Wound Dressings

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Wound Dressings

• 1. Bandages
• 2. Compressive
• 3. Fixative devices

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1. BANDAGES
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TYPES OF BANDAGES

• Conforming Bandages Flexible secondary dressing
  to secure primary dressings
• Elastic Bandages First quality bandage that acts
  as a flexible secondary dressing to secure
  primary dressings, or to ensure a good
  compression over sprains.
• Retention Bandages As their name suggests, these
  bandages are used to retain dressings in place
• Supportive / Fixation Bandages Support may be
  defined as the retention and control of tissue
  without the application of compression.

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INDICATIONS Vs CONTRAINDICATIONS

• Allergy to material
• The simple elastic bandage can cause trouble when
  it is applied too tightly.
• Problems arise when circulation in the limb
  beyond the bandage is impaired.
• The limb shouldn't swell, hurt, or be cooler
  beyond the bandage.
• The skin shouldn't have any blue or purple
  colour.

• Retention Holds dressing in place i.e. Gauze.
• Supportive/Fixation Used for immobilization
• Compression To assist in venous/lymphatic
  disorders
• Protection - Protects specified area

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METHOD OF USE

• Elastic When wrapping the bandage, start
  distally and work proximally.
• The bandage should be tighter at the distal point
  of application to where it ends proximally.
• Many people think that because a bandage is
  elastic it must be stretched. That's wrong!!!
• The stretchability is to allow the person to
  move. Simply wrap the bandage as you would a roll
  of gauze.

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ADVICE TO PATIENTS

• Frequency of dressing changes Depends on wound
  and type of bandage.
• Advice to patient/care givers
• Remove bandage if any signs of allergic reaction
  appear.
• Keep bandage dry and clean.
• Dont apply bandage too tight.

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2. COMPRESSIVE DEVICES
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TYPES OF COMPRESSIVE DEVICES

• Rigid
• non-elastic compression
• multi-layered compression
• short-stretch and single-layer compression.

• Multi-layered and short-stretch appear to be the
  most commonly used.
• Bandages are graduated (i.e. Are tighter at the
  foot and ankle and become looser with more
  proximal application)

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SO HOW DOES COMPRESSION BANDAGING WORK?

• Blockage or damage to the venous system will
  cause disruption to normal blood flow,
  manifesting itself in different ways such as
  oedema and variscosities.
• For patients with venous disease, the application
  of graduated external compression (distal to
  proximal) can help to minimise or reverse the
  skin and vascular changes by forcing fluid from
  the interstitial spaces back into the vascular
  and lymphatic compartments.

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INDICATIONS Vs CONTRAINDICATIONS

• Arterial disorders
• Infection
• Adverse Reactions
• Too tight or loose
• Wrinkles because increase in the number of layers
  increases the localised compression.
• Swollen toes
• Contact dermatitis allergies to the materials

• Venous leg ulcer management. E.g. Chronic venous
  insufficiency, lymphatic oedema.

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• Apply bandage before weightbearing
• Make sure that the leg is clean and thoroughly
  dry. Apply suitable moisturizer and check leg and
  pedal pulses, to ensure that vascularity is
  suitable
• A padding bandage is required for skin protection
  under compression bandages. Zinc paste bandage or
  dressing is applied prior to the application of
  the padding bandage.
• Apply the compression bandage in a spiral from
  toe to knee, including the heel, with a 50
  overlap of the width.
• Repeat the process using second compression
  bandage if low stretch compression bandages are
  used. Additional layers may be applied depending
  on the wound and degree of compression required.
• Pressure should be increased around the ankle and
  lower leg and gradually reduce pressure when
  proceeding proximally.
• Ensure bandage is not applied to tightly or
  loosely.it should be Kelloggs

METHOD OF USE
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Incorrectly applied bandage showing effects of
slippage

• Necrosis caused by incorrectly applied bandage

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ADVICE TO PATIENTS

• Frequency of dressing changes Dependant on the
  patients needs, but should be a minimum of once a
  week. Dressing should be changed more than once a
  week if patient is mobile
• Advice to patient/caregivers Generally
  application is by caregiver due to improper
  application with self administration or
  administration by unqualified individual.

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DIFFERENT COMPRESSIVE BANDAGES
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THE GREAT VANILLA SLICE CHALLENGE 2005
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3. FIXATIVE DEVICES
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GENERAL FEATURES

• May or may not be adhesive
• May or may not contain elastic
• May be comprised of various materials
• Holds wound dressings and tubes in place.

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TYPES OF FIXATIVE DEVICES

• Adhesive surgical tapes- smaller wounds to hold
  textile compresses in place
• Plasters with no adhesion fixation border-
  hydrogel dressings
• Tapes may also be applied in a parallel fashion
  on minor incisional wounds healing by first
  intention.
• Steri-strips

• Examples Handipore, mefix, leucoplast tape.

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INDICATIONS Vs CONTRAINDICATIONS

• When bandage is required to remain in place
• Protection of wound from environment
• Bridging edges of wounds
• Aesthetically pleasing

• Allergy to material or Zinc Oxide. Fragile skin
• Non-allergenic contact dermatitis can result when
  tackifiers are trapped between the skin and the
  adhesive.
• For patients with sensitive skin, use surgical
  tapes with skin-compatible polyacrylate
  adhesives.

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• Cut material to shape, remove backing strip or
  unroll bandage and apply to the desired area.
• 2) The application of rectangular strapping (all
  four edges fixed with strips of tape) to be most
  effective, as this technique reduces wound
  irritation caused by movement of the dressing

METHOD OF USE
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ADVICE TO PATIENT

• Frequency of dressing changes As requested by
  practitioner, or as often as wound dressing
  requires.
• Advice to patients/caregivers
• Do not wet.
• Remove bandage if irritation occurs or foot is
  turning blue/white.

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THE END