Sunday, 17 October 2010

ELASTIC BANDAGE APPLICATION

Elastic bandages exert gentle, even pressure on a body part. By supporting blood vessels, these rolled bandages promote venous return and prevent pooling of blood in the legs. They're typically used in place of antiembolism stockings to prevent thrombophlebitis and pulmonary embolism in postoperative or bedridden patients who can't stimulate venous return by muscle activity.
Elastic bandages also minimize joint swelling after trauma to the musculoskeletal system. Used with a splint, they immobilize a fracture during healing. They can provide hemostatic pressure and anchor dressings over a fresh wound or after surgical procedures, such as vein stripping.
Equipment
Elastic bandage of appropriate width • tape or pins • gauze pads or absorbent cotton. Bandages usually come in 2″ to 6″ widths and 4′ and 6′ (1.2- and 1.8-m) lengths. The 3″ width is adaptable to most applications. An elastic bandage with self-closures is also available.
Preparation of equipment
Select a bandage that wraps the affected body part completely but isn't excessively long. In most cases, use a narrower bandage for wrapping the foot, lower leg, hand, or arm and a wider bandage for the thigh or trunk. The bandage should be clean and rolled before application.
Implementation
  • Check the physician's order, and examine the area to be wrapped for lesions or skin breakdown. If these conditions are present, consult the physician before applying the elastic bandage.
  • Explain the procedure to the patient, provide privacy, and wash your hands thoroughly. Position him comfortably, with the body part to be bandaged in normal functioning position to promote circulation and prevent deformity and discomfort.
  • Avoid applying a bandage to a dependent extremity. If you're wrapping an extremity, elevate it for 15 to 30 minutes before application to facilitate venous return.
  • Apply the bandage so that two skin surfaces don't remain in contact when wrapped. Place gauze or absorbent cotton as needed between skin surfaces, such as between toes and fingers and under breasts and arms, to prevent skin irritation.
  • Hold the bandage with the roll facing upward in one hand and the free end of the bandage in the other hand. Hold the bandage roll close to the part being bandaged to ensure even tension and pressure.
  • Unroll the bandage as you wrap the body part in a spiral or spiral-reverse method. Never unroll the entire bandage before wrapping because this could produce uneven pressure, which interferes with blood circulation and cell perfusion.
  • Overlap each layer of bandage by one-half to two-thirds the width of the strip. (See Bandaging techniques.)
  • Wrap firmly but not too tightly. As you wrap, ask the patient to tell you if the bandage feels comfortable. If he complains of tingling, itching, numbness, or pain, loosen the bandage.
  • When wrapping an extremity, anchor the bandage initially by circling the body part twice. To prevent the bandage from slipping out of place on the foot, wrap it in a figure eight around the foot, the ankle, and then the foot again before continuing. The same technique works on any joint, such as the knee, wrist, or elbow. Include the heel when wrapping the foot, but never wrap the toes (or fingers) unless absolutely necessary because the distal extremities are used to detect impaired circulation.
  • When you're finished wrapping, secure the end of the bandage with tape, pins, or self-closures, being careful not to scratch or pinch the patient. Avoid using metal clips because they typically come loose when the patient moves and may get lost in the bed linens and injure him.
  • Check distal circulation after the bandage is in place because the elastic may tighten as you wrap.
  • Elevate a wrapped extremity for 15 to 30 minutes to facilitate venous return.
  • Check distal circulation once or twice every 8 hours because an elastic bandage that is too tight may result in neurovascular damage. Lift the distal end of the bandage and assess the skin underneath for color, temperature, and integrity.
  • Remove the bandage every 8 hours or whenever it's loose and wrinkled. Roll it up as you unwrap to ready it for reuse. Observe the area and provide skin care before rewrapping the bandage.
  • Change the bandage at least once daily. Bathe the skin, dry it thoroughly, and observe for irritation and breakdown before applying a fresh bandage.

Special considerations
  • Wrap an elastic bandage from the distal area to the proximal area to promote venous return. Avoid leaving gaps in bandage layers or exposed skin surfaces because this may result in uneven pressure on the body part.
  • Observe the patient for an allergic reaction because some patients can't tolerate the sizing in a new bandage. Laundering it reduces this risk.
  • Launder the bandage daily or whenever it becomes limp; laundering restores its elasticity. Always keep two bandages handy so one can be applied while the other bandage is being laundered.
  • When using an elastic bandage after a surgical procedure on an extremity (such as vein stripping) or with a splint to immobilize a fracture, remove it only as ordered rather than every 8 hours.
Home care
If the patient will be using an elastic bandage at home, teach him or a family member how to apply it correctly and how to assess for restricted circulation. Tell him to keep two bandages available so he'll have one while the other is being laundered.
Complications
Arterial obstruction—characterized by a decreased or an absent distal pulse, blanching or bluish discoloration of skin, dusky nail beds, numbness and tingling or pain and cramping, and cold skin—can result from elastic bandage application. Edema can occur from obstruction of venous return. Less serious complications include allergic reaction and skin irritation.
Documentation
Record the date and time of bandage application and removal; the application site, bandage size, skin condition before application, skin care provided after removal, and complications; the patient's tolerance of the treatment; and any patient teaching.