Pressure Dressing Indications for Wound Sites
Pressure dressings should be applied after bleeding has been controlled with direct manual pressure to maintain hemostasis and prevent rebleeding, particularly in surgical wounds, traumatic injuries, and high-risk surgical sites. 1
Primary Indications
Post-Hemorrhage Control
- Once active bleeding has been stopped with direct pressure, apply a pressure dressing to maintain bleeding cessation and prevent recurrence. 1, 2
- Pressure dressings are particularly effective after hemostatic dressings have achieved initial control, serving as the definitive maintenance therapy. 1, 2
Surgical Wound Management
- Apply pressure dressings on surgical wounds to reduce blood loss, minimize wound ooze, and decrease infection risk. 3
- Pressure dressings may reduce postoperative complications including hematoma formation and persistent wound drainage. 3
High-Risk Surgical Sites
- Consider negative-pressure wound therapy (a specialized form of pressure dressing) for patients at high risk of surgical site infection (SSI), as it reduces SSI rates by 58% overall. 1
- In randomized studies, closed-incision negative-pressure therapy reduced SSI from 9.7% to 4.8% (51% reduction). 1
- This is particularly beneficial in orthopedic surgery, abdominal surgery, and other contaminated or high-risk procedures. 1
Specific Clinical Scenarios
Traumatic Wounds
- After achieving hemostasis in trauma situations, pressure dressings prevent rebleeding during transport or while awaiting definitive care. 1, 4
- Mechanical pressure devices or pressure bandages may be considered when continuous direct manual pressure is not feasible. 1
Post-Operative Colorectal Surgery
- Negative-pressure dressings applied prophylactically to closed colorectal incisions reduce wound complications and SSI. 5
- These can be maintained for 72 hours post-operatively with high patient comfort and compliance. 5
Extremity Lacerations with Controlled Bleeding
- Once bleeding from extremity lacerations is controlled, wrap an elastic bandage firmly over gauze to maintain pressure if continuous manual pressure cannot be sustained. 4
Application Technique
Standard Pressure Dressing
- Apply gauze directly to the wound site after bleeding control. 1, 4
- Wrap elastic bandage firmly (but not so tight as to compromise circulation) to maintain consistent pressure. 4, 3
- The mechanical rationale requires adequate compression to exceed capillary pressure without occluding arterial flow. 3
Hemostatic Dressing Integration
- If hemostatic dressings were used for initial control, leave them in place and apply pressure dressing over top. 1, 2
- This combination approach achieves hemostasis in up to 90% of cases. 1, 2
Important Contraindications and Caveats
When NOT to Use Pressure Dressings
- Do not apply occlusive or pressure dressings to open chest wounds, as this can cause fatal tension pneumothorax. 1
- Avoid occlusive dressings if signs of infection are present, as they may promote bacterial growth. 2
- Do not use negative-pressure therapy on wounds with residual necrotic tissue or uncontrolled infection until complete surgical debridement is performed. 6
Monitoring Requirements
- Monitor the site frequently during the first 24 hours for signs of continued bleeding or complications. 2
- Ensure the dressing does not compromise distal circulation or cause excessive pain. 3
- For stoma sites, ensure the pressure dressing does not interfere with proper function. 2