to keep moist and in partial thickness wounds w/o necrosis or infection?

occlusive

What is the advantage to occlusive primary bandage layers?

speeds rate & quality of healing compared to dressings allowing desiccation

What is the most commonly used primary bandage layer that allows air to penetrate and allows exudate to escape?

semi-occlusive

What are the 5 steps to applying a soft padded bandage?

1. Tape Stirrups

2. Primary Layer

3. Secondary Layer

4. Tertiary Layer

5. Labeling

How are tape stirrups applied?

• Distal 1/3 of limb

• Medial & Lateral or Dorsal & Palmar/Plantar?

• Tabbed ends or tongue depressor to help separation

Why is cotton placed between toes in a modified robert jones/soft padded bandage technique?

• decreases moisture build-up

• increases patient comfort

• (don’t forget dewclaw)

What bandage layer is nonadherent, can have medication, is usually sterile, and is wicking?

primary layer

What bandage layer is absorbent, supportive, and applied distal to proximal, overlapping, and with firm, even pressure?

secondary

How are the tape stirrups used when applying the secondary bandage layer?

• separate tape stirrups

• rotate stirrups proximally while twisting 180°

• secure stirrups to underlying wrap

• prevents distal slipping

How is the tertiary layer applied?

• distal to proximal

• overlapping

• firm, even pressure

• neatly - this is what client sees !!

What should be written on a bandage label?

• date

• initials

• reminders

• warnings

When is a tie-over bandage used?

when the wound is in an area inaccessible to standard bandaging techniques (ex. hip, shoulder, axilla, or perineum

How is a tie-over bandage placed?

• Apply sutures or skin staples w/ loose loops around edges of wound

• Apply primary & secondary bandage layers

• Hold tertiary layer in place → Lacing umbilical tape or heavy suture through loose skin sutures or staples

When is a pressure relief bandage used?

• usually over bony prominence

• to treat/prevent pressure sores

When is a pressure bandage used?

• control minor hemorrhage, edema, & excess granulation tissue (direct application of corticosteroid ointment to wound helps control excess granulation tissue)

• the more convex the surface, the greater pressure exerted by dressing on tissue

When should wet adherent bandages be used and how are they used?

• wound surface has necrotic tissue , foreign matter, or viscous exudate

• sterile wide mesh gauze soaked in: sterile saline solution, 0.05% chlorohexadine solution

• necrotic tissue & foreign material adhere to gauze & removed w/ bandage

When should dry adherent bandages be used?

• when wound surface has loose necrotic tissue & foreign material

• when wound has large quantity of low-viscosity exudate that does not aggregate

What is the purpose of robert jones bandages?

• temporary immobilization of fractures (must be below elbow/stifle)

• decreases/limits soft tissue swelling

• absorbs wound exudate

What is the difference between the modified robert jones and robert jones bandage technique?

• modified adds splint material

• robert jones uses very large/thick bandage and rolled/sheet cotton and is wrapped w/ more compression

How should proximal extremity lesions be bandaged?

continue bandage up leg, around chest or abdomen & between legs to create spica type bandage

How is a paw bandage placed?

• like leg bandage except digits are covered

• after placing stirrups & contact layer, reflect cast padding over digits from dorsal to ventral - then ventral to dorsal

• wrap padding around distal limb

• conform bandage to limb w/ elastic gauze

• secure bandage w/ elastic tape in similar fashion

What are the disadvantages of a traction splint (shroeder-thomas splint)?

• labor intensive

• soft tissue complications

• lacks predictability

What is a spica splint used for?

immobilization of shoulder

What is a ehmer sling used for?

prevents pelvic limb weight bearing post hip reduction or acetabular fractures

What is a velpeau sling used for?

prevents forelimb weight bearing after shoulder/forelimb procedures

When are casts used for fractures?

• stable minimally displaced fractures

• young rapidly healing animals

• only injuries distal to elbow/stifle

• unable to repair w/ surgical techniques

What type fracture should NOT be casted?

open fractures

What should always be done after casting?

radiographs: must have >50% overlap of fracture ends in each of 2 radiographic views

Why should a cast be placed with the limb in a standing position?

• encourages use when walking

• limits muscle atrophy & joint stiffness

• shortens recovery period after removal

What are some common complications of casts?

• Slipping / loosening

• Water or urine-soaked

• Joint stiffness & muscle atrophy

• Pressure sores: Hard materials or constricting bands, Prominences

Bandage change frequency depends on:

• age

• activity

• cleanliness

• associated wounds

• swelling

What are signs to remove a bandage?

• odor

• swelling

• changes in toe temperature compared to other foot

• nail bed cyanosis

What should be left exposed when bandaging?

middle 2 toes (claws) when possible

Bandages start at toes & go up limb to avoid _______.

swelling

What is the tension applied during bandage application proportional to?

the amount of padding and size of patient

How much of your bandaging should overlap?

1/3-1/2 the width of your wrap