Exam 2: Lecture 13: Bandaging and Bandaging Techniques Flashcards
What are the goals of bandages?
-Protects wound
-Speeds wound healing
What can happen with complications of bandages?
-Complications can result in limb amputation or kill your patient
What are the good things bandages can do?
-Provide wound cleanliness
-Control wound environment
-Reduce edema & hemorrhage
-Eliminate dead space
-Immobilize injured tissue
-Minimize scar tissue
-Make patient more comfortable
What are complications with bandages?
-Patient discomfort
-Patient mutilation of bandage & wound
-Bacterial colonization of wound
-Ischemic injury
-Damage to healing tissues
-Become GI foreign body obstruction
What is another name for soft padded bandage?
-Modified Robert Jones
What does the Modified Robert Jones bandage do?
-Imobilizes limb
-Decreases/limits soft tissue swelling
-Absorbs wound exudate
-Add splint material
Fracture MUST be below the elbow/stifle
What are the 3 basic layers of a bandage?
- Primary (contact layer)
- Secondary (intermediate layer)
- Tertiary (outer layer)
What are the functions of the primary layer of the bandage?
-Debrides tissue
-Delivers medication
-Transfers wound exudate
-Forms an occlusive seal
-Minimizes pain
-Prevents excessive loss of body fluids
What layer of bandage is shown?
-Primary layer
What are the functions of the secondary layer of the bandage?
-Absorbs & stores deleterious agents
-Retards (delays or holds back) bacterial growth
-Pads wound from trauma
-Splints wound to prevent movement
-Holds primary bandage layer in place
What layer of the bandage is shown here?
-Secondary layer
What are the functions of the tertiary layer of bandages?
-Holds the other bandage layers in place
-Protects against external bacterial colonization
-Cosmesis
What layer of bandage is shown?
-Tertiary layer
What are the types of primary layers?
-Adherent
-Nonadherent
-Occlusive
-Semi-occlusive
The primary/contact layer of bandage is chosen based on
-Phase of wound healing
-Amount of exudate
-Wound location & depth
-Presence of absence of eschar
-Amount of necrosis or infection
When would we use adherent type primary bandage layers and how to use it?
-Used when wound debridement required
-May be wet or dry
When would we use nonadherent type primary bandage layers and what does it do?
-During repair phase or if no necrotic debris
-Retains moisture to promote epithelialization & prevent dehydration
-Drains excess fluid & prevents maceration
What is the occlusive type of primary bandage layer?
-Impermeable to air
-Use on nonexudative wounds to keep moist
-Speeds rate & quality of healing compared to dressings allowing desiccation
-Use in partial thickness wounds w/out necrosis or infection
What is the semi-occlusive type of primary bandage layer?
-Allows air to penetrate
-Allows exudate to escape
What is the most commonly used primary layer?
-Semi-occlusive
What are the steps for applying a soft padded bandage?
- Tape stirrups
- Primary layer
- Secondary layer
- Tertiary layer
- Labeling
How should tape stirrups be applied?
-Distal 1/3 of limb
-Medial & lateral or dorsal & palmar/plantar
-Tabbed ends or tongue depressor to help separation
When doing a modified robert jones bandage (aka a soft padded bandage) what is a good tip for toes?
Place cotton between toes:
-Decreases moisture build-up
-Increases patient comfort
-Don’t forget dewclaw
What are characteristics when applying the primary layer of the bandage?
-Contact layer
-Nonadherent
-+/- medication
-Usually sterile
-Wicking
What are the characteristics when applying the second layer of the bandage?
-Intermediate layer
-Absorbent
-Supportive
-+/- Rigid support
-Applied toes up, overlapping, firm even pressure
How do you apply the second layer of bandage?
-Separate tape stirrups
-Rotate stirrups proximally while twisting 180 degrees
-Secure stirrups to underlying wrap
What purpose do tape stirrups have?
-Prevents distal slipping
How is the tertiary layer applied?
-Toes-up
-Overlapping
-Firm, even pressure
What is important to note about the tertiary bandage layer?
-This is what the client sees!!
What is used to apply a walking pad on a bandage & how is it applied?
-Elastikon or durable material
-Very adhesive
-Water resistance
-Applied w/out much pressure since elastic properties may lead to swelling
How should you label bandages?
-Date
-Initials
-Reminders
-Warnings
What adherent bandages are no longer recommended?
-Wet-to-dry
-Dry-to-dry
When would we use a tie-over bandage?
-Wounds in an area inaccessible to standard bandaging techniques (e.g. hip, shoulder, axilla, or perineum)
What is a tie-over bandage?
-Contact & absorbent layers are held in place w/ tie-over bandage
What type of bandage would you use here?
-Tie-over bandage
How do you apply a tie over bandage?
-Apply several sutures or skin staples w/ loose loops around periphery of wound
-Apply primary & secondary bandage layers
-Hold tertiary layer by lacing umbilical tape or heavy suture through loose skin sutures or staples
When do we use a pressure relief bandage?
