Uses, Guidelines and Types of bandages.

Bandages

Applications of bandages

These are made from flannel, calico, elastic net or special paper, they can be improvised by any of the above material, or from stockings or ties

Uses of bandages.

            Maintain direct pressure over a dressing to control bleeding.

            Retain dressing and slings in position

            Prevent or reduce swelling.

            Provide support for a limb or joint.

            Restrict movement

            Assist in lifting and carrying casualty.

Guidelines

            Bandages should be applied firm enough to keep dressing and splints in position.

            But not so tight as to cause injury to the part or to impede the circulation of the blood.

            A bluish tinge of the finger or nails may be a danger sign that the bandages are too tight.

            Loss of sensation is an other sign.

Types of bandages

            Triangular bandages.

            Roller bandages

            Special-such as, many tail or ' T' bandages.

Triangular bandage

The triangular bandage may be used in nursing for slings to support an arm after injury

Roller bandages

Roller bandages are used for the following purposes..

1) To cover and to retain dressing and splints in      position.

            To exercise pressure on a part in order to prevent or to reduce swelling.

            To provide support for a part , sprained or dislocated joint

            To prevent and control haemorrhage

            To restrict movement.

            To correct deformity.

Materials

            Roller bandages are made from strips of different material of varying lengths and widths, according to the part to which they are applied.

            Materials commonly used are flannel, open wove cotton, fast edge cotton, calico, crepe or elastic net.

            Before use, the bandage should be firmly and evenly rolled, either by hand or by machine.

            The parts of the bandage are referred to as the head and the free end to tail.

Usually, a single roller bandage is used, but for, some certain parts, a double headed roller bandage is required.

            In this, the free ends of two roller bandages are sew together leaving the heads to close together, on the same side of the bandage.

            Most roller bandages are 6 yards long, except the very narrow ones, which are usually, short.

            The width lay according to the part of the body to be bandaged.

            The usual width of the bandages are, 1 Inch to 4 to 6 inches.

Part bandage                Width

Fingers        1.       inch.

Arm  2        to 2 inches.

Leg    3        to 3 inches.

Trunk         4        to 6 inches.

Head 2        inches.

Rules for the application of roller bandages

            Use a tightly rolled bandage or the correct width.

            Support the part to be bandaged through out.

            For the forearm, the hand should be prone.

            Always stand in front of the patient except when applying a cape line bandage.

            Bandage a limb in the position in which it is to remain.

            Hold the bandage with the head uppermost and apply the outer surface of the bandage to the part, never unroll more than a few inches of bandage at a time.

            Bandage from within outwards and from below upwards, maintain even pressure throughout.

            Begin the bandage with a firm oblique turn to fix it and allow each successive turn to cover two thirds of the previous one, with the free edges lying parallel.

            Make any reverse or crossing a line on the outer side of the limb, except, when this brings them over a wound or prominence of bone, in which case, they must be on the front of the limb.

            Pad the axilla or groin when bandaging these parts, so that, two of the surfaces of skin do not touch beneath the bandage.

            Finish off with a straight turn above the part, hold in the end and fasten with a safety pin.

Points to be observed

            The comfort of the patient is the first consideration, except, when arresting haemorrhage or correcting a deformity.

            Neatness and economy must be considered.

            The bandage should be firm and applied with even pressure throughout.

            The extremities must be carefully watched

            for any signs of swelling or blueness due to interference with circulation by a bandage that is too light.

Terms used in roller bandaging

            Simple spiral

            Reverse spiral

            Figure of eight

            Spica

Simple spiral

Is used for parts which are of uniform thickness, such as, a finger or a wrist.

The bandage is applied obliquely round the part, each turn cover two thirds (2/3) of the proceeding one, and the edges being kept parallel.

Reverse spiral

It is used for parts which vary in thickness and upon which the bandage of circular turns cannot be tied properly like leg and forearms. One or two simple spiral turns are usually made to carry the bandages to the point at which the spiral can no longer be employed. And then the lower edge of its last spiral is fixed with the thumb about halfway between the mid line and outer surface of the limb. The bandage is then reversed and brought down and carried round the limb, when another reverse is made immediately above the former one. These reverses are repeated as far as necessary and the bandage completed with one or two.

