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DRESSINGS AND BANDAGES Claudia Gherman, Răzvan Ciocan Learning objectives What you should know What is a dressing What is a bandage The basic principles of a bandage Indications of a bandage Types of bandages Bandaging modalities Special types of dressings What you should do List the indications of a bandage List the types of bandages Applya circular bandage Applya spiral bandage Applya spica bandage Applya figure-of-eight bandage Applyacapeline bandage Applyabandage onone or more fingers List and describe the special types of dressings Definitions A dressing is used to isolate a treated wound in order to allow healing. Dressings are most frequently made of sterile gauze, but other materials are also used. In addition to isolating the wound, dressings allow absorption of secretions and a certain protection against microbial contamination and trauma. A correct dressing should respect several principles: Any dressing will be applied with the patient in lying position, rarely in sitting position, and never in standing position o Patients can be impressed by the surgical dressing room, by instruments, and can lose consciousness and suffer trauma from falling; the lying or sitting position allows to eliminate this risk The application of a dressing requires two persons: a person applies the dressing, and the other person provides the necessary materials o This ensures not only the comfort of the procedure, but also the maintenance of asepsis A kidney tray will also be available, in which the removed dressing and the used compresses will be placed Perfect asepsis: the instruments and materials used must be sterile; hand washing before and after the application of a dressing, as well as wearing of gloves (sterile – if the dressing involves manipulation of tissues with the hands, or non-sterile – if materials and tissues can be manipulated using hemostats) is compulsory Absorption of secretions will be ensured: gauze compresses, etc. Asepsis of the wound will be performed with antiseptics adequate for its evolution stage The dressing will be secured with: Silk, cloth or paper surgical tape o Which has advantages: It allows easy wound monitoring It does not interfere with the functions of the anatomical segment concerned o But also has disadvantages: Removal is painful Sometimes it causes maceration of the underlying tissue or local reactions (erythema, pruritus) Bandages Bandages or surgical wrappings represent a method for securing dressings, for temporary immobilization or compression of different body regions. Simple dressings The instruments currently used for dressings are: Surgical hemostat Anatomical hemostat Pan’s forceps Kocher’s forceps Scissors Kidney tray Figure 1. Instruments currently used for dressings: Pan’s forceps, Kocher’s forceps, scissors, surgical hemostat, anatomical hemostat, kidney tray (from left to right) Dressing technique: Hand washing and gloving The old dressing is gently removed o If this is stuck to the wound, it is moistened with oxygenated water or physiological serum The skin around the wound is cleaned with a swab soaked in gasoline for degreasing o Application is performed from the wound to the periphery so as not to contaminate the wound The skin around the wound is disinfected with alcohol or betadine The wound is treated depending on its nature and evolution stage o Surgical wounds with aseptic evolution do not require special treatments o Secreting wounds will be cleaned by washing with antiseptic solutions o Seromas and hematomas will be drained using a bulb- headed or a hollow probe, after removing 1-2 sutures o Purulent collections will be widely opened and drained with tubes Wound protection starts with the application of 2-3 gauze compresses o For secreting wounds, an additional layer of compresses is applied (thickness depending on the amount of secretions in the wound) The dressing is secured with surgical tape or bandage Special types of dressings Grassolind sterile compress It is a sterile dressing impregnated with a paraffin-based fat substance. It is made of a network of Figure 2. meshes that allow the Grassolind dressing exudate to pass, Preventing maceration. It stimulates epithelization and granulation tissue formation. It is used to cover wounds, burns. Hydrogel dressing It absorbs secre- tions and maintains wound moisture, stimu- lates healing, and does not adhere to the wound. It is used for Superficial or deep Figure 3. Hydrogel dressing Wounds and burns up to grade 2. Sterile gel (Hydrosorb Gel) It is an absorbent polyurethane gel, permeable for gases and vapors and impermeable for germs and fluids; it is available in syringes. The gel softens necrotic tissue and facilitates its removal (debridement), incorporating the exudate and wound debris. It is used for uninfected Figure 4. wounds and for burns. Polyurethane gel Calcium alginate fiber dressing It is a hydroactive dressing made of calcium alginate fibers. It is indicated for deep, difficultly accessible wounds, infected chronic wounds, fistulas.
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