APPLICATION OF BANDAGES AND BINDERS

BANDAGES

bandage

-a piece of gauze or other material to be applied to fit body and used to cover a wound

-usually dispensed in rolls of various widths (most commonly 1.5 – 7.5 cm (0.5 – 3 in))

-before applying a bandage, the nurse needs to know its purpose and to assess the area requiring support. When bandages are used to secure dressings, the nurse wears gloves to prevent contact with body fluids.

Binders

-is a type of bandage specifically designed to fit a large body area, such as the abdomen, chest or breast

-A binder is a type of bandage designed for a specific body part; for example, the triangular binder (sling) fits the arm

-used to support large areas of the body, such as the abdomen, arm, or chest.

-can be simple, inexpensive and customizable by using plain material such as the triangular sling, or they can be of commercial design which are often easier to use, more expensive, and slightly less modifiable such as the hook and loop (Velcro) binder

Purpose

1. To create pressure over an area to stop bleeding

2. To immobilize part of the body to restrict its motion

3. To support a part of the body

4. To prevent or reduce swelling as well as to assist in the absorption of tissue fluid

5. To correct a deformity6. To secure a limb to a splint or posterior

mold7. Used to hold dressings in place8. To protect wound from contamination9. To apply and retain warmth over a joint as

in rheumatoid arthritis10. To apply pressure to lower extremities

and aid in venous return

EQUIPMENT

ASSESSMENT BEFORE APPLICATION OF BANDAGES OR BINDERS

• Inspect and palpate the area for swelling• Inspect for the presence of and status of wounds

(open wounds will require a dressing before a bandage or binder is applied)

• Note the presence of drainage (amount, color, odor, viscosity)

Inspect and palpitate for adequacy of circulation (skin temperature, color, and sensation). Pale or cyanotic skin, cool temperature, tingling, and numbness can indicate impaired circulation

• Ask the client about any pain experienced (location, intensity, onset, quality)

• Assess the ability of the client to reapply the bandage or binder when needed.

• Assess the capabilities of the client regarding activities of daily living (eg. To eat, dress, comb hair, bathe) and assess the assistance required during the convalescence period.

Types of Bandages

1. ROLLER BANDAGES- a continuous strip of material wound on itself to form a cylinder or roll.

-The free end of the roll is called the initial extremity; the end of the roll is called the terminal end. The rolled portion is called the body

.

1.1. Circular Turns- used to anchor bandages and to terminate them.

- not usually directly applied to a wound

1.2. Spiral turns- used to bandage parts of the body that are fairly uniform in circumference, for example, the upper arm or upper leg, or when the part being bandaged is cylindrical such as the area around the wrist, the trunk.

1.3. Spiral reverse turns- a spiral turn in which reverse are made halfway through such turn

- used to bandage cyclindrical/cone-shaped parts of the body that are not uniform in circumference, for example, the lower leg, thigh,or forearm.

1.4. Recurrent turns- also called the stamp bandage

-after a few circular turns to anchor the bandage, the initial end of the bandage, is placed in the center of the part being bandaged, from the well back from the tip to the covered. The body is passed back and forth over the tip. First one side and then in the other side of the center piece of bandage

-used to cover distal parts of the body, for example, the end of a finger, the skull, or the stump of an amputation, and for head bandages.

1.5. Spica – consists of ascending and descending turns with all turns overlapping and crossing each other to form an angle.

- particularly useful for bandaging the thumb, breast, the shoulder, the groin and the hip.

