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DRESSINGS AND BANDAGESClaudia Gherman, Răzvan Ciocan
Learning objectivesWhat you should know
What is a dressing What is a bandage The basic principles of a
bandage Indications of a bandage Types of bandages Bandaging
modalities Special types of dressings
What you should do List the indications of a bandage List the
types of bandages Apply a circular bandage Apply a spiral bandage
Apply a spica bandage Apply a figure-of-eight bandage Apply a
capeline bandage Apply a bandage on one or more fingers List and
describe the special types of dressings
DefinitionsA dressing is used to isolate a treated wound in
order to
allow healing. Dressings are most frequently made of sterile
gauze, but other materials are also used. In addition to isolating
the wound, dressings allow absorption of secretions and a certain
protection against microbial contamination and trauma.
A correct dressing should respect several principles: Any
dressing will be applied with the patient in lying position,
rarely in sitting position, and never in standing positiono
Patients can be impressed by the surgical dressing room,
by instruments, and can lose consciousness and suffer trauma
from falling; the lying or sitting position allows to eliminate
this risk
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The application of a dressing requires two persons: a person
applies the dressing, and the other person provides the necessary
materialso This ensures not only the comfort of the procedure,
but
also the maintenance of asepsis A kidney tray will also be
available, in which the removed
dressing and the used compresses will be placed Perfect asepsis:
the instruments and materials used must be
sterile; hand washing before and after the application of a
dressing, as well as wearing of gloves (sterile – if the dressing
involves manipulation of tissues with the hands, or non-sterile –
if materials and tissues can be manipulated using hemostats) is
compulsory
Absorption of secretions will be ensured: gauze compresses,
etc.
Asepsis of the wound will be performed with antiseptics adequate
for its evolution stage
The dressing will be secured with: Silk, cloth or paper surgical
tape
o Which has advantages: It allows easy wound monitoring It does
not interfere with the functions of the
anatomical segment concernedo But also has disadvantages:
Removal is painful Sometimes it causes maceration of the
underlying
tissue or local reactions (erythema, pruritus) Bandages
Bandages or surgical wrappings represent a method forsecuring
dressings, for temporary immobilization or compression of different
body regions.
Simple dressingsThe instruments currently used for dressings
are:
Surgical hemostat Anatomical hemostat Pan’s forceps Kocher’s
forceps Scissors Kidney tray
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Figure 1. Instruments currently used for dressings: Pan’s
forceps, Kocher’s forceps, scissors, surgical hemostat, anatomical
hemostat, kidney tray (from
left to right)
Dressing technique: Hand washing and gloving The old dressing is
gently removed
o If this is stuck to the wound, it is moistened with oxygenated
water or physiological serum
The skin around the wound is cleaned with a swab soaked in
gasoline for degreasingo Application is performed from the wound to
the periphery
so as not to contaminate the wound The skin around the wound is
disinfected with alcohol or
betadine The wound is treated depending on its nature and
evolution
stageo Surgical wounds with aseptic evolution do not require
special treatmentso Secreting wounds will be cleaned by washing
with
antiseptic solutionso Seromas and hematomas will be drained
using a bulb-
headed or a hollow probe, after removing 1-2 sutureso Purulent
collections will be widely opened and drained
with tubes Wound protection starts with the application of 2-3
gauze
compresseso For secreting wounds, an additional layer of
compresses is
applied (thickness depending on the amount of secretions in the
wound)
The dressing is secured with surgical tape or bandage
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Special types of dressingsGrassolind sterile compressIt is a
sterile
dressing impregnated with a paraffin-based fat substance. It is
made of a network of meshes that allow the exudate to pass,
Figure 2. Grassolind dressing
Preventing maceration. It stimulates epithelization and
granulation tissue formation. It is used to cover wounds,
burns.
Hydrogel dressingIt absorbs secre-
tions and maintains wound moisture, stimu-lates healing, and
does not adhere to the wound. It is used forSuperficial or deep
Figure 3. Hydrogel dressingWounds and burns up to grade 2.
Sterile gel (Hydrosorb Gel) It is an absorbent polyurethane
gel,
permeable for gases and vapors and impermeable for germs and
fluids; it is available in syringes. The gel softens necrotic
tissue and facilitates its removal (debridement), incorporating the
exudate and wound debris. It is used for uninfected wounds and for
burns.
Figure 4. Polyurethane gel
Calcium alginate fiber dressing It is a hydroactive dressing
made of calcium alginate
fibers. It is indicated for deep, difficultly accessible wounds,
infected chronic wounds, fistulas.
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Figure 5. Calcium alginate fiber dressing
Silver ion dressingIt is a mesh
dressing impregnated with triglycerides and stratified with
silver ions. It is used in infected wounds or wounds at risk for
infection, burns.
Figure 6.Silver ion dressing
Indications of bandages To prevent contamination of a wound by
maintaining sterile
compresses in place To maintain a dislocated or a fractured limb
in place To prevent or control hemorrhage To restrict joint
movements To correct a deformity To maintain adequate pressure
(elastic bandages applied to
improve venous return)
Types of bandages Light gauze bandages Simple elastic
bandages
A. B.Figure 7. Types of bandages: A. Gauze bandage; B. Elastic
bandage
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Compression bandages Orthopedic bandages Mesh bandagesA. B.
C.
Figure 8. A. Plaster bandage; B. Mesh bandage; C. Sterile
compresses
Principles of bandages The patient should be in a comfortable
position. The injured region should be supported during bandaging
(if a
joint is involved, this should be maintained in semiflexion).
