BANDAGING

1. BANDAGING
DEFINITION:
□ 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.

2. □ 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.

3. 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.

4. □ PARTS TRIANGULARLAR OF
BANDAGE
POINT
END (BASE) END

5. 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)
Head 5 4 to 6
Trunk 10 to 15 6 to 8
Leg 6 to 8 4
Arm 5 to 6 3 to 4
Fingers 2.5 2
Hand 5 3
Wrist 5 3

6. 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.

7. □ 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.

8. □ 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.

9. □
□
□
□
□
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.

10. FOLLOWING TERMS ARE USED IN
ROLLER BANDAGING.
□ Simple spiral
□ Reverse spiral
□ Figure of eight.
□ Spica
1. 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.

11. 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.

12. 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.

13. STEPS OF APPLYING ROLLAR BANDAGE:
□ FIXING
□ ROLLING
□ SECURING
CHECKING CIRCULATION AFTER
BANDAGING
□ PRESSING NAIL
□ CHECKING PULSE
□ TINGLING,COLDNESS,INABILITY TO MOVE
FINGERS

14. 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

15. 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 sling
2. Elevation sling
3. Improvised sling

16. □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 willbe 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.

17. □ 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.

18. 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.

19. Support of forearm
1: Arm sling

20. Forming sling

21. □ 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.

22. 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.

23. □A). Collar and Cuff Sling:-

24. □ 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.

26. □ 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.

27. Improvised sling

28. Improvised sling

29. 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.

30. 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.

31. 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.

32. Metal oval ring
2 inch angulation at outer bar
Side bars
Distal -W

33. □ 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.

34. □ 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 patient
4. In the treatment of joint diseases like TB
knee, septic arthritis etc.

35. 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.

37. 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.

38. □ Problems of BB Splint:-
1. Makes nursing care difficult
2. It is a heavy and cumbersome
frame.
3. It is associated with recumbent
problems like bedsores
,hypostatic pneumonia, renal
calculi, etc.

39. 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.

41. □ 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.

42. 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.

43. □ 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.

44. □ Note: Maximum permissible weight limits:--
a. Skin traction-4-5 kg
b. 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.

45. □ 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.

46. □ 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