Lecture 13: Bandaging & Bandaging Tech - SA (Exam 2) Flashcards
What are the goals of a bandage
- Protects wounds
- Speed wound healing
What can happen if there are complications w/ a bandage
- Result in limb amputation
- Kill the px
List the good things a bandage can do
- Provide wound cleanliness
- Control wound environment
- Reduce edema & hemorrhage
- Eliminate dead space
- Immobilize injured tissue
- Min scar tissue
- Make the px more comfy
List complications w/ bandages
- Patient discomfort
- Px mutilation of bandage & wound
- Bacterial colonization of wound
- Ischemic injury
- Damage to healing tissues
- Become a GI foreign body obstruction
What are indications for bandages
- Used below the elbow & stifle
- Treating injuries to reduce pain, swelling, & local tissue damage
- Protecting wounds or devices
- For transport
Describe the soft padded bandage (Modified robert jones)
- Immobilizes limb
- decreases/ limits soft tissue swelling
- Absorbs wound exudate
- Add splint material
- Fracture must be below the elbow/stifle
What are the three layers of a bandage
- Primary (contact layer)
- Secondary (Intermediate layer)
- Tertiary (out layer)
What is the functions of the primary layer
- Debrides tissue
- Delivers medication
- Transfers wound exudate
- Forms an occlusive seal
- Min pain
- Prevents excessive loss of body fluids
What are the functions of the secondary layer
- Absorbs & stores deleterious agents
- Retards bacterial growth
- Pads wound from trauma
- Splints wound to prevent movement
- Holds primary bandage layer in place
What are the fxns of the tertiary layer
- Holds other bandage layers in place
- Protects against external bacterial colonization
- Cosmesis
What are the types of primary layers
- Adherent
- Nonadherent
- Occlusive
- Semi-occlusive
What needs to be considered when selecting a primary layer
- Phase of wound healing
- Amount of exudate
- Wound location & depth
- Presence or absence of eschar
- Amount of necrosis or infection
Describe Adherent primary layers
- Used when wound debridement required
- May be wet or dry
Describe nonadherent primary layers
- During repair phase or if no necrotic debris
- Retains moisture to promote epithelialization & prevent dehydration
- Drains excess fluid & prevents maceration
Describe occlusive primary layer
- Impermeable to aire
- Use on nonexudative wounds to keep moist
- Speeds rate & quality of healing compared to dressings allowing desiccation
- Use in partial thickness wounds w/o necrosis or infection
Describe semi-occlusive primary layer
- Allows air to penetrate
- Allows exudate to escape
- Most commonly used primary layer
List the steps of applying a soft padded bandage
- Assemble bandage materials & supplies
- Tape stirrups
- primary layer
- Secondary layer
- Tertiary layer
- Labeling
How are tape stirrups applied
- Distal 1/3 of limb
- On the medial & lateral or dorsal & plant/palmar sides
- Tabbed ends or tongue depressor to help w/ seperation
What is a tip for the modified robert jones bandage
place cotton btw/ the toes to decrease moisture build-up, increases px comfort, & don’t forget the dewclaw
Describe applying the primary layer
- Contact layer
- nonadherent
- +/- meds
- usually sterile
- Wicking
Describe applying secondary layers
- Intermediate layer
- Absorbent
- Supportive
- +/- rigid support
- Applied from the toes up, 50% overlap, & firm even pressure
- Separate the tape stirrups
- Rotate the stirrups proximally while twisting 180 degrees
- Secure stirrups to the underlying wrap (this prevents distal slipping)
Describe applying tertiary layer
- Outer layer
- applied - toes up, 50% overlap, & firm even pressure
- This is what the clients see
Describe applying a walking pad
- Elastikon or durable material
- Very adhesive
- Water resistant
- Applied w/o much pressure since the elastic properties might lead to swelling
- Can use a Koozie
What need to be on the label of the bandages
- Date
- Initials
- Reminders
- Warnings
What adherent bandage layers are no longer recommended
- Wet to dry
- Dry to dry
T/F: nonadherent bandage types or recommended for all stages of wound healing
True
What bandage type is most often used in vet me
Semi occlusive
When should a tie over bandage be used
