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CHAPTER 32 Skin Integrity & Wound Healing
Procedure Steps Observe the following steps, regardless of the type of bandage you use: 1. Choose a bandage of the proper width. For example, use a 2.5-cm (1-in.) wide bandage for a finger, a 5-cm (2-in.) wide bandage for an arm, and a wider bandage for a leg. Prevents pressure and abrasion of the skin. 2. Thoroughly clean and dry the part to be covered. Use a nontoxic cleansing solution, such as normal saline. Cleaning the wound removes debris, exu- dates, and bacteria. Drainage and mois- ture on the skin contribute to irritation. 3. Remove excess moisture by gen- tly patting the wound and surround- ing skin with gauze sponge. Drainage and moisture contribute to skin breakdown. 4. Stand facing the patient. In this position you can wrap the bandage evenly in the proper direction. 5. Bandage the body part in a com- fortable position (e.g., with the joint slightly flexed) whenever possible. This prevents strain on ligaments and muscles. Movement of the extremity (extension) may cause skin damage if the bandage is too tight, or the extremity is not properly positioned. 6. Always work from distal to proxi- mal (or peripheral to central). This improves venous return and helps to prevent edema. 7. If a wound is present, apply a pri- mary dressing, as prescribed, over the wound. A primary dressing is any dressing that is placed first in the wound bed. It provides exudate absorption, holds medications in place, provides antimicrobial coverage, or maintains a moist wound bed. 8. Apply the bandage with enough pressure to provide the needed sup- port, but do not bandage too tightly. Make sure circulation to the area is not compromised.
Spiral Turns Spiral turns are a variation of the circu- lar turn technique. Spiral turns are often used to wrap an extremity. 16.Anchor the bandage by making two circular turns—the second wrap completely covering the first one. 17. Continue to wrap the extremity by encircling the body part with each turn angled at approximately 30° so that you are overlapping the preceding wrap by two-thirds of the width of the bandage. 18.Complete the wrap by making two circular turns and securing the bandage with tape or metal clips. Spiral Reverse Turns Spiral reverse turns are used to bandage cylindrical body parts that are not uni- form in size. 19. Anchor the bandage by making two circular turns. 20.Bring the next wrap up at a 30° angle. 21.Place the thumb of your non- dominant hand on the wrap to hold the bandage.
9. If possible, leave the fingers (if you are bandaging an arm) or toes (if you are bandaging a leg or foot) exposed so that you can assess the circulation to the extremity. Begin the wrap along the pad of the foot or hand, just under the first bend of the toes or fingers (metatarsal or metacarpal joints). 10. Begin the wrap with the bandage against the skin.Unwind the bandage as if rolling it over the extremity. This helps to keep the bandage snug against the skin. 11.Pad bony prominences before bandaging if there are pressure concerns. 12. Change bandages whenever they become soiled or wet from external sources (stool, urine, etc.) and inter- nal sources (drainage that has wicked on the outer surface of the bandage). Wound drainage contains chemicals, enzymes, and bacteria that can damage fragile healing tissues. 13. After bandaging, assess circula- tion and comfort regularly. Proceed to step 14, 16, 19, 25, or 28, depending on the type of bandaging you are using. Circular Turns Use this technique to wrap a finger or toe, or as an anchor at the beginning and end of another wrapping technique. 14. With one hand, hold one end of the bandage in place. With the other hand, encircle the body part two times with the bandage—the second wrap should partially cover the first wrap. Continue to wrap the body part by overlapping two- thirds of the width of the bandage. 15. Secure the bandage with tape or metal clips when you are finished if circular turns are not being com- bined with another technique.
22. Fold the bandage back on itself and continue to wrap at a 30° angle in the opposite direction. Circular turns
Bandage folds over to make spiral reverse turn
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