1.6. Figure-of eight turns – consists of making an oblique overlapping turns that ascend and descend alternately. Each turn crosses the one proceeding it so that it appears like the figure eight

-used to bandage around joints such as the elbow, knee, wrist or ankle, because they permit some movement after application

-

Circular Turns

1. Hold the bandage in your dominant and, keeping the roll uppermost, and unroll the bandage about 8 cm (3 in). This length of unrolled bandage allows good control for placement and tension

2. Apply the end of the bandage to the part of the body to be bandaged.Hold the end down with the thumb of the other hand

3. Encircle the body part a few times or as often as needed, making sure that each layer overlaps one-half to two-thirds of the previous layer. This provides even support to the area

4. The bandage should be firm but not too tight. Ask the client if the bandage feels comfortable. A tight bandage can interfere with blood circulation, whereas a loose bandage does not provide adequate protection

5. Secure the end of the bandage with tape or a safety pin over an uninjured area. Pins can cause discomfort when situated over an injured area

Spiral Turns

1. Anchor the bandage with two circular turns, and bring the bandage upward at about a 30-degree angle

2. Place the thumb of your free hand on the upper edge of the bandage. The thumb will hold the bandage while it is folded on itself

3. Unroll the bandage about 15 cm (6 in), nf then turn your hand so that the bandage falls over itself

4. Continue the bandage around the limb, overlapping each previous turn by two-thirds the width of the bandage. Make each bandage turn at the same position on the limb so that the turns of the bandage will be aligned

5. Terminate the bandage with two circular turns, and secure the end as described for circular turns.

Recurrent Turns

1. Anchor the bandage with two circular turns.

2. Fold the bandage back on itself, and bring it centrally over the distal end to be bandaged.

3. Holding it with the other hand, bring the bandage back over to the right of the center bandage but overlapping it by two-thirds the width of the bandage.

4. Bring the bandage back on the left side, also overlapping the first turn by two-thirds the width of the bandage.

5. Continue this pattern of alternating right and left until the area is covered. Overlap the preceding turn by two-thirds the bandage with each time.

6. Terminate the bandage with two circular turns. Secure end appropriately.

Figure-Eight Turns

1. Anchor the bandage with two circular turns.

2. Carry the bandage above the joint, around it and then below it, making a figure-eight.

3. Continue above and below the joint, overlapping the previous turn by two-thirds the width of the bandage.

4. Terminate the bandage above the joint with two circular turns, and then secure the end appropriately.

Key Points on Bandaging

1. Hold the roll of bandage in the dominant hand, with the loose end on the distal portion of the area to be bandaged. This end is held with the non-dominant hand.

2. When applying the bandage, hold the rolled bandage so that it unrolls from the bottom of the roll, making application easier

Cont. key points

3. The roll of the bandage id then unrolled proximally, applying slight tension as it is unrolled around the body part. Bandages are applied starting at the distal and moving toward the proximal body part

4. The first or three turns of the bandage should overlap to secure the loose end, to prevent the bandage from unwrapping.

Cont. key points

5. The roll of bandage can be transferred from hand to hand and should be applied evenly and firmly, but caution should be taken to avoid the bandage being so tight. An uneven or too tight application can create a tourniquet effect, reducing circulation, with the possibility of causing skin breakdown and nerve damage.

Types of Bandage

2. BINDERS

2.1. T-binder-is used for securing dressings in the perineum and in the groin. It is so named because it looks like a letter T

2.1.1. Single T-binder- has a tail attached at right angles to a belt. It is used for females

2.1.2. Double T-binder- has two tails attached to the belt, it is used for males. The belt is passed around the belt and secured with safety pins.

2.1.3. Four-tailed binder- used for securing dressings on the nose and chin. It has four tails, two on each side.

2.2. Many tailed binders- also called scultetus binders which provides abdominal support often an abdominal operation or delivery. It is made of muslin strips, 3-4 inches wide and 4 ft. long sewn in layers overlapping each other by one inch. The middle section is sewn together, with about 20 inches left free at each end

Steps in Applying Scultetus Binder

1. Expose the abdominal and pubic area, but not before ensuring the patient’s privacy by screening the bedside unit

2. Move the patient near the side of the nurse.

3. Raise the hip or help the patient raise her hip

4. Quickly slip the scultetus binder under the hips with the solid portion under the patient’s body and the top edge at the level of the waist

Cont. scultetus

5. Extend the tails out

6. Position the binder properly and let the patient assume the supine position

7. The bottom tail is brought across the patient with the start of application at the level of the pubic region. Pull the end tightly. If it is too long, fold the end back itself

Cont. scultetus

8. Continue applying tail toward the waist, slanting slightly forward and strips from each side of the abdomen alternating with each other.

