Lecture 13: Bandaging and Techniques

advantages of bandaging

• protects wounds

• speed wound healing

disadvantages/complications with bandaging

• result in limb amputation

• kill your patient!

bandage injury

can happen even when bandage is placed properly!

what can happen with the owners with a bandage injury??

they may blame you!

owner education is imperative!

good things that bandages do:

• provide wound cleanliness

• control wound environment

• reduce edema and hemorrhage

• eliminate dead space

• immobilize injured tissue

• minimize scar tissue

• make patient more comfortable

complications with bandages:

• patient discomfort

• patient mutilation of bandage and wound

• bacterial colonization of wound

• ischemic injury

• damage to healing tissues

• become GI foregign body obstruction

Indications for bandages:

• typically used below elbow and stifle

• treating injuries

  • bandages reduce pain, swelling, local tissue damage

• protecting wounds or devices

• for transport

soft padded bandage (modified robert jones)

immobilizes limb

decreases/limits soft tissue swelling

absorbs wound exudate

add splint material

• premade, thermoplastics, fiberglass, aluminum rods

• fracture MUST be below the elbow/stifle

the basic layers of a bandage:

1) primary (contact layer)

2) secondary (intermediate layer)

3) tertiary (outer layer)

functions of primary layer

• debrides tissue

• delivers medication

• transfers wound exudate

• forms occlusive seal

• minimizes pain

• prevents excessive loss of body fluids

primary layer

Functions of a secondary layer

• absorbs and stores deleterious agents

• retards bacterial growth

• pads wound from trauma

• splints wound to prevent movement

• holds primary bandage layer in place

secondary layer

secondary layer

functions of tertiary layer

• holds other bandage layers in place

• protects against external bacterial colonization

• cosmesis

tertiary layer

types of primary layers

• adherent

• nonadherent

• occlusive

• semi-occlusive

primary/contact layer selection

based on:

• phase of wound healing

• amount of exudate

• wound location and depth

• presence of absence of eschar

• amount of necrosis or infection

types of primary layers:

adherent vs. nonadherent

adherent primary layer

• used when wound debridement required

• may be wet or dry

nonadherent primary layer

• during repair phase or if no necrotic debris

• retains moisture to promote epitheliazation and prevent dehydration

• drains excess fluid and prevents maceration

occlusive primary layer

• impermeable to air

• use on nonexudative wounds to keep moist

• speeds rate and quality of healing compared to dressings allowing desiccation

  • use in partial thickness wounds w/o necrosis or infection

semi-occlusive primary layer

• allows air to penetrate

• allows exudate to escape

what is the most commonly used primary layer?

semi-occlusive!

applying soft padded bandage

1) tape stirrups

2) primary layers

3) secondary layer

4) tertiary layer

5) labeling

bandage material and supplies

applying tape stirrups

tape stirrups:

• distal 1/3 of limb

• medial and lateral or dorsal and palmar/plantar

• tabbed ends or tongue depressor to help separation

tape stirrups

modified rovert jones/soft padded bandage

tip for modified robert jones/soft padded bandage

place cotton between toes!

• decreases moisture build-up

• increases patient comfort

• don’t forget dewclaw

applying primary layer

• contact layer

• nonadherent

• ± medication

• usaully sterile

• wicking

contact layer - primary layer

applying secondary layer

• intermediate layer

• absorbent

• supportive

• ± rigid support

• applied

  • distal to proximal

  • overlapping

  • firm, even pressure

secondary layer

steps for applying secondary layer

• separate tape stirrups

• rotate stirrups proximally while twisting 180 degrees

• secure sirrups to underlying wrap

• prevents distal slipping

  

applying tertiary later

outer layer

applied

• distal to proximal

• overlapping

• firm, even pressure

this is what the client sees!

tertiary layer

applying a walking pad

• Elastikon or durable material

• very adhesive

• water resistant

• applied w/o pressure

  • elastic properties may lead to swelling

• doozies!

walking pad

applying labels to bandages

• date

• initials

• reminders

• warnings

applying labels to bandages

general types of bandages:

absorbant

adherent

• wet-to-dry (most common adherent)

  • no longer recommended

• wet-to-wet (contact layer expected to stay wet)

• dry-to-dry

  • no longer recommended

nonadherent

• now recommended for all stages of wound healing

occlusive

semi occlusive

• bandages most often used in vet med

tie-over

• wound in area inaccessible by standard bandaging techniques

stabilizing

post-operative or closed wound

• over closed incision or drain

which two types of bandages are no longer recommended

adherent wet-to-dry

and adherent dry-to-dry

which type of bandage is most often used in vet med?

semi occlusive

tie-over bandage

wound in area inaccessible to standard bandaging techniques (e.g. hip, shoulder, axilla, or perineum)

• contact and absorbent layers held in place with tie-over bandage

tie-over bandage would be good for this wound

tie-over bandage used to manage large open wound on lateral thigh of 6 yo greyhound

how to apply tie-over bandage

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

• apply primary and secondary bandage layers

• hold tertiary layer in place

  • lacing umbilical tape or heavy suture through loose skin sutures or staples

    

pressure relief bandage

• usually over bony prominence

• to treat/prevent pressure sores

pressure relief bandage

what are pressure bandages good for?

