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There are several types of bandages and binders and several ways in which they are
applied. When correctly applied, they promote healing, provide comfort, and can prevent
injury.
BANDAGING
Bandaging is an important part of the case management of many patients. There
are several a situation in which bandaging is indicated. A decision must be made first as
to whether or not a bandage is necessary at all. Determine what is the purpose of applying
bandage is and what is the best material that will address the needs of the patient. It is for
this purpose that a basic knowledge in bandaging is necessary to carry out a quality
patient care.
Bandages
A bandage is a strip of cloth used to wrap some part of the body. Bandages are
available in various widths, most commonly 1.5 to 7.5 cm (0.5 to 3 in). They are usually
supplied in rolls for easy application to a body part.
Many types of materials are used for bandages. Gauze is one of the most
commonly used, because it is light and porous and readily molds to the body. It is also
relatively inexpensive, so it is generally discarded when soiled. Gauze is used to retain
dressings on wounds and to bandage the fingers, hands, toes, and feet. It supports
dressings and at the same time permits air to circulate; it can be impregnated with
petroleum jelly or other medications for application to wounds.
Elasticized bandages are applied to provide pressure to an area. They are
commonly used as tensor bandages or as partial stockings to provide support and improve
the venous circulation in the legs.
The width of the bandage used depends on the size of the body part to be
bandaged. Padding (e.g. abdominal pads and gauze squares) is frequently used to cover
bony prominences (e.g. the elbow) or to separate skin surfaces (e.g. the fingers).
The bandage has the following purposes:
To limit movement
To apply warmth
To secure a dressing
To hold splints in position
To support parts of the body
To apply pressure
Parts of a Bandage
1. Initial or free end
2. Body or drum
3. Terminal or hidden end
INDICATION CONTRAINDICATION
1. Sprain 1. Hampered Circulation
2. Fracture 2. Venostasis
3. Varicose veins 3. Muscle Weakness
4. Cerebral palsy 4. Paresthesia
5. Muscle weakness 5. Numbness
6. Amputation stumps 6. Anesthesia
7. Dislocation 7. Pressure sores
8. Subluxation 8. Blisters
9. Contractures
Assessment
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 palpate 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 (e.g. to eat,
dress, com hair, bathe) and assess the assistance required during the
convalescence period.
are used to bandage an elbow, knee, or ankle, because they permit some movement after
application. Oblique turn covers ¼ of the preceding turn.
1. Circular turns
Hold the bandage in your dominant hand, 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.
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.
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.
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.
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.
2. Spiral turns
Make two circular turns. Two circular turns anchor the bandage.
Continue spiral turns at about a 30-degree angle, each turn overlapping the
preceding one by two-thirds the width of the bandage.
Terminate the bandage with two circular turns, and secure the end as
described for circular turns.
Unroll the bandage about 15 cm (6 in), and then turn your hand so that the
bandage falls over itself.
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.
Terminate the bandage with two circular turns, and secure the end as
described for circular turns.
4. Recurrent turns
Anchor the bandage with two circular turns.
Fold the bandage back on itself, and bring it centrally over the distal end to be
bandaged.
Holding it with the other hand, bring the bandage back over the end to the
right of the center bandage but overlapping it by two-thirds the width of the
bandage.
Bring the bandage back on the left side, also overlapping the first turn by two-
thirds the width of the bandage.
Continue this pattern of alternating right and left until the area is covered.
Overlap the preceding turns by two-thirds the bandage with each time.
Terminate the bandage with two circular turns. Secure end appropriately.
5. Figure-eight turns
Anchor the bandage with two circular turns.
Carry the bandage above the joint, around it, and then below it, making a
figure-eight.
Continue above and below the joint, overlapping the previous turn by two-
thirds the width of the bandage.
Terminate the bandage above the joint with two circular turns, and then secure
the end appropriately.
Requirements for a Successful Bandage
Binders
A binder is a type of bandage designed for a specific body part; for example, the
triangular binder (sling) fits the arm. Binders are used to support large areas of the body,
such as the abdomen, arm, or chest. Binders can be simple, inexpensive, and
customizable by using plain material. 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.
the neck on the injured side. A square knot will not slip. Tying the knot at the
side of the neck prevents pressure on the bony prominences of the vertebral
column at the back of the neck.
Make sure wrist is supported, to maintain alignment.
Fold the sling neatly at the elbow, and secure it with safety pins or tape. It may be
folded and fastened at the front.
Remove the sling periodically to inspect the skin for indications of irritation,
especially around the site of the knot.
SPLINTING
In current medical practice splints have been recognized in managing diseases and
injuries of the hand. The proper use of splints is a fundamental part of the treatment and
management of patients with acute or chronic injury of the extremity. Wearing of splints
can influence the performance of purposeful activities, thus, allowing individuals to
achieve their desired occupational goals. It is therefore believed that knowledge in basic
principles, types, and uses of splints is essential.
Splints
A splint is a rigid flexible appliance utilized to prevent motions of a joint or for
the fixation of displaced movable parts. Orthosis is a permanent device used to replace
or substitute for loss of muscle function.
