Bandaging and Drains Flashcards
What 3 things can happen when wounds are left unbandaged?
- desiccation
- delayed wound healing (wound-dependent)
- higher incidence of infection
What are 8 general reasons to bandage a wound?
- compression to reduce edema and control hemorrhage
- debrides wound
- protection from trauma, desiccation, contamination, and irritants
- protects drains
- stabilizes fractures
- immobilization/movement restriction of joints
- absorption of exudate
- vehicle for antiseptic
When do we avoid bandaging a wound?
if healthy granulation tissue is present, bandaging is not necessary
Why do we use stirrups fo bandages?
keeps bandage in place
In what direction should bandages be wrapped?
wrapped distal to proximal towards the medial aspect of the limb
(apply all layers in the same direction!)
How should the bandage be laid?
with even tension and 50% overlap while avoiding wrinkles
(not enough padding + wrinkles = pressure sores)
How should the digits be bandaged?
only the tips of 3 an 4 should be left exposed
How should bandages be placed for fracture stabilization?
must immobilize joints above and below the fracture
(also prevents rubbing!)
When are casts and splints used?
fractures below the stifle and elbow
How do you make stirrups?
- place 2 strips of surgical adhesive tape on healthy skin
- adhere the distal ends to tongue depressors
- once the 1st, 2nd, and conforming bandage of the 3rd layer are placed, remove the tongue depressors and rotate the tape in a 180-degree angle
- fold the tape and adhere it to the bandage before the elastic bandage of the 3rd layer is placed
What is the contact (primary) layer of a bandage? What 4 functions does it have?
wound dressing - in direct contact with the wound
- debrides necrotic wounds
- delivers medication
- absorbs exudate
- protects granulation tissue (non-adherent ones)
What 5 factors affect the choice of material for the contact (primary) layer?
- presence or absence of wound
- stage of wound healing
- amount of exudate
- necrosis/infection
- post-surgery?
What are the 5 main types of wound dressings?
- ABSORBENT - foam dressing used for contaminated and infected wounds to absorb large quantities of exudate
- ADHERENT - wet to dry or dry to dry bandaged used on necrotic wounds that need debridement
- NONADHERENT - telfa used on healthy wounds with granulation tissue that leaves less disruption to tissue
- OCCLUSIVE - air and water tight seal to maintain a moist surface and prevent water vapor transmission for partial thickness wounds lacking necrosis and infection
- SEMI-OCCLUSIVE - hydrophilic foam that allows the wound to breath but still offers protection from outside liquids
When are adherent wound dressings used? What 2 things are important to note?
open and necrotic wounds that need debridement
- debridement is non-selective, so it will remove healthy and non-healthy tissue
- painful when removed, so sedation may be required
How long are adherent wound dressings used? How many times are they typically changed?
short-term use only
change SID to BID until granulation tissue begins to appear, allowing a change to nonadherent dressings
What are the 2 types of adherent wound dressings used?
- dry to dry - direct contact, no wetness
- wet to dry - moist wound healing with a primary layer in contact with the wound (gauze) soaked in sterile saline under a dry gauze, followed by the 2nd and 3rd layers
(avascular devitalized tissue allows movement to the wet dressing)
In what 3 situations are nonadherent wound dressings used? How often should they be changed?
- clean wounds
- over suture lines
- open wounds with granulation tissue
3-7 days
How do we typically use the 2 different types of wound dressings?
start with adherent contact layer after the initial debridement and then move to a nonadherent one
What is the purpose of the intermediate (secondary) layer of a bandage? What 2 materials are typically used?
holds the primary dressing in place, keeping it in contact with the wound - should NOT be in direct contact with the wound and completely covers the primary layer
- cotton roll
- cast padding
What are the 5 functions of the intermediate (secondary) layer?
- absorption of exudate
- support/stabilization
- provides padding/compression
- contributes to decreasing dead space
- holds contact layer in place
What is the purpose of the outer (tertiary) layer? What 2 parts make up this layer?
stabilizing wrap of the intermediate layer
INNER = conforming bandage
OUTER = elastic bandage
What are the 3 functions to the outer (tertiary) layer of the bandage?
- protection from the environment
- holds bandage in place and holds other layers
- adds to immobilization
What 3 types of wounds are tie over bandages used on?