Spiral turns straight round the limb. Care should be taken and that, each reverse occurs immediately above the previous one , so that, the pattern is even. Each turn should cover two thirds of the preceding one, as in the simple spiral.

Figure of Eight

Is used for bandaging limb and for covering joints. It consists of series of loops, encircling the part in the from of a figure of eight. The upper loops being completely hidden by the successive turns end the lower loops forming the pattern. Each one cover the two thirds of the preceding loop and crossing in the same line.

The Spica

Is a form of the figure of eight in which one turn is very much large then the other. It is used for joints at right angles to the body. eg: shoulder, groin and thumb.

The divergent spica

Is a form of the figure of eight in which the turn go alternately above and below a fixed starting turn ending above, and is used for bend joints, as the elbow or heel.

Bandages for hand, wrist, forearm, elbow and Arm Hand bandage

With the pronated, (the palm held downwards) fix the bandage by a turning round the wrist and carry the roll obliquely over the back of the hand to the side of the little finger. Carry the bandage round the palm, encircling the finger with one horizontal turn, so that the lower boarder of the bandage, just touches the root of the nail of the little finger. Carry the bandage one more round the palm and then return obliquely to the wrist. The figure of eight turn round the wrist and hand are repeated until the hand is covered and the bandage is then finished with a spiral turn round the wrist.

Wrist, Forearm, and Upper arm Bandages

The wrist and forearm are bandaged by use of the simple and reverse spiral until the elbow is reached. The figure of eight turn can be so used, as the limb enlarges as an alternative to the reverse spiral turn, if preferred.

To Cover the elbow

Bend the elbow at right angles, lay the outer side of the bandage on the inner side of the joint and take one straight turn carrying the bandage over the elbow tip and round the limb of the elbow. The second turn is made to encircle forearm and the third arm. Each of these turns being made to cover the margins of the first turn. Continue the turns alternately, below and above the first turn, allowing each to cover a little more than two thirds of the previous turn, and finishing about the elbow.

The upper arm

The bandages, as is the forearm, by a succession of reverse spirals or figure of eight turns, and the bandages may be carried on from the forearm, or elbow or started independently, or most conveniently.

Finger bandages

With the hand pronated, fix the bandage by two circular turns a round the wrist leaving the end free from tying off. Afterwards, carry the bandage obliquely over the back of hand to the base of the finger to be bandaged. Taking the fingers is order, start from the little finger side.

Take on spiral turn to the base of the finger nail and then cover the finger by simple spiral turns. Then carry the bandage a cross the back of the hand to the wrist, and complete it with one straight turn round the wrist. Secure the bandage by a safety pin or by tying the two each of the bandage together. If more than one finger as to be bandaged, take a turn round the wrist between each two fingers and continue as above until the bandage is complete.

To cover the finger tip

Take the bandage straight up to the back of the finger and over the middle of the tip and down the front to the level of the second joint. Holding the turns

Back and front with the fingers of the other hand, make two more turns over the tip of the finger, one on either side of the first turn. Fix the loop with a straight circular turn as near to the tip as possible and then cover the finger by simple spiral turns as before. Being careful to make them from within outwards. Take a straight turn round the wrist and either finish off as before or continue the next finger.

Spica of thumb bandage

With the hand held, so that, the back of the thumb is upper most, take two turns round the wrist and carry the bandage over the back of the thumb. Encircle the thumb with one or two straight turns, so that, the lower border of the bandage is level with the root of the nail. Carry the bandage back. Over the back of the hand, round the wrist and repeat the figure of eight turns round thumb and wrist, until the wall of the thumb is completely covered. Complete the bandages with one straight turn, round the wrist.

Spica of shoulder bandage

Place a small pad of cotton wool in each axilla. Take 3-4 inch bandage and fix it with two spiral turns round the upper part of the arm. Take two or three reverse spiral turns round the upper arm until the bandages reaches the point of the shoulder. Then carry the bandage over the shoulder, across the back and under the opposite armpit. Bring it back across the chest and arm round under the armpit and over the shoulder again covering two thirds of the previous turn. This form a figure of eight round the arm and the body and the turns are repeated until the whole shoulder is covered. The bandage should be secured by a pin immediately over the injured shoulder.

