✔️13 - SA Bandaging & Bandaging Technique 🟢

1. Protects wounds

2. Speed wound healing

What are the 2 goals of a bandage?

1. Result in limb amputation

2. Kill your patient!

Complications with a bandage can cause what 2 things?

true

T/F - Bandage injury can happen to any clinician even when bandage is placed properly

owner education

Because pet owners will want to blame you, _____ is imperative

1. Provide wound cleanliness

2. Control wound environment

3. Reduce edema & hemorrhage

4. Eliminate dead space

5. Immobilize injured tissue

6. Minimize scar tissue

7. Make patient more comfortable

What are the good things that bandages do? (7)

1. Patient discomfort

2. Patient mutilation of bandage & wound

3. Bacterial colonization of wound

4. Ischemic injury

5. Damage to healing tissues

6. Become a GI foreign body obstruction

What are some complications with bandages? (6)

1. treating injuries

2. protecting wounds or devices

3. for transport

What are the indications for bandages? (3)

1. Pain

2. Swelling

3. Local tissue damage

Bandages reduce what 3 things?

below elbow & stifle

Bandages are typically used/placed in what area?

Modified Robert Jones

-Soft padded bandage

-Immobilizes limb

-Decreases/limits soft tissue swelling

-Absorbs wound exudate

-Add splint material

elbow/stifle

Fracture must be below the _____ to use a soft padded/Modified Robert Jones bandage

1. Primary (contact layer)

2. Secondary (intermediate layer)

3. Tertiary (outer layer)

What are the 3 basic layers of a bandage?

contact

Primary bandage layer = _____ layer

intermediate

Secondary bandage layer = _____ layer

outer

Tertiary bandage layer = _____ layer

1. Debrides tissue

2. Delivers medication

3. Transfers wound exudate

4. Forms an occlusive seal

5. Minimizes pain

6. Prevents excessive loss of body fluids

What are the functions of the primary bandage layer? (6)

1. Absorbs & stores deleterious agents

2. Retards bacterial growth

3. Pads wound from trauma

4. Splints wound to prevent movement

5. Holds primary bandage layer in place

What are the functions of the secondary bandage layer? (5)

1. Holds other bandage layers in place

2. Protects against external bacterial

colonization

3. Cosmesis

What are the functions of the tertiary bandage layer? (3)

1. Adherent

2. Nonadherent

3. Occlusive

4. Semi-occlusive

What are the types of primary layers? (4)

1. Phase of wound healing

2. Amount of exudate

3. Wound location & depth

4. Presence of absence of eschar

5. Amount of necrosis or infection

Primary/contact bandage layer selection is based on what things? (5)

adherent

[Adherent/nonadherent] primary bandage layer:

-Used when wound debridement required

-May be wet or dry

nonadherent

[Adherent/nonadherent] primary bandage layer:

-During repair phase or if no necrotic debris

-Retains moisture to promote epithelialization &

prevent dehydration

-Drains excess fluid & prevents maceration

occlusive

_____ primary bandage layers:

-Impermeable to air

-Use on nonexudative wounds to keep moist

-Speeds rate & quality of healing compared

to dressings allowing desiccation

-Use in partial thickness wounds w/o necrosis or infection

semi-occlusive

_____ primary bandage layers:

-Allows air to penetrate

-Allows exudate to escape

-Most commonly used primary layer

1. Tape Stirrups

2. Primary Layer

3. Secondary Layer

4. Tertiary Layer

5. Labeling

How do we apply a soft padded bandage? (5)

1. Distal 1/3 of limb

2. Either on the lateral and medial surface or dorsal and palmar/plantar surface of the foot

3. Tabbed ends or tongue depressor to help separation

Describe tape stirrups (3)

between toes

With a Modified Robert Jones or Soft Padded Bandage, we place cotton _____

1. Decreases moisture build-up

2. Increases patient comfort

Why do we place cotton between the toes when placing a Modified Robert Jones or Soft Padded Bandage? (2)

dewclaw

When placing cotton between the toes, we should not forget about the _____

primary

The following are associated with applying the _____ layer:

