Bandages/ Drains Flashcards
What can happen to unbandaged wounds?
What can happen to unbandaged
wounds?
* Desiccation
* Delayed wound healing- Wound dependent
* Higher incidence of infection
Why do we bandage wounds?
- Compression/ Pressure
- Reduce edema/ deadspace
- Debrides wound
- Protection: Trauma, dessication, contamination, irritants.
- Protects Drains
- Stabilizes fractures
- Immobilization/ movement restriction (joints)
- Absorb exudate
- Vehicle for antiseptic
Why should you use bandages in hospital?
Prevent nonsocomial infections
What are important things to remember when applying a bandage ?
1.) Use Stirrups
2.) Distal to proximal
3.) Medial to lateral
4.) 50% overlap
5.) No wrinkles
6.) Use adequate padding to avoid pressure sores.
7.) If digits out, only tips of 3 and 4
8.) Correct tightness ( too tight will cause damage, too lose will come off)
9.) Fracture - immobilize joints above and below fracture
10.) Casts and splints usually for fractures below stifle and elbow
11.) Fractures and luxations require rigid support.
How do you make stirrups?
When do you place the bottom pieces of stirrup onto the bandage?
after 2nd layer before elastic layer is placed.
What is the contact or primary layer of a bandage?
Dressing in direct contact with wound
* “Wound dressing”
What is the function of the primary / contact layer?
Functions:
* Debride necrotic wound
* Deliver medication
* Absorb exudate
* Protect granulation tissue
* Non adherent dressing
What guides your choice of material for your primary/ contact layer?
Choice of material depends on…
* Presence or absence of wound
* Stage of wound healing
* Amount of exudate
* Necrosis/infection
Protects against iatorgenic infection
Post op ect.
What are the types of wound dressings?
Absorbant
Adherent
Non adhesisve
Occlusive
Semiocclusive
What is an absorbent dressing? When would you use it?
Absorbent dressings will absorb large quantities of exudate. They are usually for wounds that are contaminate/infected and wounds that you want alot of debridement. Typically a foam dressing.
What is an adherent dressing? When would you use it?
An adherent dressing is a dressing that is used on wounds that require debridement. You will see this used for necrotic wounds. These bandages can be wet to dry or dry to dry bandages.
What is an non- adherent dressing? When would you use it?
You would use a non adherent dressing on a healthy wound with granulation tissue. You choose this because it has less debridement to underlying tissue. Telfa pads are typically what is used.
What is an occlusive dressing? When would you use it?
Air and water tight seal -> maintains moist wound surface but prevents water vapor transmission
* Partial thickness wounds without necrosis or infection
What is a semi-occlusive dressing? When would you use it?
Allows the wound to “breath” but is protecting it from outside liquids
* Hydrophilic foam
When using an adherent contact layer what are the resons for this? How often would you change it? What is important to remember about this dressing? When do you switch to a non adhesive dressing?
Necrotic / open wounds. Wounds that need debridement.
Painful when removed.
Short term use only ( change SID to BID until granulation tissue appears then switch to nonadhesive dressing.)
What is important to remember about debridemebt?
Debridement is non selective. It will remove healthy and unhealthy tissue.
What is a dry to dry dressing?
Dressing with direct contact to the wound. The layer is dry (ie. sterile dry gauze + wrap around)
What is a wet to dry bandage?
Wound dressing is moist, primary layer is in direct contact with the wound and is moistened, usually with sterile saline or some other topical agent. You place dry guaze then continue with 2nd and 3rd layer.
What is the goal of wet to dry bandages and dry to dry bandages?
Goal is to accelerate healing.
What is the mechanism of a wet to dry bandage?
- Devitalized tissue has no blood supply, so moisture will move to the dry guaze then there will be movement of gross devitalized tissue to dry bandage.
What is a non adherent contact layer used for? What are semi and occlusive dressings used for? How long should these bandages be changed? What is important to remember about changing these bandages?
Used for : clean wounds, over suture lines, open wounds with granulation tissue.
Semi occlusive/ occlusive dressings help retain moisture at wound site to promote moist wound healing.
Change ever 3-7 days, but if you are concerned about the bandage condition just change it.
What is your intermediate/ secondary layer of a bandage? What is its function?
True or False: Your second layer of bandage should minimally come into contact with your wound.
FALSE
What is the purpose of your outer/ tertiary layer? What is the functions of this layer?