Bandages for the foot, ankle and leg

If the patient is in bed, the heel should be elevated on a support, about 6 inches high. If he is up and about, he should be seated in a chair with the foot supported on a stool or another chair. To avoid stooping, the nurse may, if she prefers, sit opposite to the patient and take his foot on her knee.

Foot and ankle bandage

Take one or two turns round the ankle to fix the bandage and then take it on obliquely across the foot, the root of the little toe. Make one horizontal turn right round the foot at his level and then carry the bandage back over the foot and take a turn round the ankle just above the heel. Figure of eight turns are then repeated round the foot and ankle, each turn over lapping the preceding turn by two third of its width, until the whole foot is covered.

If the bandage is to be continued up the leg, the reverse spiral or figure of eight turns may be used as for the arm.

To cover the heel

The leg should be supported, so that, the heel projects well over the edge of the chair, stool or cushion on which it is placed.

The foot should be kept at right angles to the leg. Commence the bandage by a turn over the tip of the heel. The bandage is then carried round the foot just below the tip of the heel, so that, the margin of the bandage covering the tip of the heel is well covered. It is then brought over the ankle and taken round the leg, just above the tip of the heel, so that, the other margin of the bandage covering the heel tip is now also covered. The turns are repeated. Each turn being made just below and above the preceding one until the heel is well covered and the bandage so extends from halfway along the foot to well above the ankle.

Bandage for the knee

Flex the knee, lay the outer side of the bandage against the knee and take one straight turn over the knee cap. The bandage is thus brought round the knee, just below and the just above. Note that the margins of the bandage covering the kneecap are covered as in the elbow and heel bandages. The turns are repeated below and above the joint until the whole knee is covered and the bandage is then secured by one straight turn round the thigh.

Spica of hip bandage

Place the outside of the bandage on the inner side of the thigh about 6 inches below the groin. Carry the bandage horizontally round the limb and make three or four ascending reverse spiral turns round the thigh. Carry the bandages from within outwards over the front of the groin and up round the hip and back, passing over the prominence of the hip bone on the opposite side. Bring the bandage down, over the abdomen to the outer side of the thigh and repeat the figure of eight round the body and the thigh until the hip is covered. Spica of groin bandage

This is applied in the same way as the spica for the hip except that the bandage is started higher up. The reverse spiral and omitted and the crossings are made over the front of the groin instead of on the outer side of the front of the thigh.

Double spica of groin bandage

Lay the outer surface of the bandage over the right groin from without inwards and pass the bandage round the thigh, carrying it up over the front of the right groin to the left hip. Round the back and right hip and over the lower part of the abdomen to the outer side of the thigh. Pass the bandage under the thigh, up to the left groin round the back and right hip and down again to the inner side of the right hip and down to the inner side of the right thigh. These turns, which really from of double figure of eight, round the body and right thigh and round the body and left thigh, are repeated until both groins as covered each turn being slightly higher than the covering two thirds of the preceding one.

Head and other bandage Capeline bandage

The bandage is, sometimes, used when the whole scalp is to be covered. A double headed roller bandage is used. The patient should be seated and the nurse should sand behind the patient. Place a center of the outer surface of the bandage in the center of the forehead, the lower border of the bandage lying just above the eyebrows. The head of the bandage as brought

over the temples and above the years to the nape of te neck where the ends are crossed. The upper bandage being carried, round the head and other brought over the center of the top of the scalp to the root of the nose. The bandage which encircles head is now brought over the forehead, covering and fixing the bandage which could cross the scalp. This bandage is then brought back over the scalp. Slightly to one side of the center, thus covering one margin of the original turn. At the back, it is again crossed and fixed by the encircling bandage and is turn back over the scalp to the opposite side of the centerline, now covering the other margin of its original turn. These backward and forward turns are repeated to alternate side of the center, each one being, in turn, fixed by the encircling bandage until the whole scalp is covered. The bandages is completed by a circular turn round the head and pinned in the center of the forehead.

Ear bandage

Lay the outer surface of the bandage against forehead and carry the bandage round the head in one circular turn, bandaging away from the injured ear. Towards the sound side, carry the bandage round to the back of the head, low down in the nape of the neck again, repeat these.