When the wound is in an area inaccessible by standard bandaging tech
What is this
Tie over bandage
Describe a tie over bandage
- Apply several sutures or skin staples w/ loose loops around the periphery of the wound
- Apply primary & secondary bandage layers
- Hold tertiary layer by lacing umbilical tape or heavy suture through loose skin sutures or staples
When are pressure relief bandages used
- Usually over bony prominence
- To treat/prevent pressure sores
What does pressure bandage do
- Facilitates control of minor hemorrhage, edema, & excess granulation ( direct application of corticosteroid ointment to the wound helps control excess granulation tissue)
- Them more convex the surface the greater the pressure exerted by the dressing on tissue
When to use adherent bandages & why
- Wound surface has necrotic tissue, foreign matter, or viscous exuate
- Necrotic tissue & foreign material adhere to gauze & are removed w/ the bandage
When to use dry adherent bandages
- When wound surface has loose necrotic tissue & foreign material
- When wound has large quantity of low viscosity exudate that doesn’t aggregate
What does the robert jones bandage do
- Immobilize
- Decreases/limits soft tissue swelling
- Absorbs wound exudate
Describe the robert jones bandage
- Very large/thick bandage
- Uses rolled/sheet cotton
- Wrapped w/ more compression
How should proximal extremity lesions be bandaged
Continue the bandage up the leg, around the chest or abdomen, & btw/ the legs to create spica type bandage
How should a paw bandage be place
- Placed like the leg except the digits are covered
- After placing the stirrups & contact layer reflect the casting pad over digits from dorsal to ventral then ventral to dorsal
- Wrap padding around the distal limb
- Conform bandage to limb w/ elastic gauze
- Secure bandage w/ elastic tape in similar fashion
Name a traction splint and the cons
- Schroeder-Thomas splint
- Labor intensive
- Soft tissue complications
- Lacks predictability
What is a spica splint used for
Immobilization of the shoulder
What is the ehmer sling
- “Ehmer Femur”
- To prevent pelvic limb weight bearing
- Post hip reduction or acetabular fractures
What is a velpeau sling
- “Velpeau elbow”
- To prevent forelimb weight bearing
- After shoulder/forelimb procedures
When to casts for fractures
- Stable min displaced fractures
- Young rapidly healing animals
- Only injuries distal to the elbow/stifle
- Unable to repair w/ surgical tech
- Discuss expense w/ owner
- Swelling reduced prior to cast
- Green stick may not need sedation
- Displaced fractures = general anesthesia
- Check @ least every 2 W
T/F: Cast open fractures
False
When should you radiograph during casting & what should be seen on the Xray
- After casting
- Must have >50% of fracture ends (in ea of 2 radiographic views)
What limb position should the cast be placed
- Standing position
- Encourages use when walking
- Limits muscle atrophy & joint stiffness
- Shortens recovery period after removal
What are common complications
- Slipping/loosening
- Water or urine soaked
- Joint stiffness & muscle atrophy
- pressure sores
- More padding = less well immobilized
What about checking & changing
- Require high degree of client compliance
- Discharge should include verbal, written, & visual instructions for clients
- Check freq
What does changing frequency depend on
- Age
- Activity
- Cleanliness
- Associated wounds
- Swelling
What should be assessed when checking bandages
- Clean
- Dry
- Comfort (chewing? Lameness increase?)
When should a bandage be removed
- Signs of oder
- Swelling
- Toe temperature (compared to other foot)
- Nail bed cyanosis
What are some rules to remember when bandaging
- Sedation or anesthesia may be req
- Leave middle 2 toes (claws) exposed when possible
- Bandages start @ toes & go up limb to avoid swelling
- Keep limb in physiologic position (Not standing & do not apply w/ limb in full extension)
- Overlap 1/3 to 1/2 the width of you wrap
- Apply firm even pressuring application (proportional to amount of padding & size of px)
- Owner compliance
- No single dressing produces optimum microenvironment for all wounds or all stages of wound healing of a single wound
- Identify underlying structures