- wounds in highly mobile areas
- wounds that are difficult to close (high tension)
- wounds near the hind end, upper portions of the extremities, and the inguinal area
What are 2 functions of the tie over bandage? What 2 dressings are most commonly used?
- maintains position during motion
- holds various dressings in place
- wet to dry
- nonadherent
What is important to note about the sutures places for tie over bandages?
place suture loops far enough from the edge of the wound and loose enough to avoid necrosis
What are 3 common complications with improperly placing a tie over bandage?
- necrosis
- focal infection around suture sites
- suture loop failure
What are 3 characteristics of the modified Robert Jones (Schanz) bandage? What materials are used?
- protects soft tissue wounds
- provides minimal tissue compression (not particularly good for dead space)
- provides minimal immobilization and support (can still bear weight)
- porous tape for stirrups
- cast padding
- conforming bandage
- elastic bandage
When is the reinforced modified Robert Jones bandage used? How does it compare to the modified Robert Jones bandage?
additional support for fractures an other orthopedic injuries
same materials, but includes an additional splint rode, fiberglass immobilizer, or thermoplastic splint for extra reinforcement
When is the Robert Jones bandage used? What materials are used?
emergency, temporary stabilization of fractures below the elbow and stifle or post-operatively
- porous tape
- (wound dressing)
- cotton roll (makes it bulky!)
- conforming bandage
- elastic bandage
When is the Spica splint used? What materials are used?
temporary stabilization of humeral (scapula) or femoral fractures (hip) and port-operative immobilization
- porous tape
- cotton roll
- conforming bandage
- rigid support (cast material, splint rod)
- elastic bandage
What is the purpose of the Velpeau sling/bandage? What are 2 reasons to use this bandage?
prevents weight-bearing on forelimb while keeping it immobilized against the chest
- stabilizing scapular fractures that do not require internal fixation (non-displaced fx, sx not necessary)
- immobilization following injuries or surgery on the shoulder (luxation)
What is the purpose of the Ehmer sling/bandage? How does it maneuver the limb?
prevents weight bearing on hindlimbs with injuries to coxofemoral joint (luxation)
- abduction (hock out)
- internal rotation of the femur (knee in)
In what 3 situations are full casts necessary? In what 2 situations are they not used?
- minimally displaced, stable fractures of the radius, ulna, tibial, or fibula
- incomplete fractures
- adjunct fixation following internal fixation of a fracture
- skin wounds
- swollen tissue
(this is staying on for a while, no chances to check tissue healing)
What are 5 signs of trouble following bandage application that should be looked at?
- foul odor
- swollen, cyanotic, or cold digits
- excessive drainage or discharge
- pet mutilating bandage (a little is normal, excessive is suspicious)
- ADR pet - pain, fever, anorexia, depression
What are surgical drains? What are 3 functions?
implants that allow removal of fluid and/or gas from a wound or body cavity
- relieve pressure that impairs perfusion or causes pain
- removes excessive fluid
- enables easy monitoring of exudate to see improvement or complications
What are the 2 types of drains?
- PASSIVE: relies on gravity, capillary action, pressure differentials, or overflow to move gas/fluid around the tube with drainage related to surface area
- ACTIVE: applies an artificial pressure gradient to pull fluid or gas from wound, involving suction
What is the most common passive drain? What are 3 characteristics?
Penrose drain
1. works by gravity and capillary action along the side of the drain
2. soft latex tubing that collapses easily
3. open system
What are the 7 steps to placing a Penrose drain?
- choose a ventral exit location and make a stab incision to facilitate drainage
- pass drain from within the wound outward through the ventral incision
- examine pocketing and determine where to place the proximal end of the drain
- place percutaneous tacking suture through the proximal aspect of the drain
- +/- tacking on ventral exit location
- close wound
- place bandage
What’s wrong with this drain?
- 2 exits
- ventral exit coming out of wound
What’s wrong with this drain?
exit not ventral enough
What do active drains look like? How do they work?
closed system that collects fluid into a reservoir
works with (continuous or intermittent) negative pressure to enable placement of the drain exit in any location
What is the most common type of active drain? What does it look like?
Jackson Pratt Drain
radiopaque fenestrated tubing that is connected to a collection system
Simple closed suction system:
- 22, 25 G butterfly
- bloodwork tube
