DRESSINGS AND BANDAGESClaudia Gherman, Răzvan Ciocan

Learning objectivesWhat you should know

What is a dressing What is a bandage The basic principles of a bandage Indications of a bandage Types of bandages Bandaging modalities Special types of dressings

What you should do List the indications of a bandage List the types of bandages Apply a circular bandage Apply a spiral bandage Apply a spica bandage Apply a figure-of-eight bandage Apply a capeline bandage Apply a bandage on one or more fingers List and describe the special types of dressings

DefinitionsA dressing is used to isolate a treated wound in order to

allow healing. Dressings are most frequently made of sterile gauze, but other materials are also used. In addition to isolating the wound, dressings allow absorption of secretions and a certain protection against microbial contamination and trauma.

A correct dressing should respect several principles: Any dressing will be applied with the patient in lying position,

rarely in sitting position, and never in standing positiono Patients can be impressed by the surgical dressing room,

by instruments, and can lose consciousness and suffer trauma from falling; the lying or sitting position allows to eliminate this risk

The application of a dressing requires two persons: a person applies the dressing, and the other person provides the necessary materialso This ensures not only the comfort of the procedure, but

also the maintenance of asepsis A kidney tray will also be available, in which the removed

dressing and the used compresses will be placed Perfect asepsis: the instruments and materials used must be

sterile; hand washing before and after the application of a dressing, as well as wearing of gloves (sterile – if the dressing involves manipulation of tissues with the hands, or non-sterile – if materials and tissues can be manipulated using hemostats) is compulsory

Absorption of secretions will be ensured: gauze compresses, etc.

Asepsis of the wound will be performed with antiseptics adequate for its evolution stage

The dressing will be secured with: Silk, cloth or paper surgical tape

o Which has advantages: It allows easy wound monitoring It does not interfere with the functions of the

anatomical segment concernedo But also has disadvantages:

Removal is painful Sometimes it causes maceration of the underlying

tissue or local reactions (erythema, pruritus) Bandages

Bandages or surgical wrappings represent a method forsecuring dressings, for temporary immobilization or compression of different body regions.

Simple dressingsThe instruments currently used for dressings are:

Surgical hemostat Anatomical hemostat Pan’s forceps Kocher’s forceps Scissors Kidney tray

Figure 1. Instruments currently used for dressings: Pan’s forceps, Kocher’s forceps, scissors, surgical hemostat, anatomical hemostat, kidney tray (from

left to right)

Dressing technique: Hand washing and gloving The old dressing is gently removed

o If this is stuck to the wound, it is moistened with oxygenated water or physiological serum

The skin around the wound is cleaned with a swab soaked in gasoline for degreasingo Application is performed from the wound to the periphery

so as not to contaminate the wound The skin around the wound is disinfected with alcohol or

betadine The wound is treated depending on its nature and evolution

stageo Surgical wounds with aseptic evolution do not require

special treatmentso Secreting wounds will be cleaned by washing with

antiseptic solutionso Seromas and hematomas will be drained using a bulb-

headed or a hollow probe, after removing 1-2 sutureso Purulent collections will be widely opened and drained

with tubes Wound protection starts with the application of 2-3 gauze

compresseso For secreting wounds, an additional layer of compresses is

applied (thickness depending on the amount of secretions in the wound)

The dressing is secured with surgical tape or bandage

Special types of dressingsGrassolind sterile compressIt is a sterile

dressing impregnated with a paraffin-based fat substance. It is made of a network of meshes that allow the exudate to pass,

Figure 2. Grassolind dressing

Preventing maceration. It stimulates epithelization and granulation tissue formation. It is used to cover wounds, burns.

Hydrogel dressingIt absorbs secre-

tions and maintains wound moisture, stimu-lates healing, and does not adhere to the wound. It is used forSuperficial or deep Figure 3. Hydrogel dressingWounds and burns up to grade 2.

Sterile gel (Hydrosorb Gel) It is an absorbent polyurethane gel,

permeable for gases and vapors and impermeable for germs and fluids; it is available in syringes. The gel softens necrotic tissue and facilitates its removal (debridement), incorporating the exudate and wound debris. It is used for uninfected wounds and for burns.

Figure 4. Polyurethane gel

Calcium alginate fiber dressing It is a hydroactive dressing made of calcium alginate

fibers. It is indicated for deep, difficultly accessible wounds, infected chronic wounds, fistulas.

Figure 5. Calcium alginate fiber dressing

Silver ion dressingIt is a mesh

dressing impregnated with triglycerides and stratified with silver ions. It is used in infected wounds or wounds at risk for infection, burns.

Figure 6.Silver ion dressing

Indications of bandages To prevent contamination of a wound by maintaining sterile

compresses in place To maintain a dislocated or a fractured limb in place To prevent or control hemorrhage To restrict joint movements To correct a deformity To maintain adequate pressure (elastic bandages applied to

improve venous return)

Types of bandages Light gauze bandages Simple elastic bandages

A. B.Figure 7. Types of bandages: A. Gauze bandage; B. Elastic bandage

Compression bandages Orthopedic bandages Mesh bandagesA. B. C.

Figure 8. A. Plaster bandage; B. Mesh bandage; C. Sterile compresses

Principles of bandages The patient should be in a comfortable position. The injured region should be supported during bandaging (if a

joint is involved, this should be maintained in semiflexion). The bandage should be of an appropriate size and material.

