What is the proper technique for bandaging a wound?

Proper Technique for Bandaging a Wound

The proper technique for bandaging a wound involves thorough wound cleaning with warm water or saline, applying a non-adherent contact layer directly to the wound, securing it with a secondary absorbent layer, and then wrapping with a bandage while avoiding excessive pressure. 1

Initial Wound Assessment and Preparation

• Clean the wound thoroughly with warm tap water or sterile saline (100-1000 mL) to effectively remove bacterial contamination 1
• Warming the cleaning solution can help reduce pain during the cleaning process 2
• Debride any necrotic tissue if present during wound cleaning 1
• Handle the skin carefully to minimize epidermal detachment 1

Bandaging Materials and Layers

A proper bandage consists of three essential layers:

1. Primary Layer (Contact Layer):

   • Use a thin non-adherent contact layer directly on the wound surface (e.g., Mepitel™ or Telfa™) 1
   • This prevents the bandage from sticking to the wound and damaging new tissue during removal 2
   • For small neonatal bony prominences, a thin non-adherent contact layer is especially important 2

2. Secondary Layer (Absorbent Layer):

   • Apply a thin foam secondary layer (e.g., Mepilex Lite) to absorb exudate 2
   • Choose appropriate material based on wound characteristics:
     • For dry wounds: saline-moistened gauze or hydrogels
     • For exudative wounds: alginates or foams to absorb excess fluid 1

3. Tertiary Layer (Securing Layer):

   • Secure with a small gauze bandage or tubular bandage 2
   • Avoid using adhesive tape directly on skin to prevent further trauma 1
   • Use tubular bandages (e.g., Tubifast) or gauze bandages rather than tape 2

Bandaging Technique

1. Application:

   • Dress wounds one limb at a time to reduce movement and potential new trauma 2
   • Apply a small amount of antibiotic ointment before bandaging if appropriate 3
   • For adults and children over 2 years: apply a small amount of antibiotic product (equal to the surface area of fingertip) 1-3 times daily 3

2. Securing the Bandage:

   • Ensure the bandage is secure but not too tight
   • Allow free movement of at least 5mm to prevent pressure-related lesions 2
   • For circular bandages, monitor distal perfusion to ensure circulation isn't compromised 2

3. Special Considerations:

   • When bandaging limbs, be careful to avoid creating a tourniquet effect 2
   • Use Y-compress under external fixation plates to avoid formation of moist cavities 2
   • Ensure incisions at puncture sites are sufficiently large (8mm) to prevent pressure-related skin lesions 2

Bandage Care and Maintenance

• Change dressings daily for fresh wounds until granulation occurs (usually days 1-7) 2

• After initial wound healing, change dressings every 2-3 days 2

• During dressing changes:

  • Remove old dressing
  • Inspect the wound (check for bleeding, erythema, secretion, etc.)
  • Clean, disinfect, and completely dry the area
  • Apply new dressing 2

• After feed administration or medication, flush tubes with approximately 40ml of drinking water 2

• After initial wound healing (1-2 weeks), washing with soap and water or showering is possible, but always remove dressings before washing 2

Monitoring for Complications

• Monitor for signs of infection: increased redness, swelling, warmth, drainage, pain, or fever 1
• The most common complication is local wound infection (approximately 15% of cases) 2
• Less than 5mm of reddening around the outer stoma canal is frequent and not necessarily a sign of infection 2
• For persistent local infections, take a swab for microbiological examination and consider antibiotic treatment 2

By following these guidelines, you can properly bandage wounds to promote healing while minimizing the risk of infection and other complications.