Each turn being slightly higher than the previous one as it cover the dressing, but slightly over as it cover the hair. Continue until the whole is covered and complete the bandage by one straight turn around the forehead, pinning where all the turns cross one another some people prefer to take the bandage around the forehead between each turn covering the dressing, but this makes a heavy bulk around the head which is not really necessary.

Eye bandage

Lay the outer surface of the bandage against the forehead and take the circular turn round the head, bandaging away from the injured eye. Carry the bandage on, round side for the second time. Take it obliquely to the back of the head, under the prominence at the back of the skull and from there bring it upwards beneath the ear of the affected side, over the pad of the circular turn and continue.

Over the head to the starting point. Repeat this turn two or three times until the dressing is covered, finishing with a safety pin just above the good eye.

Many tail bandages

Many tail bandages are used for abdominal wound certain chest dressing and for any part where the use of a roller bandage would entail a great amount of movement and exertion for the patient. It consists of a number of strips or tails of cotton material, 4-6 inches wide and of sufficient length to encircle the part and overlap at least 8  inches . Each strip overlies the one above by two thirds of its width and the whole is secured in the center by a piece of the same material. All seams must be sewn so that, there are no hard ridges to hurt the patient. Bandages for the chest are sometimes provided with two tails, stitched to the top of the back piece and slanting slightly outwards, which pass over the shoulder and are pinned to the front the bandage when the other tails are folded over to keep the bandage from slipping down. Similarly, abdominal bandages are sometimes provided with two tails stitched to the bottom of back piece and are called groin straps which are passed between the legs and secured to the front of the bandage to prevent it from slipping up. Smaller many tail bandages may sometimes be used to keep a dressing on a limb.

The advantage of the many tail bandage are that, it is easily applied and adjusted and a wound can be inspected without any disturbance to the patient.

The disadvantages are that, if it is applied with little support, it tends to slip and become displaced and can easily be undone by the patient.

The application of abdominal many tail bandage

For the bandage to be comfortably and efficiently applied , two people are required , although in and emergency one can manage. The patient should be lying quite flat before any attempt is made to apply or adjust a many tail bandage. The bandage is prepared with the tails rolled into the center, from either end, the smooth portion of the back being uppermost and being placed next to the patient. The bandage is placed in the position, so that, the center band lies under the patients back. The bandage is applied from below upwards. One tail being brought across the body at a time and held in position by a tail from the opposite side. The last tail is brought obliquely downwards and secured with a safety pin.

T Bandage

'T' bandages consist of two strips o flannel, about 4 inches wide, stitches together in the form of a 'T'. The horizontal strip is made long enough to pass round the body and the vertical strip is passed up between the legs. It is then pinned to the horizontal strip to keep rectal of perineal dressing in position.

Plaster of paris bandages

Plaster bandages may be brought ready- made, such as , the 'Gypsona' tape bandage or may be prepared by rubbing dry plaster of paris into the meshes of strip of book muslin. Plaster of paris bandages are used.

            To make splints to immobilize  fractures

            To protect the wound or to immobilize a part to relieve a pain and promote healing.

            To make plaster beds and jackets.

The bandages are applied wet and as they dry, they form a hard support to the fracture site. It should be protected from bending or cracking until completely dry and set. A plaster tends to shrink as it dries and if it gets too tight, it may impede

circulation. A patient with a plaster applied to a limb should be instructed to report back to the hospital immediately if the extremely becomes blue, cold, or swollen.

Adhesive bandage

In certain circumstances, the doctor may order an adhesive bandage to be worn. These give fine support and may be used for protection and to promote healing in condition, such as, varicose ulcer. Examples of those are elastoplast and crepe bandages. These are supplied according to similar rules to those relating to roller bandages. But great care must be taken to see that the bandage lies smoothly against the skin and that , there are no folds or wrinkles in the bandage.

Tubular gauze bandage

This is a special form of tubular bandage, which can be applied with an applicator to any part of the body. It is ideal for small dressing on hands and limbs.

Bandage for the jaw

Take a narrow strip of material, about 4 feet long or a narrow fold triangular bandage and place the center of it, under the chin. Carry one end upwards over the top of the head and cross with the other end above the ear. Carry the shorter       end low  down across the  front of the forehead and the larger  end in to opposite direction round the back of the head and tie off close, above the other ear.