BANDAGINGDEFINITION: Bandaging is the process of covering a wound or

an injured part.

USES:Bandages are used for following purposes: To prevent contamination of wound by holding

dressings in position. To provide support to the part that is injured,

sprained or dislocated joint. To provide rest to the part that is injured. To prevent & control hemorrhage.

To restrict movement / immobilize a fracture or a dislocation.

To correct deformity. To maintain pressure e.g. elastic bandages

applied to the improve venous return.

TYPES OF BANDAGES: Triangular Bandage. Roller Bandage. Special Bandage. E.g. T- bandage.

MATERIALS COMMONLY USED FOR BANDAGES:

Cotton Cotton gauze Jute Wool Special materials like crape bandage,

elastic bandage.PARTS ROLLAR OF BANDAGE: Head Free End or tail.

PARTS TRIANGULARLAR OF BANDAGE

POINT

END (BASE) END

SIZES OF BANDAGE: The size of the bandage varies according to

the part it is supposed to bandage Part To be Bandaged Width(Cm) Length (Mts)

HeadTrunkLegArmFingersHandWrist

510 to 15 6 to 8 5 to 6 2.555

4 to 6 6 to 843 to 4233

GENERAL PRINCIPLES: - Select a bandage of proper size & suitable

material. Put the patient in a comfortable position. Support the injured area while bandaging. If a joint is involved, flex it slightly. Face the patient while applying the

bandage, except when applying it to the head.

Hold the roll of the bandage in the right hand when applying bandage on the left side, Hold the bandage with the roll uppermost & apply the outer surface to the skin, unrolling a few centimeters of the bandage at a time.

Put some cotton wool on the part to be bandaged so that the bandage does not slip or cause cutting into the skin underneath.

Bandage from below upward, & from within outward.

Hold the end of the of the bandage over the outer aspect of the injured area & wind the bandage around the part twice to fix it.

When bandaging a limb start with an oblique turn to keep the bandage in position, as an alternative method.

Cover two thirds of the bandage by the next one, while covering a large area by winding the roller bandage around the part. Keep the edges parallel.

Keep even & not too tight pressure while applying bandage, too tight bandage interferes with circulation.

Finish with a straight turn & fix the end with a safety pin, sticking plaster or by dividing the terminal portion of the bandage longitudinally & tying the two ends around the bandaged part.

If possible, leave fingers & toes exposed to check circulation.

Do not bandage the part too tightly or too loosely. Observe the extremities carefully for any signs of

swelling or blueness due to interference with circulation by a bandage that is too tight.

When removing a bandage, pass it from one hand to the other, so that it is collected in a concertina fashion.

FOLLOWING TERMS ARE USED IN ROLLER BANDAGING.

Simple spiral Reverse spiral Figure of eight. Spica1. Simple Spiral : This type of bandage is used for uniform

thickness part i.e. wrist or finger. Each turn of the bandage overlaps the previous turn.

2.Reverse Spiral: This bandage is used for the parts where

the thickness varies e.g. legs & forearms. It is applied in the same way as the general spiral bandage, but each turn is reversed as necessary to prevent gaping & to make the bandage smooth.

3.Figure of Eight: This bandage is used for elbow & knee

joints. This bandage is made by forming two loops or oblique turns over a joint. The turns alternately ascend & descend to cover the part.

4.Spica: It is a form of the figure of eight bandage.

The turn is larger than the other. It is used for joints at right angles to the body, e.g. the shoulder, groin, thumb.

5.Special Bandages: A). Many Tail Bandage: This bandage is usually used for

abdominal wounds & chest injuries. It is prepared from a number of strips or tails of flannel or cotton material. It is 4 to 6 inches wide & has sufficient length to cover the affected part.

STEPS OF APPLYING ROLLAR BANDAGE:

FIXING ROLLING SECURING

CHECKING CIRCULATION AFTER BANDAGING

PRESSING NAIL CHECKING PULSE TINGLING,COLDNESS,INABILITY TO MOVE

FINGERS

TYING THE BANDAGE;

FOR TYING THE BANDAGE A ‘REEF KNOT’ MUST BE ALWAYS USED.