The recommended size of different bandages is indicated in the table below.

Table 1. Size of adequate bandages for different anatomical regionsAnatomical region Width (cm) Length (m)Head 5 4-6Chest and abdomen 10-15 6-8Upper limb 6-8 4Lower limb 5-6 3-4Fingers 2.5 2Hand 5 3Radiocarpal joint 5 3

The bandage roll is held in the dominant hand, with the rolled-up portion towards the palm. In this way, the roll is held more firmly and the risk to drop it is lower.

Attention should be paid to avoid the formation of folds that can make circulation difficult or can induce pain.

During bandaging, constant tension on the bandage is maintained – not too high, not too low.

In the end, the bandage is secured by applying a surgical tape or pliers.

During and at the end of bandaging, the temperature of the extremity, its color, pulse, the possibility to move the body region concerned are checked.

Bandaging modalitiesThe main bandaging modalities are:

Circular bandage Spiral bandage Spica bandage Figure-of-eight bandage Recurrent fold bandage Fan-shaped bandage (rarely used because it is unstable)

A. B. C. D. E. F.

Figure 9. Types of bandages: A. Circular bandage; B. Spiral bandage; C. Figure-of-eight bandage; D. Spica bandage; E. Fan-shaped bandage; F.

Recurrent fold bandageCircular bandageIt is applicable in the case of small wounds. Circular

bandaging is applied only in the affected area. It provides effective support of the injured part, being useful in wounds of the lower limbs, upper limbs, fingers and toes.

Circular bandaging is used to start any bandage. A number of circular turns are applied proximally to the area concerned, which have the role to secure the bandage. A corner of the bandage is folded over the first turn and then covered by the second turn; in this way, the bandage becomes more stable.

Figure 10. Any bandage starts with circular bandaging; folding of a

bandage corner secures the bandage in place.

Spiral bandageAfter securing the bandage by circular turns, oblique turns

are performed so as to cover 1/3 of the previous turns. This type of bandage is indicated to be used for upper and lower limbs.

Figure 11. Spiral bandaging

Spica bandage and figure-of-eight bandageThey are used particularly for the hand, radiocarpal joint,

ankle.Spica bandage: it is

initiated by circular turns above the joint, to anchor the bandage, after which the bandage is advanced in the shape of an eight, each turn covering 1/3 or 2/3 of the preceding turn. The bandage is completed by circular turns on the support point. Figure 12. Spica bandage

Figure-of-eight bandage: it starts with circular turns below the joint, after which the turns are continued obliquely over the joint, and the bandage is advanced by other circular turns above the joint. The bandage returns obliquely on the opposite side, crossing the first ascending turn, then it continues in theshape of an eight, covering half

Figure 13. Figure-of-eight bandage for the radiocarpal joint combined with

circular bandage for the second finger, using the third finger as a splint

Of the preceding turn. This continues several times, and the bandage ends above the joint with circular turns.

Figure 14. Figure-of-eight ankle bandage technique

Capeline bandageIt is a head bandage. It starts

by two circular turns over the forehead and the occipital region, then by parallel turns from anterior to posterior direction, which overlap over 2/3 of their width. At the end, another two circular turns are performed to maintain in place the ends of the parallel turns, and the Figure 15. Capeline bandageBandage is secured with surgical tape.

Figure 16. Capeline technique

Amputation stump bandageFor amputation stump bandaging, several recurrent turns

over the stump are secured with several circular turns (similarly to the capeline technique).

Figure 17. Amputation stump bandage

Finger bandageIn the case of fingers, spica

bandage is difficult to apply, and spiral bandage is unstable. To

bandage a finger, a combination of recurrent fold bandage and circular bandage is preferred. The bandage is passed over the end of the finger

Several times; then, several circular turns are made to secure it. In

Figure 18. Finger bandage

Fact, it is the same technique as the capeline or the amputation stump bandaging technique.

Nose and chin bandageA sufficient length of bandage is cut from a bandage roll

with a 5 cm width. Two median incisions are cut at both ends with scissors, leaving a sufficient portion to cover the wound. The bandage is placed in position and is secured by tying the lower ends in front of the ears and the upper ends at a 90 angle in relation to these, below the ears.

Figure 19. Nose bandage and chin bandage

Dessault’s bandageIt is used for shoulder immobilization – for example, after

reduction of a scapulohumeral dislocation. It immobilizes the arm against the chest (preventing arm abduction), and supports the arm (lifting it towards the shoulder).

The affected arm is positioned against the chest and the forearm is flexed at 90. The bandage starts with two circular turns over the arm and chest. Then, it continues over the shoulderat 45 in relation to the first two turns, and descends towards the elbow to maintain it at a right angle.

Figure 20. Dessault’s bandage

Assessment / self-assessment form

Stage / Criterion Correct IncorrectApply a circular bandageApply a spiral bandageApply a spica bandageApply a figure-of-eight bandageApply a capeline bandageApply a bandage on one or more fingersApply a Dessault’s bandageList the basic principles of a bandageIllustrate the special types of dressingsFor each bandage: Position the patient Keep the roll with the rolled-up portion towards the palm Perform the initial turn to secure the bandage Apply the bandage Complete the bandage