Bandaging techniques

Chapter 4

Bandaging techniques

A well-produced bandage that does the job it is intended to do, does not slip off and does not cut off the circulation is a technique that can be achieved by regular practice. Although in many practices it is the nurse who is left to bandage the limb after you, the veterinary surgeon, have carried out the clinical procedure, it is important that you know how to bandage competently. A neat bandage that stays on will impress your clients – after all, this may be the only bit that they can see.

Bandages have a number of functions and the main ones are shown in Table 4.1.

Bandaging rules

Before you start to bandage anything you should be aware of the following ‘rules’. If necessary, practice your technique in private on a soft toy or on a partner!

1. Action: Wash your hands thoroughly before you start.

    Rationale: To prevent the introduction of infection. You may consider wearing gloves, but this may impede your dexterity.

2. Action: Collect all your equipment together and make sure that is it close at hand.

    Rationale: This saves time; when dealing with an animal you cannot expect it to sit quietly on the table while you search for different bandages. Plan ahead – you will appear much more competent and will feel better about the procedure.

3. Action: If applicable, remove any soiled bandages and dispose of them in the clinical waste bin.

    Rationale: To prevent the spread of infection the clinical waste will eventually be incinerated.

4. Action: When bandaging a lower limb, always include the foot.

    Rationale: To reduce the risk of swelling and cutting off the circulation to the toes. This can result in sloughing off of the skin over the toes and in the worst case the complete loss of the toes.

5. Action: If the foot is included always place cottonwool pads between the toes (Fig. 4.1).

    Rationale: This absorbs sweat and prevents rubbing. (However, current thinking is moving away from this idea as the cottonwool may become soaked and cause rubbing rather than preventing it!)

6. Action: Keep the bandage rolled up and always have the roll on the top as you unwind (Fig. 4.1).

    Rationale: This helps you to control the bandage and to maintain tension.

7. Action: Always overlap the layers of a bandage by half of its width.

    Rationale: To prevent the development of gaps. This could let in infection or allow the patient to interfere with the area underneath. It may also cause swelling in the gaps.

8. Action: If bandaging tails or limbs always work from the distal to the proximal end of the area.

    Rationale: There is a risk of trapping blood or fluid if you interfere with the venous return to the heart. Results in painful swelling.

9. Action: Never use safety pins to secure the ends – use sticky zinc tape instead, although this is not recommended.

    Rationale: The patient may swallow a safety pin. Sticky tape such as zinc tape may cause skin irritation and is difficult to remove from the hair.

10. Action: When immobilizing a fracture, always include the joints above and below the area.

    Rationale: To prevent movement of the area.

11. Action: On completion, check that the bandage is not too tight – you should be able to get two fingers under the layers.

    Rationale: Bandages that are too tight will restrict blood flow to the area delaying healing, and causing pain and swelling and subsequently patient interference.

12. Action: On completion, check that the bandage is not too loose.

    Rationale: Bandages that are too loose will not serve their correct purpose and may fall off or be pulled off by the patient.

Wound management

Surgical wounds, which are usually sutured and allowed to heal by first intention, are rarely bandaged, although you may need to consider the use of an Elizabethan collar to prevent interference. Chronic wounds (i.e. those that may involve loss of tissue and are deep or infected) will be left to heal by second intention and may be protected by bandaging.

Before applying the bandage the wound must be decontaminated:

1. Clip and clean the skin surrounding the wound – all hair must be removed to keep the wound clean and to promote rapid healing.

2. Lavage – wash the wound thoroughly with large volumes of sterile saline to remove any debris and to dilute any bacteria present. Do not be too vigorous as this will further damage the tissues.

3. Debridement – this is the single most important step in promoting wound healing and is the removal of infected, necrotic or contaminated tissue from the wound that would otherwise delay healing. Tidy up the wound edges if surgical repair is to be attempted.

    There are three main ways of debriding a wound:

Anatomy of a bandage

Most bandages consist of the following layers:

1. Wound dressings – this layer is in direct contact with the wound and the aim is to promote healing and to prevent further harm. Dressings provide an environment that is neither too wet nor too dry; the different types are summarized in Table 4.2.

2. Primary layer – this holds the dressing in place and absorbs any exudate. It also distributes the pressure evenly and provides padding to the wound. The most common materials are orthopaedic wool (e.g. Sofban®) and cottonwool sheets.

3. Secondary layer – the primary layer is stabilized using some form of conforming bandage that has a degree of stretch in it. It is important not to overstretch the material resulting in an overtight bandage, which will restrict blood supply to the area and could cause gangrene. Do not confuse firmness with tightness: the bandage must be firm but not too tight and you should be able to get two fingers under it.

4. Tertiary layer – this consists of an elastic cohesive bandage that protects the whole structure and prevents interference by the patient. This layer is very often coloured or may even have words printed on it, which is purely for the benefit of humans! At the top of the bandage the tertiary layer should not extend over the secondary layer as it may rub. Never use an adhesive tape to stick the bandage to the skin or fur as this will cause irritation and can be difficult to remove. If bandaging a lower limb always cover the foot. Increased protection from moisture and mud may be gained by covering the foot with a commercial canvas boot or by using an empty drip bag. Do not leave an impervious cover on the foot all the time as it restricts air and moisture flow and may lead to skin complications.

