Applying bandages: tips and tricks for technicians
KITCHENER, ON – Bandages are used routinely in veterinary practice for a variety of reasons, including limiting hemorrhage, immobilizing an area, and protecting a limb. They are also used to treat open wounds by preventing contamination or desiccation, absorbing exudate, and aiding in mechanical debridement of the wound, explained Anne Sylvestre, BSc, DVM, DVSc, CCRP, Diplomate ACVS/ECVS, speaking at a Golden Triangle Veterinary Association seminar.
Bandage layers
Dr. Sylvestre explained that the primary or contact layer is the topical agent and/or material used to cover a wound or incision. The Telfa pad is an example of a primary contact layer.
The secondary/middle or padding layer is typically composed of cast/cotton padding which functions, in the case of a wound, as an absorptive layer, and as a restrictive or immobilizing layer in an unstable limb. If applied properly, it will help resolve swelling. Contraindications for greater padding are weight and comfort for the patient and the cost of materials. The padding should be placed immediately after the contact layer or immediately on the skin if there is no primary layer needed.
The tertiary/outer or kling layer provides the bandage with shape and structure, and offers some protection against wetness and soiling. Dr. Sylvestre noted that the most common error that she sees when removing a referral patient’s bandage is that the kling has been applied directly on the skin, followed by the cast padding. This type of structure, where the tertiary layer is applied before the secondary, compresses the tissues indirectly, causing the kling to ‘bunch up’ in places and be uncomfortable. If the kling is applied tightly, it can act as a pressure bandage.
Applying the bandage
The key to success when applying a bandage is to start at the toes, use even pressure, overlap each turn of the bandage by about half, and avoid creating wrinkles because they can cause the patient discomfort. The rule of thumb is to only have the two middle toes protruding from the bandage to allow for assessment of swelling and evaporation of sweat, and a decreased potential for interdigital infections. The only time the paw (including digits 3 & 4) is enclosed is if the problem is located within the distal aspect of the paw itself, otherwise the digit will swell significantly and the bandage will need to be re-applied.
Stirrups are usedto prevent a bulky bandage from covering the two exposed toes, and are supposed to be used with bandages and well-padded splints. Dr. Sylvestre stressed that stirrups are not intended to replace good bandage application.
The skin over bony prominences on the paws can be protected with the use of donuts, which can be created using kling or stockinette made to fit around the protuberance and prevent the bandage material from rubbing against it.
Bandage care
Educating the owner about bandage care and follow-up care is critical. Bandages should be assessed and changed at least weekly, or more often if the bandage gets wet, foul smelling, the pet starts to chew at the bandage, or the pet’s lameness worsens. It may be worthwhile for the owner to purchase dog boots to protect the bandage.
Make sure to….
- Avoid wrapping a bandage too tightly or too loosely, as it will either be uncomfortable to the patient and possibly cause swelling in the toes, or will be ineffective and will need to be reapplied
- Avoid applying bandages over bony prominences because the rubbing can cause decubital ulcers. Bandage donuts are the best solution in combination with diligent bandage application, care, and wound management
- Select the appropriate bandage. For example, a Spica bandage or splint is recommended for the upper portion of the forelimb (elbow and humerus)
- Ensure that the layers are applied in the proper order
- Avoid using bandaging that is too heavy, constricting the patient’s mobility and causing discomfort
- Educate clients so they are active participants in their pet’s bandage care
Types of bandages
The soft padded is the most widely used bandage. It can be combined with a splint to help immobilize the limb.
The splinted bandage is a soft padded bandage with extra support or form added to the tertiary layer (e.g. kling) to give the bandage form and structure. Using a splint over the bandage helps to prevent the cast padding from bunching up, causing discomfort. Preformed splints (metasplints, spoon splints) are commercially available, as well as “do-it-yourself” malleable fibreglass rolls or strips (Delta-Lite, Dynacast). Dr. Sylvestre said that a tongue depressor or two usually work well for cats and small dogs. Her preference is to allow the toes to support weight when the animal is weight bearing, unless there is a fracture/luxation within the manus. She stressed the importance of ensuring that the splint maintains the normal joint positions.
The “cross-your-heart” bandage wraps in front of the shoulders and crosses over at the level of the manubrium, producing a comfortable bandage that will not slip or rotate.
The Spica bandage/splint combines a cross-your-heart bandage with a forelimb soft-padded bandage. It starts at the toes, with the cast padding to above the elbow and then around the chest. It should cross in front of the contralateral shoulder and fully incorporate the ipsilateral shoulder. The pattern should be repeated with the kling and then the vetwrap. If additional support is needed, a splint can be created using fibreglass material or an aluminum rod.
The Velpeau bandage is similar to the Spica splint, but the antebrachium is tucked into the bandage close to the chest. This makes the bandage non-weight bearing, and so there is no need for a splint. This bandage is typically used for scapula fractures.
The carpal flexion bandage prevents the animal from weight bearing on the limb by placing the carpus and holding it in flexion with tape. Dr. Sylvestre recommended using a non-elastic sticky tape so that the bandage remains in place.
The Robert-Jones bandage is used for temporary fracture immobilization, and to help decrease swelling in a limb. With a large quantity of cotton padding around the limb, the kling must be applied very tightly to give the bandage its shape and holding power. Dr. Sylvestre noted that this type of bandage can only be applied to fractures distal to the elbow and stifle joints.
The Robinson bandage/sling is applied to the hind limb to prevent weight bearing on the limb. It is best applied by using sticky, non-elastic tape. It is most commonly indicated for procedures or conditions involving the hind limb that are not readily managed with a splint or soft padded bandage (i.e. proximal tibia, femur, and hip joint).
The Ehmer sling is very helpful in increasing the success rate of a closed hip reduction. Dr. Sylvestre said that since it is not commonly used, she consults her textbook first. She added that she finds white tape (sticky and non-elastic) applied directly to the skin increases the success rate, though she admitted her lack of success in applying this type of sling to a cat!
Tie-over bandages are commonly used for wounds on the caudal or lateral aspect of the thigh or the hip area, but they can be uncomfortable to the patient. Large stay sutures are placed in the skin surrounding the wound and the primary bandage layer laced over the wound, using the stay sutures and anchor points for the ‘lacing’. Relatively large suture material (size ‘0’) should be used, and plenty of stay sutures placed to help distribute the tension. Dr. Sylvestre recommended taking time to evenly distribute the tension among each stay suture, avoiding making the tie over tight and using excessive primary padding, as this will add weight to the bandage.CVT