• control minor hemorrhage, edema, and 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 to use wet adherent bandages

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

• sterile wide mesh gauze soaked in:

  • sterile saline solution

  • 1:40 (0.05%) Chlorohexadine diacetate

• necrotic tissue and foreign material adhere to gauze and removed with bandage

when to use dry adherent bandages

• when wound surface has loose necrotic tissue and foreign material

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

robert jones is used for: (REMEMBER THIS)

temporarily immobilization of fractures

• decreases/limits soft tissue swelling

• absorbs wound exudate

soft padded (modified robert jones) uses

similar benefit as with robert jones

add splint material

• premade, thermoplastics, fiberglass, aluminum rods

*FRACTURE MUST BE BELOW ELBOW/STIFLE

Robert Jones vs Soft Padded (Modified Robert Jones)

Robert Jones:

• very large/thick bandage

• uses rolled/sheet cotton

• wrapped with more compression

Soft Padded (Modified Robert Jones)

• similar benefits as Robert Jones

• add splint material

  • premade, thermoplastics, fiberglass, aluminum rods

Robert Jones vs. Modified Robert Jones

Proximal Extremity Lesions

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

Paw bandage

placed like leg bandage except digits are covered

after placing stirrups and contact layer

• reflect cast padding over digits from dorsal to ventral - then ventral to dorsal

wrap padding around distal limb

conform bandage to limb with elastic gauze

secure bandage with elastic tape in similar fashion

Schroeder-Thomas Splint

traction splint

• labor intensive

• soft tissue complications

• lacks predictability

  

which type of splint has “historical significance”

Schroeder-Thomas Splint

Spica splint

for immobilization of shoulder

Ehmer Sling

what is the Ehmer Sling for?

• prevents pelvic limb wt-bearing

• post hip reduction or acetabular fractures

• “Ehmer Femur”

Velpeau Sling

• prevents forelimb wt-bearing

• after shoulder/forelimb procedures

“Velpeau Elbow”

Velpeau Sling

Casts for fractures

• stable minimally displaced fractures

• young rapidly healing animals

• unable to repair with surgical techniques

• expense: discuss with owner

• potential issue?

• only injuries distal to elbow/stifle!!!

should you cast open fractures?

NO!!!

• always radiograph after casting

• must have > 50 % overlap of fracture ends

• in each of 2 radiograph views

what must you ensure happens before casting?

swelling reduces

greenstick fractures may not need what?

sedation

displaced fractures require

general anesthesia

when to check casts?

at least q2 weeks (weekly initially if possible)

how to place cast

with limb in standing position

• encourages use when walking

• limits muscle atrophy and joint stiffness

• shortens recovery period after removal

tendon repair protection

• support an arthrodesis!

common complications with bandaging

• slipping/loosening

• water or urine-soaked

• joint stiffness and muscle atrophy

• pressure sores

  • hard materials or constricting bands

  • prominences

checking and changing bandages

• bandages require high degree of client compliance!

• discharge should include verbal, written, and visual instructions for clients

• check frequently!!

check frequency for bandages:

• age

• activity

• cleanliness

• associated wounds

• swelling

assessing bandage

clean

dry

• protect during post-op recovery, hospital blue pads

• plastic bag when going outsidea

assessing bandage - comfort:

• chewing at bandage

• lameness increase after discharge

when to remove bandage?

with these signs:

• odor - swelling

• toe temperature - compare to other foot!

• nail bed cyanosis

if any doubt… REMOVE IT!!!

Rules to remember:

• sedation or anesthesia may be required

• leave middle 2 toes (claws) exposed when possible!!

• bandages start at toes and go up limb to avoid swelling!

keep toes how when bandaging

in physiologic position

• typocally standing

• do NOT apply with limb in full extension (straight)

how much should you overlap your bandage material?

1/3 to ½ the width of your wrap

apply firm even pressure during application of bandages, tension should be proportional to:

amount of padding and size of patient

owner compliance with bandaging is the:

key to success!

no single dressing has optimum microenvironment for all wounds or all stages of what?

wound healing of single wound

when bandaging, identify underlying structures, examples:

mark the ear!

prevents iatrogenic injury