Bandages and Binders – Principles,
Responsibility, Apply
Simple Nursing Procedure
Binders and Bandages are applied over or around the dressings to provide extra protection and therapeutic benefits by:
1. Creating pressure over the body part
2. Immobilizing the body part
3. Supporting the wound
4. Reducing or preventing edema
5. Securing a splint
6. Securing dressings
Bandages are made up of different materials such as gauze, elasticized knit, elastic webbing flannel, muslin, calico, crepe etc. gauze bandages are lightweight and inexpensive, mold easily around the contours of the body and permit air circulation to body parts but can also be used to exert pressure over a body part. Flannel and muslin bandages are thicker than gauze and thus stronger for supporting or applying pressure. A flannel bandage is also insulating to provide warmth.
Binders are bandages that are made of large pieces of material to fit a specific body part. Most binder is made up of elastic, cotton, muslin or flannel. According to the size and shape of the bandages they are classified as – roller bandages, many tailed bandage, T- bandages, tubular gauzes etc.
Principles for Applying Bandages and Binders
Correctly applied bandages and binders do not cause injury to underlying and nearby body parts or create discomfort to the client. Before a bandage or a binder is applied the nurse’s responsibilities:
Nurse’s Responsibility
1. Inspection of the skin for abrasions, edema, discoloration, or exposed wound edges.
2. Exposed wounds or open abrasions should be covered with a sterile dressing.
3. Inspect the underlying dressing and if soiled it must be changed.
4. Skin integrity of the underlying body parts and the parts that are distal to the bandages are assessed for signs of circulatory impairment (e.g. pallor or cyanosis, decreased or absent pulse, swelling, coolness, numbness and tingling).
Applying Bandage and Binders
The important principles to be considered in applying bandages and binders are:
Choose a neatly rolled bandage of correct width and length.
Finger – 1 inch
Head and arm – 2 to 2 and half inch
Leg – 3 to 3 and half inch
Trunk – 4 to 6 inches
To Roll the Bandage:
1. Fold one end of the bandage upon itself again and again until a small stiff roll is formed, firm enough to grasp between the thumb and the finger without bending. It this roll is not tight, it will be impossible to make a well rolled bandage. This roll is held between the thumb and the index finger of the left hand and the free end is held tightly between the index finger and the middle finger of the right hand. The cylinder is revolved by the left hand, while the right hand holds the free end firmly and acts as a guide to keep the bandage even.
2 . Clean and dry the part that is to be bandaged.
3. Except while arresting haemorrhage or correcting deformity, foremost consideration is given for the comfort of the patient.
4. Face the patient except when applying a capeline bandage.
5. See that the patient is placed in a comfortable position with the part properly supported.
6. Prevent friction between and against skin surfaces by applying gauze or cotton padding. Skin surfaces in contact with each other (e.g., between toes, under breasts, in the axilla, groin) can rub against each other to cause abrasion. Bandages over prominences may rub against skin to cause breakdown.
7. Position the body part to be bandaged in comfortable position of normal anatomical alignment. Because bandages cause restriction to movement, immobilization in normal functional position reduces risk of deformity or injury, e.g., elbow bent at right angles when applying the elbow bandage.
8. Hold the head of the bandage in right hand, when bandaging the left limb and vice versa.
9. When bandaging extremities apply bandage first at distal end and progress towards trunk. Gradual application of pressure from distal toward proximal portion of extremity promotes venous return and minimizes risk of oedema or circulatory impairment.
10. Apply the outer side of the free end to the part to be bandaged and fix it in a position by circular turn.
11. Bandage from below upwards, from within outwards, over the front of the limb.
12. Apply bandage securely to prevent slippage during movement.
13. Apply bandage firmly with equal tension exerted over each turn or layer. Avoid excess overlapping of bandage layers. It should neither too tight nor too loose. Apply each turn of the bandage in such a way that it covers two thirds of the preceding one. The margin should be kept parallel. The pattern is made on the outer part of the limb. Application of even pressure prevents unequal pressure distribution over bandaged body part. Localized pressure can cause circulatory impairment.
14. Never roll or unroll a bandage and drag it around the limb. It causes discomfort to the patient. Never unwind more bandage than it is absolutely necessary.
15. Leave the fingers and toes uncovered, so that circulation can be observed. If they become pale, cold, blue or numb, it is an indication that the bandage is too tight and is cutting off the blood supply. Untie the bandage and apply it again.
16. When applying a bandage over a wet dressing, no tension is applied as it will shrink and become tight.
17. Never ignore any complaints of pain or discomfort experienced by the patient. This should be investigated and the cause is removed immediately.
18. When completed, fix the bandage with a circular turn and secure it with a safety pin or other suitable material such as adhesive strapping.
19. Do not use extra turns in order to use all the bandages. Neatness and economy of the bandage should be considered but the bandage should fulfill its purpose and always must cover the dressing completely.
20. Wrinkled bandages are uncomfortable.
21. Pin, knots or ties are placed away from the wound or tender skin areas because these materials can exert localized pressure and irritation.
Triangular Bandages
Triangular bandages are used mainly as sling to support the limbs. They may also used to cover dressings over a large area.
Tailed Bandages
Many tailed bandages (scultetus) are a rectangular piece of strong cloth with many tails attached to either sides of it. It is commonly used as abdominal binder for the support of the abdominal musculature to prevent wound dehiscence and evisceration following abdominal surgery, and to keep dressings in place. In order to apply a many tailed binder, place the patient in a supine position, lying on the centre of the binder, with the tails equally extended to either sides. Powder may be applied to the skin surface to decrease friction. Starting at the bottom of the binder, bring each tail at a slightly upward angle, crossing at the midline. Anchor the end of each tail with your hand until it is secured by the opposite tail. If the tails are too long, they should be folded. The upper tails are overlapped along a straight line and pinned in place.
Many tailed bandages are applied after paracentesis and child births in order to maintain the intra-abdominal pressure and to prevent shock and collapse. In such cases, the bandage is applied from above downwards. The potential dangers of an abdominal binder are respiratory difficulty and hypotension due to compression of the vena cava.
‘T’ Binder
‘T’ binder is used to secure rectal or perineal dressings. The double ‘T’ binder is used for the males and the single for the females. The single or double ‘T’ straps are brought between the patient’s legs and are pinned to the waist band in front.
Tubular Gauze
Tubular gauze is a bandage in the shape of a tube, designed to cover cylindrical parts of the body and to secure dressings.
Elastic Bandage
An elastic bandage is a roller bandage used to provide support, to minimize swelling in joints following musculo-skeletal trauma and to enhance venous return to the heart. The elastic bandages are applied with even tension and pressure. They should be untied and re-applied daily. Elastic bandages applied too tightly can cause arterial occlusion which may result in gangrene.
After a bandage is applied, it must be assessed and documented. Any changes in circulation, integrity of the skin, comfort, changes in body function e.g., movement etc. must be assessed and reported and recorded.