Care and maintenance of bandages

All bandages must be constantly monitored and the owners should be given written instructions at discharge. Poorly monitored bandages will delay healing and may result in sloughing of the skin.

1. Check the bandage every 4 hours for the first 24 hours.

2. Check twice daily for the duration of the bandage. This may be done by the owners, but the animal should be seen in the surgery every 4–5 days.

3. Make sure that the owners understand their responsibility to the patient and are aware of what to look for.

4. Exercise restriction is usually indicated, but this depends on the need for the bandage. In some cases exercise restriction may need to be enforced.

5. Monitor the bandage for the following: smell, wetness, swollen toes, cold toes, soiling, slippage and patient interference. Change the bandage if any of these have occurred.

6. If an open wound is present the bandage must be changed regularly – at least once a day. If no wound is present the bandage should be changed every 8–10 days.

7. Complications may include: maceration of the skin, swelling of the limb, wound contamination, dermatitis, necrosis of the skin and gangrene of the limb.

Types of bandage

Procedure: Limb bandage

This is used to support and protect wounds, reduce pain and swelling and prevent movement.

1. Action: Gather all your equipment together and arrange it within reach of the examination table.

    Rationale: This enables you to complete the bandage quickly and efficiently.

2. Action: Place the animal on a stable examination table covered in a non-slip mat.

    Rationale: If the animal feels secure it will be less likely to try and escape.

3. Action: Ask the owner or an assistant to restrain the animal appropriately so that you have access to the affected limb (see Ch. 1).

    Rationale: The animal may try to move during the procedure. Correct restraint will allow you to work quickly and efficiently.

4. Action: Apply cottonwool padding between the digits of the affected limb (Fig. 4.1).

    Rationale: This prevents rubbing and absorbs the sweat between the toes. (However, current practice is moving away from this idea and you will need to decide for yourself.)

5. Action: Apply an appropriate wound dressing to the affected area.

    Rationale: For example this may be used to cover a cut footpad or after the removal of a dew claw. This will promote healing.

6. Action: Apply the primary padding layer. Start on the cranial aspect of the limb, run the bandage down over the toes to the caudal aspect of the limb and then go back again (Fig. 4.1).

    Rationale: This holds the dressing in place, provides support and helps to absorb any exudate.

7. Action: Turn the bandage through 90° and, working from the distal to the proximal part of the limb, cover the toes in a figure-of-eight arrangement.

    Rationale: This makes the bandage firm and protective.

8. Action: Work up the limb until you are over the joint above the injury.

    Rationale: This helps to distribute the pressure of the bandage evenly.

9. Action: Apply a tertiary layer to the limb following the same pattern and working from distal to proximal.

    Rationale: This will hold everything together and protect the limb from daily wear and tear.

10. Action: Check the tension on the bandage.

    Rationale: If it is too loose the bandage will fall off very soon; it is too tight it may damage the underlying tissues.

Procedure: Tail bandage

This is used to protect the tail after traumatic injuries.

1. Action: Gather all your equipment together and arrange it within reach of the examination table.

    Rationale: This enables you to complete the bandage quickly and efficiently.

2. Action: Place the animal on a stable examination table covered in a non-slip mat.

    Rationale: If the animal feels secure it will be less likely to try and escape.

3. Action: Ask the owner or an assistant to restrain the animal in a standing position or sitting with the tail extended.

    Rationale: This depends on the size and nature of the patient.

4. Action: Apply an appropriate dressing to the wound on the tail.

    Rationale: This will promote healing.

5. Action: If the wound is on the end of the tail, cover the dressing with a large empty syringe case pierced with hole to provide ventilation.

    Rationale: This provides a quick and easy method of covering and holding the dressing in place. Good ventilation is important for wound healing.

6. Action: If the wound is higher up the tail, then apply a layer of conforming bandage over the dressing.

    Rationale: Even if the wound is on the proximal end of the tail, you should bandage the entire tail to prevent swelling towards the tip. In this area of the body there is no need to provide a layer of padding over the dressing.

7. Action: Cover either the syringe case or the conforming bandage with a layer of cohesive bandage, working from the caudal end to the proximal end of the tail.

    Rationale: This will protect the inner layers of the bandage and will prevent swelling of the tail tip.

8. Action: As you progress proximally towards the top of the conforming bandage, start to work the animal’s tail hair into the cohesive bandage.

    Rationale: This will help the bandage to stay in place. Tail bandages will slip off easily and you may have to use sticky tape to hold it to the hair.

9. Action: Check that the bandage is secure and not too tight.

    Rationale: Overtight bandages cause tissue damage and eventual necrosis.

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Jul 24, 2016 | Posted by in SMALL ANIMAL | Comments Off on Bandaging techniques
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