|Fundamentals of Nursing Practice||© Rhodora Cruz|
Applying bandages and binders
Bandages and binders protect an underlying wound or dressing, provide pressure, warmth, support, or immobilization. Most bandages are of a gauze material; binders are often made of muslin. Bandages or binders need not be sterile when there are underlying sterile dressings to protect the wound. Avoid bandaging over wrinkled dressings, which can produce pressure on the wound or skin. Also do not apply bandage or binder over a dressing that appears soiled because this can lead to infection. Approximately after you applied bandage or binder, check the patient for comfort. A bandage or binder that is too tight can interfere with circulation, causing swelling, numbness, tingling, or color changes in the distal are. Bandages are applied on parts from distal to proximal, to facilitate venous return.
Types of Bandages
Roller gauze is available in is soft, strong, and comfortable. It is used to hold dressings in place. Another bandage is kling and it is soft, meshlike flexible bandage and stretchable. Another type of roller bandage is a heavier type of stretchable material commonly known as the elastic bandage. One brand that is used is Ace. Elastic bandages are used to give constant pressure over an area or to support an injured joint. When used to a lower extremity, it facilitates venous return.
Methods of Application
There are five general methods of applying roll bandages: circular, spiral, reverse spiral, figure-8, and recurrent fold.
The circular-turn bandage is used to secure a dressing or to cover a confined area of an extremity. With the roll on the inner aspect, unroll the bandage either toward you or laterally, holding the loose end until it is secured by the first circle of the bandage. Two or three turns may be needed to cover an area adequately. Hold the bandage in place with tape or a clip.
The spiral begins distally on an extremity and wind proximally, to cover a wider area with comfort. Begin with the circular method. After securing with one or two complete overlaps, place the bandage to overlap a half or two-thirds of the width, and in this manner move evenly up the extremity to provide even support. Tape or clip the bandage in place.
Reverse spiral begins distally also like the spiral. Begin as you would for the spiral bandage. When the end is secured by the first turn, hold your thumb on the bandage as it approaches the side nearest you and fold over, reversing the direction downward. Repeat this step with each turn, overlapping as before. When the desired area is covered, end with a circular wrap and secure the bandage with tape or a clip.
This bandage is most often used on a joint to provide easy flexion. Make the first turns over the joint, securing with the overlap. Make the next turn higher than, or superior to, the joint. Make the following turn lower than, or inferior to, the joint. Continue working in this manner, one turn above and one below. Secure the bandage with tape or clip.
The recurrent fold bandage can be adapted for use on many parts of the body. It is used for the finger, hand, toe, or foot. This type of bandage is also applicable for use as a head dressing or on a stump of an extremity. Begin by holding the end of the bandage is place with one circular turn. Then, bring the roll down over the end of the body part and back up behind. When used on the head, the circular turn made and then turns are made over and back across the top of the head. Subsequent turns are folded alternately to the right and left of the initial center fold. Keep your fingers in place at the top to secure the bandage until a circular turn or two can be made to complete the bandage. Clip or tape in place.
Specific Bandaging Procedures
Wrapping an Ankle and Lower Leg
Secure the bandage around the instep with a single circular wrap. Form a figure 8 around the ankle. Then, wrap the leg using spiral wrap.
Applying Elastic Stockings
Elastic stockings are used to provide firm support to the soft tissue. This prevents the pooling of venous blood in the deep veins and the development of blood clots. The elastic stockings are usually applied to the patient before he or she gets out of bed. Begin by sliding your hand into the stocking to the foot. Turn the leg of the stocking down over your hand until the leg is inside out but the foot is still side out inside the leg. Pull the foot of the stocking onto the patientís foot, carefully placing the heel of the stocking over the heel of the foot. Pull the stocking up gradually over the leg. Make sure that the stocking fits smoothly without wrinkles
A recurrent bandage is placed on the stump first, and then a spiral is started at the distal end of the stump and moved up to the thigh
Apply the stocking by turning it inside out, placing the end of the tube against the end of the stump, and gradually inverting the stocking over the stump.
Binders are generally used on the trunk of the body to hold dressings in place or to support tissues. They can be placed around the chest, the abdomen, or the pelvic area.
Straight Abdominal Binder
Place the patient in a supine position. Ask the patient to lift upward, using the legs, or roll the patient onto the binder. It should be smooth so that wrinkles do not cause pressure on the patientís skin. Overlap the edges of the binder snugly over the abdomen. Holding it in place, fasten the binder with safety pins or Velcro.
Scultetus Abdominal Binder
Place the binder underneath the supine patient, being careful to check for underlying wrinkles. Lace the lower tail in a slightly oblique direction up the abdomen. Lace the tail on the opposite side in a similar way. Continue lacing in this interlocking fashion until all the tails have been neatly and securely placed.
Elastic Net Binder
Elastic net binders are used to hold dressings in place and not for support. These binders come in a variety of circumferences. Begin by gathering the net in your hands, stretch it and slip it upward over the feet and legs to the position around the abdomen.
Select the appropriate binder according to the patientís gender. Place it underneath the patient smoothly, with the waistband at waist level and the tails pointing down the midline of the back. Bring the waist tails around the patient and overlap. Bring the center tail or tails up between the patientís legs and over perineal dressings. Make sure the two tails of the double T-binder are on either side of the scrotum and penis.
To make an arm sling from muslin, fold of cut a 36-inch square of fabric diagonally. Slings are applied in two ways.
With the patient facing you, place one end of the triangle over the unaffected shoulder and the long straight border under the hand of the injured side. Loop upward, positioning the other end of the triangle over the affected shoulder. Tie or pin the ends to one side of the neck, using a square not, or pin smoothly, using a safety pin. Do not secure a sling at the back of the neck because this could exert pressure. Fold the corner flat and neatly at the elbow, and pin.
With the patient facing you, place the sling across the body and underneath the arms. Bring the corner of the sling that is under the unaffected arm to the back. Bring the lower corner up over the affected shoulder to the back, and tie. Fold the sling neatly at the elbow, and pin.
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