A splint can be corrugated cardboard, folded newspapers, boards, straight sticks,
or a rolled-up blanket. A splint helps protect the injury until help arrives. The splint
should be long enough to extend beyond the joints on both sides of the fracture.
Classifications of Splint
A. Mechanical Characteristics
1. Static splints – used to provide static support and
immobilizations
2. Dynamic splints – alter the range of passive motion of a
joint or joints by employing traction devices.
B. Source of Power
1. Internally-powered splints – make use of the patient’s
residual muscle power to produce motion of nonfunctional
joints
2. Externally-powered splints – are driven by an external
source.
Splinting Materials
1. No external heat
a. Working temperature is 70 -75 F (21-24 C)
b. Advantages: quick to work with, gives rigid immobilization, and
inexpensive
c. Disadvantages: does not hold up over time and cannot become wet
2. Low temperature thermoplastics
a. Soften in water heated between 135-150 F
b. Advantage: can work with material directly on the skin
c. Disadvantage: may melt in a hot car or if left on hot surface
3. High temperature thermoplastics
a. Advantage: provides strong mobilization
b. Disadvantages: material cannot be formed directly on the patient’s skin
without stockinette, and it does not contour well.
Categories of Thermoplastics
Plastic
Rubber-like
Plastic and rubber-like
Elastic
Flexible
Properties of Splints
1. Conformability
2. Flexibility
3. Durability
4. Rigidity
5. Moisture permeability
6. Finish
7. Color
Splinting Precautions
1. Alter splint if areas on the skin persist 20 minutes after removal of splint
2. Increasing surface area of splint decreases potential for pressure sores
Splinting
Indications:
Fracture
Dislocated joint after reduction
Sprain: torn or stretched ligaments
Strain: torn or stretched muscles or tendons
Postoperative immobilization
Contraindications:
Absolute: none.
Relative: Injuries involving open wounds or infections need easily
removable splints to allow soft tissue care.
Equipment:
Cast padding (soft roll)
Plaster/fiberglass
Lukewarm water
Ace bandages
Disposable gloves
Positioning:
Ankle/foot: 90° angle between foot and leg, neutral eversion/inversion
Techniques in Splinting:
Splint padding
Apply cast padding to entire area to be splinted with 2–3 inches of proximal and
distal overhang.
Padding should be applied evenly in a circular fashion from distal to proximal,
with each turn overlapping by 50% of the next turn to allow at least two layers of
padding in all areas.
Fiberglass/plaster
General technique: Immobilize fracture one joint above and one joint below injury.
Ace wrap
Wrap Ace bandage around splint with gentle tension.
Ace wrap should never be tight enough to cause venous compression.
Hold extremity in desired position until splint hardens (approximately 5–10
minutes with fiberglass, 10–15 minutes with plaster).
Specific Splints:
1. Posterior elbow splint
Begin 4-inch-wide splint from posterior upper arm, moving across the posterior
elbow.
Extend the splint over the ulnar border of the forearm and hand to just proximal to
the MCP joint.
Begin with 3- to 4-inch-wide splint in the palm of the hand at the level of the
MCP joints.
Extend splint up dorsal aspect of the forearm, around the elbow flexed at 90°,
down the volar aspect of the forearm and hand, to just proximal to the MCP joint.
Be sure that the splint does not limit MCP motion.
Apply 3- to 4-inch-wide slab from ulnar aspect of proximal forearm down along
the ulnar aspect of the small finger.
Fold edges around dorsal and volar aspect of hand and ring/small fingers.
Place the wrist in neutral supination/pronation with 20°–30° extension.
Apply to radial border as above for ulnar side with a hole cut out to allow motion
of the thumb.
Ankle splint
Apply 4-inch-wide splint beginning at the medial upper thigh and extending down
the medial knee and ankle.
Continue the splint around the heel and up the lateral side of the ankle and knee to
the lateral upper thigh, forming a U shape.
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For additional stability, apply a 6-inch splint from the posterior upper thigh down
to the posterior aspect of the leg and plantar surface of the foot.
7. Ankle splint
- Use for isolated ankle injuries.
Apply 4-inch-wide splint beginning at the proximal border of the upper calf,
extending down the medial calf and ankle, and around the heel and up the lateral
ankle and lateral calf.
For additional stability, apply a 6-inch splint from the posterior upper calf down
the posterior aspect of the lower leg and the plantar surface of the foot.
2. Cast sores
Compression of skin over extended periods can lead to necrosis and breakdown.
Be sure all bony and tendinous prominences are well padded.
Be cautious about applying splints in unconscious patients or patients with
insensate skin.
If patient complains of burning pain or discomfort, remove splint and inspect skin.
3. Joint contracture
Long-term immobilization can lead to shortening of ligaments and tendons if
improperly positioned.
Check and re-check position of splint as it hardens.
Avoid immobilization for longer than 3 weeks for shoulder and elbow injuries; 6
to 8 weeks for any other injury.
If contracture develops, begin physical therapy immediately.
Orthopedics consults.