What are tieover bandages? What is the purpose of these bandages? What is important to remember about suture placement?
What are potential complications of tie over bandages?
- Skin necrosis ( loosen sutures)
- Focal infection around suture sites
- Suture loop failure.
What is the term external coaptation referencing?
- Use of casts, splints, bandages, or slings to stabilize fractures or luxations or protect wounds
What are temporary support coaptations and what are they used for?
Temporary Support ->first aid
* Robert Jones Bandag
* Modified reinforced Robert Jones (splints)
What are primary support coaptations and what are they used for?
- Primary Support -> selected fractures
- Cast
- Modified reinforced Robert Jones (splints)
What are secondary support coaptations and what are they used for?
Secondary support->aid to surgical reduction and internal fixation
* Modified Robert Jones
* Reinforced modified Robert Jones
* Slings
What interventions should occur for an unstabilized fracture?
Stabilize with splint/ bandage right away. This is so bone fragments cannot migrate/cause damage.
In a patient with an open fracture, besides bandaging what is another intervention you should immediately do?
Give broad spectrum antibiotics.
What is another name for modified robert jones bandage?
Schanz bandage
What is a modified robert jones bandage used for? What materials are used? How can it be used on a patient with a laceration?
What bandage is seen here?
Tieover bandage
What is the bandage seen here?
Mo dified Robert Jones (Schanz) Bandage
What bandage is seen here?
Reinforced Modified Robert Jones
What is a reinforced modified robert jones used for?
Additional support for fractures and other orthopedic injuries
In the reinforced modified robert jones, where is the reinforcement placed?
- Reinforcement is placed between conforming bandage and elastic bandage layer
What bandage is seen here?
Robert jones bandage
What is a robert jones bandage used for? What about post opperatively?
Emergency, temporary stabilization of the
fractures below the elbow and stifle * When used post operatively
* Protects soft tissue wounds * Adds extra stabilization * Aids limb immobilization * Tissue compression
What is an identifying characteristic of a robert jones bandage?
Its quite bulky
What kind of bandage is this?
Spica Splint
What is a spica splint used for? What does it prevent? What materials do you need?
Which bandage requires the use of cast material or a splint rod?
a.) Spica splint
b.) modified robert jones
c.) Velpeau sling
d.) Ehmer sling
a.) Spica splint
What is this bandage?
Velpeau splint
What is a velpeau splint used for? What is the purpose? When shouldnt you use it? What materials are used?
Do not use with a displaced fracture
Which should you not use a splint for?
a.) Shoulder luxation
b.) Non- displaced fracture
c.) Displaced fracture
d.) Post op immobilization
C
What bandage is this?
Ehmer Sling
If you have completed your ehmer sling correctly what conformation should the leg be in?
Abduction (hock out) and internal rotation of the femur (knee in)
What can an ehmer sling be used to treat?
Prevents weight bearing on hindlimb with
injuries to coxofemoral joint
* Coxofemoral luxation
What materials are used for an ehmer sling?
- Materials:
- Conforming bandage
- Elastic bandage
What type of bandage would you use for a dog who has luxated their coxofemoral joint?
a.) Robert Jones Modifed reinforced
b.) Spica splint
c.) Velpeau sling
d.) Ehmer sling
D
What type of bandage would you use for a dog who has luxated their shoulder joint?
a.) Robert Jones Modifed reinforced
b.) Spica splint
c.) Velpeau sling
d.) Ehmer sling
C
What type of bandage would you use for a dog who has fractured there humeus or femur?
a.) Robert Jones Modifed reinforced
b.) Spica splint
c.) Velpeau sling
d.) Ehmer sling
B
What type of bandage would you use for a puppy who has a minimally displced stable fracture of there radius ?
a.) Full cast
b.) Spica splint
c.) Velpeau sling
d.) Ehmer sling
A
What is this bandage?
Full cast
What can you use a full cast for?
When should you not use a full cast on a patient?
When skin has a wound or is swollen. You want to be able to see whats going on.
What materials are used for a full cast?
How do you apply a bandage?
1.) ensure paw/ coat dry
2.) Place stirrups (if bandaging from foot put some cotton between digits to prevent toe rubbing inside.