KNOT SHOULD NOT CAUSE DISCOMFORT.

TUCK THE LOOSE ENDS OF BANDAGE OUT OF SIGHT

SLINGS Definition:- Slings are used to provide support and

protection for injured arms, wrists and hands or for immobilising an upperlimb when there are arm or chest injuries.

Types of Slings:-1 . Arm sling2. Elevation sling 3. Improvised sling

1.Arm Sling :- This is used when there are injuries to the

upperlimb and for some chest injuries. It holds the forearm across the chest but it

is only effective if the casualty sits or stands.

When an arm sling is in the correct position ,the casualty's hand will be slightly higher than the elbow.. The base of the triangular bandage should lie at the root of the little finger leaving the finger nails exposed.

Method of Application:- 1. Ask the casualty to sit down and support

the forearm on the injured side with the wrist and hand slightly higher than the elbow.

2. Using the hollow between the elbow and the chest slide one end of the triangular bandage between the chest and forearm so that its point reaches well beyond the elbow.

3. Place the upper end over the shoulder on the sound side and around the back of the neck to the front of the injured side.

4. Still supporting the forearm, carry the lower end of the bandage up over the hand and forearm and using a reef knot, tie off on the injured side in the hollow above the collar bone .

5. Bring the point forward and secure it to the front of the bandage with a safety pin.

6. Check the circulation. If it is affected adjust the bandage or the position of the sling.

Support of forearm

1: Arm sling

Forming sling

2. Elevation Sling:- This sling is used to support the hand and

forearm in a well raised position. -If the hand is bleeding. -There are complicated chest injuries. -There are shoulder injuries.

A). Collar and Cuff Sling:- This is used to support the wrist only.

Method of Application:- 1 . The elbow is bent, the forearm is placed

across the chest in such a way that the fingers touch the opposite shoulder. Now the sling is applied

2. A clove-hitch is passed round the wrist and the ends tied in the hollow above the collar bone on the injured side.

Clove-hitch is made with a narrow bandage. Two loops are made and laid one on top of the other.

A). Collar and Cuff Sling:-

B. Triangular Sling:- -This is used in treating a fracture of the

collarbone. It helps to keep the hand raised high up giving relief from pain due to the fracture.

Method of Application:- 1.Place the forearm across the chest with the

fingers pointing towards the opposite shoulder and the palm over the breastbone.

2. Place an open bandage over the chest with one end over the hand and the point beyond the elbow.

3.Improvised Sling:- If no triangular bandages are available

slings may be improvised in several ways to provide support-

(a) Turn the free end of a coat and pin it to the clothing.

(b) Pass the hand inside the buttoned coat or shirt.

(c) Pin the sleeve of the injured limb. to clothing.

(d) Use mufflers, scarf, belt, tie or soft cloth.

Improvised sling

Improvised sling

SPLINTS A splint is a rigid appliance, usually made of wood or

metal, which is tied to a fractured limb to support it and prevent movement from taking place at the site of fracture.

Using a Splint:- If a splint is not used properly, it may cause damage.

Therefore, remember the following points when using a splint:-

1.Make sure that the splint is well padded. This is particularly important when splints are improvised from pieces of wood which are uneven.

2. Make sure that the splint is sufficiently long to immobilize the joint above and the joint below the fracture.

3. Make sure that the bandage used to secure. The splint have the knot tied on the splint and not on the fleas.

IMPORTANT SPLINTS IN ORTHOPAEDIC OTHER THAN PLASTER SPLINTS

Splints occupy a very special place in the treatment methodologies in orthopaedics. Any material which is reasonably hard like a rolled newspaper, card board, wooden planks, books, etc. can function as a splint. However these are crude and are mostly useful during first aid treatment of bone and joint injuries.

Refined splints used in orthopaedics are:- plaster of Paris splints, Thomas splints, Bohler-Braun splints, Aeroplane splints.

PLASTER SPLINTS-1.Thomas Splint:- This is one of the very commonly used

splints in orthopaedics. It was discovered by H.O. Thomas in

1876 to assist for ambulatory treatment of TB knee.

