Bandages, Dressings, Drains

Question 1

why do we use bandages? list 6 reasons

Answer 1

promote healing, protect the wound, absorb exudate, manage dead space, apply pressure, provide support

Question 2

list the layers of a bandage and what their function is

Answer 2

primary–>contact with the skin/wound
secondary–> absorption
tertiary–>hold the bandage in place

Question 3

the tightness of a bandage is proportional to two things and inversely proportional to two things. list these

Answer 3

proportional to: number of layers, tension
inversley proportional to: radius of the limb, width of bandage material

Question 4

what kind of bandage is a “wet to dry” bandage? is this a good choice in most cases?

Answer 4

an adherent bandage
no, these are old school and not commonly used

Question 5

what is the logic behind using an adherent bandage?

Answer 5

to mechanically debride the wound (but they are painful and rip off healthy tissue too!)

Question 6

if you MUST use an adherent bandage, where should you NOT place one?

Answer 6

on granulation tissue or epithelialized tissue

Question 7

list 2 kinds of non adherent primary layers

Answer 7

telfa pads ot jellonet (gauze + vasilene)

Question 8

when are occlusive bandages used?

Answer 8

when there is a lot of exudate, they absorb fluid and “waterproof” the wound, more common in people. think of a blister band aid

Question 9

the secondary layer of a bandage is usually applied ______ with _____ overlap

Answer 9

circumfrencially, 50%

Question 10

when you are applying a seconday layer, you should start ____ and go ____

Answer 10

distal, proximal

Question 11

if you are placing a splint, what layer should it go on top of?

Answer 11

the secondary layer

Question 12

what is the classic example of a secondary layer?

Answer 12

cotton white gauze

Question 13

which layer sets the pressure of the bandage?

Answer 13

the tertiary layer

Question 14

when should you change a bandage?

Answer 14

it is wound dependent and absroptive capacity of the bandage, whether there is infection, and type od dressing. AKA it depends

Question 15

there are several types of bandage anchors. name 5

Answer 15

stirrups (tape), tape overlay, figure of 8, hair overlay, and tie over

Question 16

what is autolytic debridement?

Answer 16

endogenous enzymes debriding the wound for you

Question 17

are hyperosmotic saline dressings antimicrobial? what do they do? when is it best used?

Answer 17

it is antimicrobial if 20% saline or higher
helps with autolytic debridement
best if used in the inflammatory phase

Question 18

what kind of dressing is sugar? what are it’s properties and what phase is it best used in?

Answer 18

hyperosotic
NOT antimicrobial, possibly supplying nutrients to the wound bed
best for inflammatory phase

Question 19

honey is an antimicrobial dressing. list the 4 properties that make it antimicrobial

Answer 19

contains peroxide (H2O2), hyperosmotic, low pH, and inhibin content

Question 20

what phase is honey best used in as a wound dressing?

Answer 20

inflammatory phase

Question 21

honey decreases 2 things and enhances 2 things. list them

Answer 21

decreases inflammation and edema
enhances granulation and epithelialization

Question 22

why would you use a topical antibiotic?

Answer 22

to reduce microbial burden during the inflammatory phase

Question 23

are topical antibiotics sufficient to treat most infections?

Answer 23

no! you may just want to use oral antibiotics if there is an infecton in the wound!

Question 24

what is silver used for

Answer 24

for infected wounds, silver is directly antimicrobial. usually used in human patients and burn victims

Question 25

what are enzymatic agents?

Answer 25

they eat necrotic and dead tissue, can be given additional to surgery in the inflammatory phase

Question 26

why would you use a hydrogel?

Answer 26

to provide EXOGENOUS moisture to promote epithelialization in partial thickness wounds

Question 27

what are hydrocolloids and alginates used for?

Answer 27

to absorb exudate and enhace the autolytic debridement process, can promote granulation

Question 28

negative pressure wound therapy is good for what 4 reasons?

Answer 28

improve perfusion, reducing edema, stimulate granulation tissue, clear exudate

Question 29

what is the purpose of a drain?

Answer 29

to get rid of fluid or gas from body cavities OR the sub Q space

Question 30

list 3 benefits of drains

Answer 30

they remove blood and serum, relieve pressure, and remove inflammatory mediators

Question 31

what is the difference between passive and acitive drainage?

Answer 31

passive is just letting gravity or body movement do the job
active is sucking out the stuff from the wound

Question 32

how should you use a penrose drain properly?

Answer 32

NEVER use it for a dirty or infected wound
NEVER fenestrate the tube
DON’T use it in exchange for proper wound management or aseptic technique
place them DEEP
suture only the EXIT
MUST have a bandage to cover it!

Question 33

list 5 reasons why closed active drains are better than penrose drains

Answer 33

less ascending bacterial infection
less skin complications
decreased seroma and hematoma formation
you can quantify the fluid
it’s the only drain that can be used in body cavities like a septic abdomen or pleural efusion

Question 34

when you place a bandage what should you tell the owner to look out for?

Answer 34

swelling, worsening lameness, slipping, sudden discomfort, systemic illness signs, smell, if it gets wet (especially the secondary layer)

Question 35

list 4 bandage complications

Answer 35

too tight, cut off blood supply
rub sores
slipping
stiffness of joints being immobolized