-Usually over bony prominence
-To treat/prevent pressure sores
What do pressure bandages do?
-Facilitates control of minor hemorrhage, edema, & excess granulation tissue
-The more convex the surface, the greater pressure exerted by dressing on tissue
When do you use wet adherent bandages?
-Wound surface has necrotic tissue, foreign matter, or viscous exudate
How do you use wet adherent bandages?
-Sterile wide mesh gauze soaked in: sterile saline solution & 1:40 (0.05%) chlorohexadine diacetate
-Necrotic tissue & foreign material adhere to gauze & are removed w/ bandage
When are dry adherent bandages used?
-When wound surface has loose necrotic tissue & foreign material
-When wound has large quantity of low-viscosity exudate that does not aggregate
What do Robert Jones bandages do?
-Immobilizes
-Decreases/limits soft tissue swelling
-Absorbs wound exudate
What do Soft padded (modified robert jones bandages do?
-Similar benefits as Robert Jones
-Add splint material
-Fracture MUST be below elbow/stifle
What bandage is this and how do you know?
Robert Jones
-Very large/thick bandage
-Uses rolled/sheet cotton
-Wrapped w/ more compression
What bandage is this and how do you know?
Soft padded (Modified Robert Jones)
-Similar benefits as Robert Jones
-Add splint material
How do we modify the bandage for proximal extremity lesions?
-Continue bandage up leg, around chest or abdomen & between legs to create spica type bandage
What type of wound is this bandage for?
-Proximal extremity lesions
What is different between a paw bandage and a leg bandage?
-A paw bandage is placed like a leg bandage except digits are covered
How do we place a paw bandage?
-After placing stirrups & contact layer reflect cast padding over digits from dorsal to ventral-then ventral to dorsal
-Wrap padding around distal limb
-Conform bandage to limb w/ elastic gauze
-Secure bandage w/ elastic tape in similar fashion
What is a Schroeder-Thomas splint?
Traction splint
-Labor intensive
-Soft tissue complications
-Lacks predictability
What is a Spica splint?
-For immobilization of shoulder
What type of splint is this?
-Schroeder-Thomas splint
What type of splint is this?
-Spica splint
What is an Ehmer sling?
-(Remember “Ehmer Femur”)
-To prevent pelvic limb from being weight bearing
-Post hip reduction or acetabular fractures
What is a Velpeau sling?
-“Velpeau Elbow”
-To prevent forelimb from being weight bearing
-After shoulder/forelimb procedures
Which sling is this?
-Ehmer sling
Which sling is this?
-Velpeau sling
When and why do we do casts for fractures?
-Stable minimally displaced fractures
-Young rapidly healing animals
-Only injuries distal to elbow/stifle
-Unable to repair w/ surgical techniques
What do you need to do with the client if wanting to do a cast for a fracture?
-Discuss the expense with the owner, can be an issue
What kind of fractures cannot be casted?
-Open fractures
What do you need to do before placing a cast for a fracture?
-Swelling needs to be reduced prior to casting
What fractures may not need sedation to cast and what fractures do?
-Greenstick fractures may not need sedation
-Displaced fractures -> general anesthesia
What should you always do after casting, and what needs to happen for it to be a good cast?
-Always radiograph after casting
-Must have >50% overlap of fracture ends in EACH of 2 radiographic views
How often do you need to check casts for fractures?
-Check at least every 2 weeks, but weekly initially if possible
How do you place a cast for fracture?
Place w/ limb in standing position
-Encourages use when walking
-Limits muscle atrophy & joint stiffness
-Shortens recovery period after removal
What are common complications of casts for fractures?
-Slipping/loosening
-Water or urine-soaked
-Joint stiffness & muscle atrophy
-Pressure sores (hard materials or constricting bands, prominences)
More padding on casting =
Less well immobilized
What do bandages require from clients and you?
-Bandages require high degree of client compliance!
-Discharge should include verbal, written & visual instructions for clients
-Check frequently
What does the change frequency of a bandage depend on?
-Age
-Activity
-Cleanliness
-Associated wounds
-Swelling
What are some signs the bandage is uncomfortable?
-Chewing at bandage
-Lameness increase after discharge
What signs mean remove the bandage?
-Odor (means swelling)
-Toe temperature (compare to other foot)
-Nail bed cyanosis
-If ANY doubt -> REMOVE
What are some special considerations when bandaging a cat?
-Bandage paralysis
What are some rules to remember about bandages?
-Leave middle 2 toes (claws) exposed when possible
-Bandages start at toes & go up limb to avoid swelling
-Keep limb in physiologic position (typically standing, do NOT apply w/ limb in full extension (straight)
-Overlap 1/3 to 1/2 the width of your wrap
-Apply firm even pressure during application
-Owner compliance - Key to success!
-No single dressing produces optimum microenvironment for all wounds or all stages of wound healing of single wound
-Identify underlying structures
