Principles of Bandaging

What are the bandage layers?

primary, secondary, and tertiary

What is another term for the primary bandage layer?

contact

What is another term for the secondary bandage layer?

intermediate

What is another term for the tertiary bandage layer?

outer

What is the primary layer of the bandage?

should be applied aseptically to prevent contamination/infection since in contact with wound surface, absorbs or transfers exudate to secondary layer, maintains moist wound environment

Wound surface should be kept moist, while the periwound should be ______.

dry

When should the bandage be changed in regards to the primary layer?

changed once absorptive capacity has been reached or if no longer appropriate for the stage of wound healing and/or the amount of exudate

What is the secondary layer of the bandage?

secures primary layer and helps eliminate dead space

What are the two parts of the secondary layer?

inner absorbent and outer securing

What is the inner absorbent part of the secondary layer in a bandage?

generate low pressure with high tension → difficult to place too tightly; cast padding, combine/cotton roll

What is the outer securing part of the secondary layer in a bandage?

moderate pressure with moderate to high tension → can place too tightly; roll gauze, “kling”

What does the thickness of the secondary layer depend on?

wound needs: exudate absorption, pressure, immobilization, support, and protection

What are circumferential layers?

50% overlap for each circumferential pass, should lay flat without wrinkles to apply even tension, each layer extends the full length of the bandage and ends proximally

What regions may need extra padding to reduce the risk of a tourniquet effect?

proximal to digits, carpi, tarsi

What is the tertiary layer of the bandage?

establishes bandage pressure since it generates high pressure even with low to moderate tension → easiest layer to place too tightly; protects underlying layers from external contamination and damage

How do you ensure pressure relief for your bandage?

build the bandage to contain an empty space over the area of concern; doughnuts, windows, and splints

What should the frequency of bandage changes be?

should be changed before secondary layer is completely saturated and well before strike through occurs, sooner if soiled, slipped, etc

What is a robert-jones or modified robert-jones bandage?

“soft padded” bandage used to cover and protect wounds, limit joint mobility, limit postoperative swelling; can be combined with a rigid layer

How should a circumferential bandage be performed?

always start at the very distal extent of an extremity and should extend proximal to the joint above the area of concern, ensure limb is bandage at normal functional angle that supination/pronation does not occur

What is a tie-over (tie-on) bandage?

placed in areas of the body not amendable to circumferential bandages, suture loops placed in areas of normal tissue 1-2 cm from wound edge (full thickness bites), cover with impermeable tertiary layer