It is now widely used for the treatment of shaft fractures of femur, knee injuries etc.

Metal oval ring2 inch angulation at outer bar

Side bars

Distal -W

Parts of a Thomas splint : A Thomas splint consists of four parts:- 1. A padded metal oval ring with soft

leather set at an angle of 1200 to the inner bar.

2. Two side bars-one inner and another outer bars of equal length. They bisect the oval ring

3. Distal end-where the two side bars are joined in the form of a ‘W'.

4. Outer side bar is angled 2 inches below the padded ring to clear the prominent greater trochanter.

Uses of Thomas splint:-1. To immobilise fracture femur anywhere.2. As a first aid measure to immobilise the

lower limb injuries.3. For transportation of an injured patient4. In the treatment of joint diseases like TB

knee, septic arthritis etc.

Bohler-Braun (BB) Splint:- This is Bohler's modification of Braun splint.

It consists of a heavy metallic frame with four' pulleys:-

1. Proximal pulley prevents foot drop.2. Second pulley to apply traction. in the line

of femur. 3. Third pulley to apply traction in the line of

supracondylar area of femur.4. Fourth pulley to apply traction in line of the

legs.

Indications Skeletal traction is applied through this

frame for comminuted trochanteric fractures of the femur.

It is also used for the treatment of fracture shaft femur and supracondylar fractures of the femur.

Rarely it can be used for the fracture shaft of tibia and fibula.

One important precaution which should be taken while using the BB splint is to provide support at the fracture site and not at the knee joint to prevent angulation especially in supracondylar fractures of femur.

Problems of BB Splint:-1. Makes nursing care difficult2. It is a heavy and cumbersome

frame.3. It is associated with recumbent

problems like bedsores ,hypostatic pneumonia, renal calculi, etc.

PNEUMATIC SPLINTS These are the present generation splints

and are more aesthetic, light and effective. They consist of the splints made up of

pneumatic material and can be easily applied to the limbs by inflating it with air.

They provide a tight fit and are more comfortable to the patient.

Most of the ambulances today carry these splints which are easy to transport unlike the crude and hard Thomas splints, etc.

Care of the Splints by the Nurse-1. Padding- The splint should ,be well padded

at the bony prominences and at the injury sites.

2. Bandage- This should be tied with optimum pressure.

3. Exercises -Active exercises of the joints and muscles should be permitted within the splints.

4. Checking -Daily checking and adjustments of the splints are recommended.

5. Neurovascular status- Distal neurovascular status should be assessed daily.

NURSING CARE FOR PATIENTS TREATED WITH SPLINTS

Nursing care assumes extreme importance in patients treated with splints as most of these patients are severely injured and are bed ridden. This can be discussed under two headings:-

A}-NURSING CARE BEFORE APPLICATION OF THE SPLINT

Take consent. Inform the patient about the procedure. Remove any tight fitting clothes and change

them into easy to wear dresses.

Clean the affected part. Select right sized splint. Adequately pad the pressure points and the

perineum. Apply the splint gently. Check for the tightness of the weight cord. After application check for the peripheral

pulses and nerve function. Apply proper weight as per the directions of

the surgeon. Foot end elevation may be required to give

the counter traction.

Note: Maximum permissible weight limits:-- a. Skin traction-4-5 kgb. Skeletal traction-8.10 kg

B}-NURSING CARE AFTER APPLICATION OF THE SPLINT.

Check the pressure points and perineum everyday for abnormal pressure.

Tighten the weight cord arid increase or decrease the weight as per the advise of the doctor.

Bed pan and urinecan has to be given with care to avoid disturbance to the injured site.

Care of the back is very important to prevent bedsores .

Sponge bath the patient everyday. To prevent soiling of the bed sheets and the

bed but proper rubber sheets. Attend to the hair and nails of the patient. Arrange to supply proper diet to the

patients being treated on splints. . Instruct the patient to carry out active

exercises of the unaffected joints.

Isometric exercises for the immobilised joints.

Change the splint if the canvas gets soiled. If traction, either skin or skeletal, is applied

through the splint then the nursing care should proceed on the lines described for treatment on traction