• Contact layer

• Nonadherent

• +/- Medication

• Usually sterile

• Wicking

secondary

The following are associated with applying the _____ layer:

• Intermediate layer

• Absorbent

• Supportive

• +/- Rigid support

• Applied - toes up, overlapping, with firm, even pressure

1. Separate tape stirrups

2. Rotate stirrups proximally while twisting 180°

3. Secure stirrups to underlying wrap (prevents distal slipping)

When placing tape stirrups during secondary layer application, we must do what 3 things?

tertiary

The following are associated with applying the _____ layer:

• Outer Layer

• Applied - toes-up, overlapping, with firm, even pressure

• This is what clients

see!

Elastikon®

_____ or durable material is used when applying a walking pad

1. Elastikon® or durable material

2. Very adhesive

3. Water resistant

4. Applied w/o much pressure since elastic properties may lead to swelling

Describe walking pads (4)

1. Date

2. Initials

3. Reminders

4. Warnings

What do we need to label on bandages? (4)

Wet-to-dry

What is the most common adherent bandage, that is no longer recommended?

Wet-to-wet

With a _____ adherent bandage, the contact layer is expected to stay wet

true

T/F - Dry-to-dry adherent bandages are no longer recommended

nonadherent

_____ bandages are now recommended for all stages of wound healing

Semi Occlusive

What are the most often used bandages in vet med?

Tie-Over

We use _____ bandages when a wound is in an area inaccessible by standard bandaging techniques (e.g., hip, shoulder, axilla, or perineum)

1. absorbent

2. adherent

3. nonadherent

4. occlusive

5. semiocclusive

6. tie-over

7. stabilizing

8. post-operative or closed wound

What are the 8 general types of bandages?

post-operative or closed wound

______ bandages are placed over closed incisions or drains

contact; absorbent

_____ and _____ layers held in place w/ tie-over bandage

1. Apply several sutures or skin

staples w/ loose loops around

periphery of wound

2. Apply primary & secondary

bandage layers

3. Hold tertiary layer by lacing

umbilical tape or heavy

suture through loose skin

sutures or staples

What are the steps for placing a tie-over bandage? (3)

pressure relief

_____ bandages:

• Usually over bony prominence

• To treat/prevent pressure sores

1. minor hemorrhage

2. edema

3. excess granulation tissue

Pressure bandages facilitate control of what 3 things?

corticosteroid ointment

With pressure bandages, direct application of _____ to wound helps control excess granulation tissue

convex; greater

The more _____ the surface, the [greater/lesser] pressure exerted by dressing on tissue

wet

We place a [wet/dry] adherent bandage when the wound surface has necrotic tissue, foreign matter, or viscous exudate

1. Sterile wide mesh gauze soaked in sterile saline solution

2. Sterile wide mesh gauze soaked in 1:40 (0.05%) Chlorohexadine diacetate

What can we use to create a wet bandage? (2)

removed

Necrotic tissue & foreign material adhere to gauze & _____ w/ the wet bandage

dry

[Dry/wet] adherent bandages are placed when wound surface has loose necrotic tissue & foreign material

large

A dry adherent bandage is placed when wound has [small/large] quantity of low-viscosity exudate that does not aggregate

Robert Jones

• Immobilizes

• Decreases/limits soft tissue swelling

• Absorbs wound exudate

Soft padded (Modified Robert Jones)

• Similar benefits as w/ Robert Jones

• Add splint material

• Premade, thermoplastics, fiberglass, aluminum rods

*Fracture MUST be below elbow / stifle

1. Very large/thick bandage

2. Uses rolled/sheet cotton

3. Wrapped w/ more compression

Describe Robert Jones (3)