9. Secure firmly at the waist with safety pin .

2.3 Triangular binder

- is commonly a sling to support an injured arm. It can be made from alarge diaper about 40 inches square. It can be used as a large arm sling, a small sling, to support the patient’s wrist hand, and as a triangular sling to support his arm with his hand elevated. It is also useful for retaining dressing on the elbow hand shoulder, hip, knee and foot.

Triangular Arm Sling

1. Ask the client to flex the elbow to an 80-degree angle or less, depending on the purpose. The thumb should be facing upward or inward towards the body. An 80-degree angle is sufficient to support the forearm, to prevent swelling of the hand, and to relieve pressure on the shoulder joint (e. g. to support the paralyzed arm of a stroke client whose shoulder might otherwise become dislocated) . A more acute angle is preferred if there is swelling of the hand

Triangular Arm Sling

1. With the apex of the triangle pointing toward the elbow, place one end of the triangle over the shoulder of an uninjured side, then carry it around the neck so that it hangs over the shoulder on the injured side, then carry it hangs over the shoulder on the injured side.

Cont. triangular

2.Place the sling against the body and under the injured arm (the apex of the triangle is now behind the elbow of the injured side)

3. Assist the patient to flex his elbows with his thumbs upward until it is at right angle of his upper arm

4. Bring the lower corner of the triangle up cover the arm to the shoulder of the injured side.

Cont. triangular

5. Make sure the wrist is supported, to maintain alignment.

6. Fold the sling neatly at the elbow, and secure it with safety pins or tape. It may be folded and fastened at the front.

7. Remove the sling periodically to inspect the skin for indications of irritation, especially around the site of the knot

2.4. Straight binders- straight piece of material usually

about 15-20 cm or 6-8 inches wde and long enough to move than circle the torso. It generally is used for the chest and abdomen. It must be applied to fit the contours of the body. This is usually done by making small tucks in the binder as necessary. In some instances, these tucks can be secured with safety pins. A straight binder for the chest often is provided with a shoulder strap so that it will not slip down the trunk

Straight Binder

1. With the client in a supine position, place the binder smoothly under the body, with the upper border of the binder at the waist and the lower border at the level of the gluteal fold. A binder placed over the waist interferes with respiration; one placed too low interferes with elimination and walking

Cont. straight

2. Apply padding over the iliac crest if the client is thin.

3. Bring the ends around the client, overlap them, and secure them with pins or Velcro. Place the top pin horizontally at the waist to allow for comfort when moving.

Securing Peritoneal Dressings

-previously, T-binders were used to secure dressings to the peritoneal area. T-binders have been replaced with sanitary disposable garments that fit like briefs. Placing an appropriate sized abdominal pad or sanitary napkin in the garment allows the wound to be protected and drainage to be collected for either males or females.

3. Stockinette- is a stretchable tubular bandage constricted so that a body part may be inserted into it such as finger, a foot or an arm. It is useful for making caps for securing dressings in the head.

4. Elasticized stockings

- the stockings help to promote venous return and to avoid stagnation of blood and possible clot formation.

- It provides pressure on the legs of persons with varicose veins, those with circulatory disturbances and for women during pregnancy.

Lifespan Considerations in Applying Bandages and Binders

CHILDREN

• Allow the child to help with the procedure by holding supplies, opening boxes, counting turns and so on.

• If a young client is apprehensive, demonstrate the procedure on a doll or stuffed animal.

• Encourage the child to decorate the bandage• Teach the caregivers to apply bandage and

binders safely

Elderly

• Older clients may need extra support during the procedure, especially if arthritis, contractures, or tremors are present

• Avoid constricting the client’s circulation with a tight bandage or binder. Observe skin and bony prominences frequently for signs of impaired circulation. The risk for skin breakdown increases with age.

