Friday, 22 October 2010

PRESSURE DRESSING APPLICATION

For effective control of capillary or small-vein bleeding, temporary application of pressure directly over a wound may be achieved with a bulk dressing held by a glove-protected hand, bound into place with a pressure bandage, or held under pressure by an inflated air splint. A pressure dressing requires frequent checks for wound drainage to determine its effectiveness in controlling bleeding.
Pressure dressing may be prescribed for patients with fluid volume deficit, impaired skin integrity, impaired tissue integrity, or altered tissue perfusion.
Equipment
Two or more sterile gauze pads • roller gauze • adhesive tape • clean disposable gloves • metric ruler.
P.187

Preparation of equipment
Obtain the pressure dressing quickly to avoid excessive blood loss. Use clean cloth for the dressing if sterile gauze pads are unavailable.
Implementation
  • Quickly explain the procedure to the patient to help decrease his anxiety, and put on gloves.
  • Elevate the injured body part to help reduce bleeding.
  • Place enough gauze pads over the wound to cover it. Don't clean the wound until the bleeding stops.
  • For an extremity or a trunk wound, hold the dressing firmly over the wound and wrap the roller gauze tightly across it and around the body part to provide pressure on the wound. Secure the bandage with adhesive tape.
  • To apply a dressing to the neck, the shoulder, or another location that can't be tightly wrapped, don't use roller gauze. Instead, apply tape directly over the dressings to provide the necessary pressure at the wound site.
  • Check pulse, temperature, and skin condition distal to the wound site because excessive pressure can obstruct normal circulation.
  • Check the dressing frequently to monitor wound drainage. Use the metric standard of measurement to determine the amount of drainage, and document these serial measurements for later reference. Don't circle a potentially wet dressing with ink because this provides no permanent documentation in the medical record and also runs the risk of contaminating the dressing.
  • If the dressing becomes saturated, don't remove it because this will interfere with the pressure. Instead, apply an additional dressing over the saturated one and continue to monitor and record drainage.
  • Obtain additional medical care as soon as possible.
Special considerations
  • Apply pressure directly to the wound with your gloved hand if sterile gauze pads and clean cloth are unavailable.
  • Avoid using an elastic bandage to bind the dressing because it can't be wrapped tightly enough to create pressure on the wound site.
Complications
A pressure dressing that is applied too tightly can impair circulation.
Documentation
When the bleeding is controlled, record the date and time of dressing application, presence or absence of distal pulses, integrity of distal skin, amount of wound drainage, and complications.