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 is external coaptation? What are the 3 types?
use of cast, splints, bandages, or slings to stabilize fractures or luxations and protect wounds
- TEMPORARY SUPPORT - first aid; Robert Jones bandage, modified reinforced Robert Jones
- PRIMARY SUPPORT - cast, modified Robert Jones
- SECONDARY SUPPORT - aid to surgical reduction and internal fixation; modified Robert Jones, reinforced modified Robert Jones, slings
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
What should be done when a patient presents with a laceration on their limb? What bandage is typically placed?
- clean
- lavage
- debride
- primary closure
- modified Robert Jones 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
Where in the bandage is the reinforcement placed in the reinforced modified Robert Jones bandage?
between the conforming bandage and the elastic bandage layer
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
What are the 4 functions of the Robert Jones bandage when used post-operatively?
- protects soft tissue wounds
- adds extra stabilization
- aids in limb immobilization
- tissue compression
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)
Why are Velpeau slings not used on displaced fractures? What materials are used?
without surgery, if it is placed improperly, malunion fractures can occur
- cast padding
- conforming bandage
- elastic bandage
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)
What materials are used in the Ehmer sling/bandage?
- conforming bandage
- elastic bandage
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)
How do young animals compare with healing in casts with older animals?
fast healing —> change more frequently, can take off sooner
What are the 7 general steps to bandage application?
- ensure paw and hair coat is dry
- place stirrups
- place primary contact layer directly over wound (+/- ointment)
- apply second layer with cotton roll/cast padding, wrapping from distal to proximal maintaining even tension and 50% overlap
- apply conforming bandage of tertiary layer
- remove the free end of each stirrup, rotate it 180 degrees, fold it, and adhere it to the bandage
- apply the elastic bandage of the tertiary layer, leaving the tips of digits 3 and 4 exposed
What adjustment should be made to the bandage application if the foot is completely covered?
place cotton wool between digits to prevent toes from rubbing the inside of the bandage
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 4 practices should the client do with their bandaged pet?
- confine animal and restrict exercise
- keep bandage clean and dry
- assess toes 2x daily
- monitor for dislodgement, tightness, soiling, swelling, lameness, patient tampering, or strike through
How often should wound bandages, slings, splints, and casts be changed/monitored?
WOUND BANDAGES: change at least every 12-24 hours depending on nature of wound and amount of exudate
SLINGS: evaluate at least every 24 hours
SPLINTS: change every 2-3 weeks
CASTS: evaluate every 2-3 weeks
What 6 things should be told to patients watching pets with bandages/slings/casts?
- keep bandage clean and dry (cover with plastic bag if grass is wet and remove bag once indoors)
- twice daily monitoring the toes for swelling (compare with other leg)
- watch for strike through
- monitor for foul odor
- monitor for excessive licking or chewing
- make sure bandage cast is not slipping down the leg and there are no cores developing at contact points with the skin
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 4 implications for the use of a surgical drain? What is important to remember?
- need to eliminate dead space
- remove existing fluid or gas
- prevent accumulation of fluid or gas
- contamination or infection
regardless of drain, it will incite and inflammatory response and can introduce or reduce body’s response to bacteria
What are drains typically made out of?
latex, silicone, polyethylene
- can affect wound healing due to tissue reaction to material
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 kind of exit is preferred for passive drains? How can they be kept dry and clean?
single exit > 2 exit wounds
- decreases the risk of ascending infection
bandaging drains to absorb fluid coming from the wound
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
Why are fenestrated drains not typically used?
- doesn’t conform as well to wounds
- fenestration decreases effectiveness by reducing surface area
What are the 6 advantages to using passive drains?
- allows drainage
- helps obliterate dead space
- soft and malleable, so less painful
- inexpensive
- great for small tissue pockets
- air entering area doesn’t affect drain function
What are 5 disadvantages to using passive drains?
- irritating
- can lead to ascending infection
- can’t be connected for suction
- gravity dependent
- can get clogged
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 5 things should be kept in mind when placing a drain?
- drains should never exit through the incision line - should be lateral and ventral
- drains should not lie directly under the suture line, or else chances of dehiscence are higher
- place percutaneous taking sutures over buried taking sutures
- determining exit point is key
- bandage to keep clean and dry
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 are 3 advantages to the active drain over a passive one? What is the primary cause of failure?
- greater efficiency
- allows close monitoring of discharge
- risk of infection is lower than passive
obstruction
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
Where should the fenestrated end of the Jackson Pratt drain be placed? Where should the tube exit?
deepest portion of the wound or where fluid accumulation is anticipated
through the skin away from the incision and wound closure and secured with a purse string and finger trap
What is a major disadvantage to active drains over passive drains?
any air that enters the system will affect the negative pressure gradient, so the wound must be completely closed
Simple closed suction system:
- 22, 25 G butterfly
- bloodwork tube
In what 3 situations are drains removed? When are they removed?
(whenever they are no longer beneficial)
1. drainage decreases (rarely stops entirely)
2. discharge becomes serous or serosanguineous
3. previously infected wound fluid samples of cytological evaluation shows signs of no infection
typically 3-7 days
How are active and passive drains removed?
ACTIVE: cut purse string and fingertrap and slowly withdraw
PASSIVE: remove percutaneous tacking suture and slowly withdraw
ensure the entirety of the drain is removed - measure before and after