Home Care Considerations

• Assess the client’s or caregiver’s knowledge level of reason for bandages or binders. Assess ability and willingness to perform the bandaging procedure.

• Ensure that the client has the proper supplies; assess for adequate and safe storage of supplies in the home, and ensure client knows how to obtain replacement supplies

• The client should have two binders so that there is one to wear while the other is being washed. Bandages and binders should be washed inside a mesh laundry bag to keep them from becoming twisted and to prevent Velcro or hooks from catching on other laundry.

• Instruct the client’s caregiver on the importance of and how to:

1. Wash hands thoroughly before handling dressing supplies and applying the bandage.

2. Report skin breakdown, redness, pain or pallor of the affected area.

3. Check for adequate peripheral circulation after applying bandage.

PERFORMANCE EVALUATION FOR APPLICATION

OF BANDAGES AND BINDERS• Definition:

• Application of strip of material such as gauze used to protect, immobilize, compress, or support a wound or injured body part

Purpose• To create pressure over an area to stop bleeding• To immobilize part of the body to restrict its motion• To support a part of the body• To prevent or reduce swelling as well as to assist in the

absorption of tissue fluid• To correct a deformity• To secure a limb to a splint or posterior mold• Used to hold dressings in place• To protect wound from contamination• To apply and retain warmth over a joint as in rheumatoid arthritis• To apply pressure to lower extremities and aid in venous return

• Equipment– bandage– binder

1. Observe medical asepsis when applying bandages and binders. When an open wound is present, apply the bandage over the sterile dressing. (The area which bandage and binders are applied should be clean and dry. They are washed and sterilized between uses on different patient when recleaned for use)

2. Use porous rather than non-porous materials when possible. (Porous materials allow for evaporation of perspiration and the escape of heat by allowing air to circulate)

3. Apply small amount of powder to the unbroken skin. Make very certain that the powder does not enter a wound if one is present. (Powder helps the skin dry and it decreases friction in the skin. Powder on an open wound irritates tissues and delays healing)

4. Do not allow two skin surfaces to touch each other under the bandage or binder. Use absorbent material such as cotton wadding or gauze between touching skin surfaces. For example, when toes or fingers are bandaged together, place padding between then first to prevent skin from rubbing against the skin. Similar protection is needed in the axillary area, the breasts, and folds in the groin or abdomen (Skin surfaces touching each other will cause rubbing and friction when the patient moves materials placed between the skin surfaces absorbs moisture to further reduce skin irritation and injury)

5. Pad bony prominces over which bandages and binders are placed. Hollow contours may be filled with padding (These techniques increase comfort for patient and help maintain equal pressure on bony parts)

6. Place the part to be bandaged comfortably at rest in its normal anatomic alignment. For example, when bandaging the foot, support it so that the bandage will not force in the foot drop position. Joints should be slightly flexed rather than extended or hyperextended.(If the part to be bandaged is not in proper alighnment, the part may be forced into an improper position and a deformity could result)

7. Apply a bandage or binder with sufficient but with neither too little not much pressure. (Applying a bandage or binder with sufficient pressure provides for the amount of immobilization or support desired, ensured that it remains in place and secures a dressing if one is present. Too little pressure defeats the purposes of the bandage or binder and allows it to slip about on the skin. Too much pressure may interfere with circulation and cause discomfort)

8. Apply a bandage over a wet dressings or draining wound less rightly than usual. (If a bandage or binder becomes wet, it is likely to shrink when it dries and become too tight for safety and comfort )

9. Do not apply a binder on the chest too snugly. (A binder applied too snugly on the chest wall interferes with breathing allowing exposed fingers and toes on bandage extremity permits nurse to observe for sign of change in circulation in the extremity)