1. Similar benefits as Robert Jones

2. Add splint material - Premade, thermoplastics, fiberglass, aluminum rods

Describe Modified Robert Jones (2)

spica

With proximal extremity lesions, we continue to bandage up leg, around chest or abdomen& between legs to create _____ type bandage

digits are covered

A paw bandage is placed like a leg bandage except the _____

1. After placing stirrups & contact layer, reflect cast padding over digits from dorsal to ventral-then ventral to dorsal

2. Wrap padding around distal limb

3. Conform bandage to limb w/ elastic

gauze

4. Secure bandage w/ elastic tape in

similar fashion

How do we place a paw bandage?

Schroeder-Thomas Splint

• Traction splint

• Labor intensive

• Soft tissue complications

• Lacks predictability

spica

A _____ splint can be used for immobilization of the shoulder

Ehmer "Femur" Sling

• To prevent pelvic limb weight-bearing

• Post hip reduction or acetabular fractures

Velpeau "Elbow" Sling

• To prevent forelimb weight-bearing

• After shoulder / forelimb procedures

true

T/F - Casts are used to stable minimally displaced fractures

young, rapidly healing

Casts for fractures are used for what kind of animals?

elbow/stifle

Casts are used only for injures distal to the _____

surgical

Casts are used for fractures when we are unable to repair with _____ techniques

swelling

_____ must be reduced prior to applying fracture cast

sedation

Casting for Greenstick fractures may not need _____

displaced

Casting for _____ fractures need general anesthesia

open fractures

We DO NOT cast _____

radiograph

We should always _____ after casting

>50

Casts must have _____% overlap of fracture ends, in each of 2 radiographic views

weekly; 2

Casts should we checked _____ initially, and then every __#__ weeks

standing

We should place casts with the limb in _____ position

1. Encourages use when walking

2. Limits muscle atrophy & joint stiffness

3. Shortens recovery period after removal

Why should we place a cast in standing position? (3)

tendon; arthrodesis

Casts provide _____ repair protection and support an _____

1. Slipping / loosening

2. Water or urine-soaked

3. Joint stiffness & muscle atrophy

4. Pressure sores

What are the common complications with casts? (4)

1. Hard materials or constricting bands

2. Prominences

Why do pressure sores happen? (2)

padding

More _____ = less well immobilized

true

T/F - Bandages require high degree of client

compliance and discharge should include verbal, written, & visual instructions

1. Age

2. Activity

3. Cleanliness

4. Associated wounds

5. Swelling

Change frequency depends on what things? (5)

true

T/F - When assessing a bandage, we should make sure its clean, dry, and comfortable

plastic bag

A _____ can be used to keep a cast/bandage dry when patient goes outside

1. chewing at it

2. lameness increases after discharge

A patient can show that a bandage is uncomfortable by doing what? (2)

1. odor

2. swelling

3. toe temperature (compare to other foot)

4. nail bed cyanosis (blue color)

What are the signs for when its time to remove a bandage? (4)

true

T/F - If any doubt, remove the bandage

bandage paralysis

What is a special consideration for cat bandages/casts?

1. Sedation or anesthesia maybe required

2. Leave middle 2 toes(claws) exposed when possible

3. Bandages start at toes & go up limb to avoid swelling

4. Keep limb in physiologic position

5. Overlap 1/3 to 1/2 the width of your wrap

6. Apply firm even pressure during application

7. Owner compliance - Key to success!

8. No single dressing produces optimum microenvironment for all wounds or all stages of wound healing of single wound

9. Identify underlying structures

What are the main rules to remember? (9)

swelling

Bandages start at toes & go up limb to avoid

_____

typically standing

What is the physiologic position?

full extension (straight)

Do NOT apply bandage w/ limb in _____

tension

_____ of bandage should be proportional to amount of padding & size of patient

iatrogenic injury

Marking the "ear" of the bandage, to identify underlying structures, prevents _____