The bandage should be of an appropriate size and material.
The recommended size of different bandages is indicated in the
table below.
Table 1. Size of adequate bandages for different anatomical
regionsAnatomical region Width (cm) Length (m)Head 5 4-6Chest and
abdomen 10-15 6-8Upper limb 6-8 4Lower limb 5-6 3-4Fingers 2.5
2Hand 5 3Radiocarpal joint 5 3
The bandage roll is held in the dominant hand, with the
rolled-up portion towards the palm. In this way, the roll is held
more firmly and the risk to drop it is lower.
Attention should be paid to avoid the formation of folds that
can make circulation difficult or can induce pain.
During bandaging, constant tension on the bandage is maintained
– not too high, not too low.
In the end, the bandage is secured by applying a surgical tape
or pliers.
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During and at the end of bandaging, the temperature of the
extremity, its color, pulse, the possibility to move the body
region concerned are checked.
Bandaging modalitiesThe main bandaging modalities are:
Circular bandage Spiral bandage Spica bandage Figure-of-eight
bandage Recurrent fold bandage Fan-shaped bandage (rarely used
because it is unstable)
A. B. C. D. E. F.
Figure 9. Types of bandages: A. Circular bandage; B. Spiral
bandage; C. Figure-of-eight bandage; D. Spica bandage; E.
Fan-shaped bandage; F.
Recurrent fold bandageCircular bandageIt is applicable in the
case of small wounds. Circular
bandaging is applied only in the affected area. It provides
effective support of the injured part, being useful in wounds of
the lower limbs, upper limbs, fingers and toes.
Circular bandaging is used to start any bandage. A number of
circular turns are applied proximally to the area concerned, which
have the role to secure the bandage. A corner of the bandage is
folded over the first turn and then covered by the second turn; in
this way, the bandage becomes more stable.
Figure 10. Any bandage starts with circular bandaging; folding
of a
bandage corner secures the bandage in place.
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Spiral bandageAfter securing the bandage by circular turns,
oblique turns
are performed so as to cover 1/3 of the previous turns. This
type of bandage is indicated to be used for upper and lower
limbs.
Figure 11. Spiral bandaging
Spica bandage and figure-of-eight bandageThey are used
particularly for the hand, radiocarpal joint,
ankle.Spica bandage: it is
initiated by circular turns above the joint, to anchor the
bandage, after which the bandage is advanced in the shape of an
eight, each turn covering 1/3 or 2/3 of the preceding turn. The
bandage is completed by circular turns on the support point. Figure
12. Spica bandage
Figure-of-eight bandage: it starts with circular turns below the
joint, after which the turns are continued obliquely over the
joint, and the bandage is advanced by other circular turns above
the joint. The bandage returns obliquely on the opposite side,
crossing the first ascending turn, then it continues in theshape of
an eight, covering half
Figure 13. Figure-of-eight bandage for the radiocarpal joint
combined with
circular bandage for the second finger, using the third finger
as a splint
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Of the preceding turn. This continues several times, and the
bandage ends above the joint with circular turns.
Figure 14. Figure-of-eight ankle bandage technique
Capeline bandageIt is a head bandage. It starts
by two circular turns over the forehead and the occipital
region, then by parallel turns from anterior to posterior
direction, which overlap over 2/3 of their width. At the end,
another two circular turns are performed to maintain in place the
ends of the parallel turns, and the Figure 15. Capeline
bandageBandage is secured with surgical tape.
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Figure 16. Capeline technique
Amputation stump bandageFor amputation stump bandaging, several
recurrent turns
over the stump are secured with several circular turns
(similarly to the capeline technique).
Figure 17. Amputation stump bandage
Finger bandageIn the case of fingers, spica
bandage is difficult to apply, and spiral bandage is unstable.
To
bandage a finger, a combination of recurrent fold bandage and
circular bandage is preferred. The bandage is passed over the end
of the finger
Several times; then, several circular turns are made to secure
it. In
Figure 18. Finger bandage
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Fact, it is the same technique as the capeline or the amputation
stump bandaging technique.
Nose and chin bandageA sufficient length of bandage is cut from
a bandage roll
with a 5 cm width. Two median incisions are cut at both ends
with scissors, leaving a sufficient portion to cover the wound. The
bandage is placed in position and is secured by tying the lower
ends in front of the ears and the upper ends at a 90 angle in
relation to these, below the ears.
Figure 19. Nose bandage and chin bandage
Dessault’s bandageIt is used for shoulder immobilization – for
example, after
reduction of a scapulohumeral dislocation. It immobilizes the
arm against the chest (preventing arm abduction), and supports the
arm (lifting it towards the shoulder).
The affected arm is positioned against the chest and the forearm
is flexed at 90. The bandage starts with two circular turns over
the arm and chest. Then, it continues over the shoulderat 45 in
relation to the first two turns, and descends towards the elbow to
maintain it at a right angle.
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Figure 20. Dessault’s bandage
Assessment / self-assessment form
Stage / Criterion Correct IncorrectApply a circular bandageApply
a spiral bandageApply a spica bandageApply a figure-of-eight
bandageApply a capeline bandageApply a bandage on one or more
fingersApply a Dessault’s bandageList the basic principles of a
bandageIllustrate the special types of dressingsFor each bandage:
Position the patient Keep the roll with the rolled-up portion
towards the palm Perform the initial turn to secure the bandage
Apply the bandage Complete the bandage