3.) Place primary contact layer over wound site ( +/- ointment)
4.) apply secondary layer with cotton roll/ cast padding (wrap distal to proximal maintaing even tension and 50% overlap. Dont make too tight)
5.) Similarly apply conforming bandage of tertiary layer
6.) Before applying elastic bandage of tertiary layer ensure free end of stirrup is removed and rotated 180 degrees at its base
7.) Fold tape to adhere bandage before elastic of 3rd bandage is placed.
8.) Apply elastic bandage tertiary layer.
Remember: weap distal to proximal maintaining even tension + 50 % overlap and not too tight. Leave tips of digits 3 and 4 exposed.
What are signs of issues with bandages?
Odor
Swelling
Cyanotic
Cold digits
Excessive drainage
Pet mutilating bandage
ADR pet
Pain
Fever anorexia depression.
What is important for bandage maintenance?
confine animal
keep bandage clean and dry
ascess toes bid
monitor for complications
What must you monitor for when maintaining a bandage?
dislodgement
Tightness
Soiling
Swelling
Lameness on any leg
Patient tampering
Strike through/ soak through.
What animals will require more frequent bandage changes/ bandage monitoring?
Young rapidly growing animals
How often should you change wound bandages?
BID - SID depending on nature of wound/ amount of exudate
How often should you change slings?
Evaluate SID
How often should you change splints/ casts?
Change splints every 2-3 weeks and evaluate casts every 2-3 weeks
What should your discharge instructions say to your owner for bandage maintenance/ monitoring
?
- Keep bandage clean/ dry. cover with plastic bag if going outside and grass is wet. Remove bag when indoors
- Monitor toes twice daily for swelling, comparing to other leg
- Watch for strikethrough ( any discharge coming through is not good)
- Monitor for foul odor.
- Monitor for pet licking/ chewing. If they are going at it alot something may be wrong.
- Make sure bandage/ cast is not slipping down the leg/ no sores are developing at contact points with skin.
- IF BANDAGE IS WET , COME CHANGE IT IMMEDIATELY
What are surgical drains? What is their function? What
- Implants that allow removal of fluid and or gas from a wound
or body or cavity - Can relieve pressure that impairs perfusion or causes pain
- Enables monitoring for potential complications
- Easy sampling of fluid during healing
- Regardless of drain it will incite an inflammatory response and can introduce or reduce body’s response to bacteria
What are the indications for surgical drains?
What kind of drains can you see?
Passive or Active
What are passive drains?
What are active drains?
What is a potential consequence of using drains?
Materials-> latex, silicone, polyethylene
* Can affect wound healing due to tissue reactions to material
Hoe do you place a penrose drain?
How many exits should there be for a passive drain? Why? How do you care for the drain site?
What is a penrose drain? How does it work? Does that make it a passive or active drain?
What is the downside to using a fenestrated passive drain?
Fenestrating drain may decrease effectiveness by reducing
surface area
What are the advantages of a passive drains?
Advantages-> allows drainage, helps obliterate dead space, soft
and malleable so less painful, inexpensive, great for small tissue
pockets, air entering area does not affect drain function
What are the disadvantages of passive drains?
Disadvantage-> irritating, can lead to ascending infection, can’t
be connected to suction, gravity dependent, can get clogged
What are important things to keep in mind when placing a drain ?
- Drains should never exit through the incision line
- Drains should not lie directly under suture line
- Increased risk of dehiscence
- Percutaneous tacking sutures over buried tacking
sutures - Determining exit point is key!
- Bandage
What is wrong in this image?
What is wrong in this image?
What is an active drain? How does it work? Is it preferrable or have more risks? What may cause drain failure?
What drain is seen in this image?
Jackson Pratt Drain
What kind of drain is seen here?
Penrose drain
What is a Jackson Pratt drain? Where should the fenestrated portion be found ? Where does the tube exit the skin? How would you secure it?
What can happen if air enters the active drain system?
It can fail
How can you create a simple closed suction system?
When do you normally remove drains?
When they are no longer beneficial usually 3-7 days
- when discharge is serosanguinous
- Drainage decreases
If you are managing an infected wound with a drain, what should you do before removing the drain?
You want to obtain fluid samples for cytologic evaluation before removing drain.
How do you remove active drains?
Active drains->cut purse string and fingertrap and then slowly withdraw drain
How do you remove passive drains?
Passive drains->remove percutaneous tacking suture and
then slowly withdraw drain
Why does fluid continue to accumulate with a drain?
Drainage decreases
but Rarely stops completely-FB reaction elicited by drain
What should you do when removing a drain?
Make sure its all there.