10. Leave a small portion of an extremity, such as the fingers or toes exposed.

11. Observe for signs of impaired circulation which includes coldness, numbness of the part, swelling, bluish coloring of the skin and nailbeds and tingling pain. Report sign promptly. A test of circulation can be done by applying pressure on the nailbeds with four fingers. In normal circumstances, the area will blanch first and then return to its original nailbed is released. If the bandage is too tight the blood neither leaves nor return to the area quickly. (Corrective action should be taken if signs of impaired circulation is present. Prolonged can result in the death of tissue cells)

12. Do not leave a considerable portion of the end of an extremity uncovered. For example, start bandaging an arm or leg, the foot or hand rather than begin the bandage somewhere at midarm or midleg. The heel should not be left exposed when the foot or legs are bandaged. (Swelling is likely to result if a large exposed area of an extremity is left uncovered below a bandage. After a swelling occurs, tension on the lower border of the bandage increases making the situation worse)

13. Bandage an extremity towards the body. (Bandaging towards the body helps prevent congestion and interference with circulation in the distal part of the extremity. Heavy and extensive bandaging makes the area unnecessarily warm and it will not be comfortable for the patient. Pressure from pins, clips and knots is uncomfortable, may interfere with circulation and may cause injury to skin and nerve tissues)

14. Avoid unnecessary thickness per extensive bandage

15. Place pins, clips and knot used to secure the bandage or binder well away from a wound or a tender and inflamed area. Also, place them so that they do not cause unnecessary pressure on a part of the body. For example, a knot to secure a sling should be placed near the shoulder rather than over the cervical position of the spine.

16. Check the bandage and binders at regular intervals, including the times when the patient is asleep. Note the circulation and see that the patient is in proper body alignment. If a bandage or binders has loosened or slipped out of place, reapply it when necessary. (It is important to assess the patient’s condition at regular intervals in order to determine the effectiveness of a bandage or binder and to note any signs of problems promplty)

PERFORMANCE EVALUATION FOR APPLICATION

OF SCULTETUS BINDER• Definition:

A scultetus binder is a many-tailed binder or bandage with an attached central piece. The tails are overlapped. The last two, tied or pinned, act to secure the others. A Scultetus binder may be opened or removed without moving the bandaged part of the body. Also called Scultetus bandage.

Purpose

• abdominal support dressing

• hold dressings in place

Equipment

• -scultetus binder

• -safety pin

1. Expose the abdominal and pubic area, but not before ensuring the patient’s privacy by screening the bedside unit

2. Move the patient near the side of the nurse

3. Raise the hip or help the patient raise her hip

4.Quickly slip the scultetus binder under the hips with the solid portion under the patient’s body and the top edge at level of the waist.

5. Extend the tails out.

6. Position the binder properly and let the patient assume supine position.

7. The bottom tail is brought across the patient with the start of the application at the level of the pubic region. Pull the end tightly. If it is too long, fold the end back itself.

8. Continue applying tail toward the waist slanting slightly forward and strips from each side of the abdomen alternating with each other.

9. Secure firmly at the waist with a safety pin.

PERFORMANCE EVALUATION FOR APPLICATION

OF LARGE ARM SLINGPurpose• To immobilize part of the body to restrict its

motion• To support a part of the body• To correct a deformity• To secure a limb to a splint or posterior mold• Used to hold dressings in place• To protect wound from contamination

Equipment

• - triangular bandage

1. With the apex of the triangle pointing toward the elbow, place one end of the triangle over the shoulder of an uninjured side, then carry it around the neck so that it hangs over the shoulder on the injured side, then carry it hangs over the shoulder on the injured side.

2.Place the sling against the body and under the injured arm (the apex of the triangle is now behind the elbow of the injured side)

3. Assist the patient to flex his elbows with his thumbs upward until it is at right angle of his upper arm

4. Bring the lower corner of the triangle up cover the arm to the shoulder of the injured side.

5. Tie the end together with a square knot

6. Fold the apex of the triangle forward the elbow and secure with safety pins

7. Adjust the height of the sling by adjusting the knot at the back.

THE END

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