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Bandages, casts, slings, and splints

Clinical Textbook for Veterinary Technicians 7th ed
by McCurnin and Bassert, pgs. 1239-1243, 1249-1264

Objectives: understand the role bandages play in healing, recognize signs of complications that can occur with bandages/casts, be able to critique a proper bandage fit, be able to instruct clients on bandage care, know the 3 layers of a typical bandage, know the constructions and purpose of various types of bandages (limb, trunk, ear, tail, paw, hip, and Robert-Jones), be familiar with splints, slings, and casts, understand cast removal technique

Bandaging is both an art and a science. Like other clinical techniques in veterinary medicine it is important to know and understand the "science" (what materials to use, when, why and how). But, applying effective and acceptable appearing bandages is truly an art! It takes lots of practice to develop bandaging skills and just when you think you have it mastered that "special" patient comes along that gets out of every bandage.

I) Bandages
A) Bandages promote healing by:
   1) protecting the wound from contamination and drying
   2) decreasing the possibility of self trauma
   3) decreasing swelling and edema
   4) decreasing seroma or hematoma formation

B) Signs of improper bandage fit and/or problems include:
   1) swelling above or below bandage
   2) redness or discoloration of skin near bandage
   3) odor
   4) moisture
   5) excessive chewing or licking
   6) cool extremity

C) The following should be avoided when applying bandages:
   1) Creating pressure rings: the tourniquet effect can cause serious tissue       damage distal to the pressure ring
      
a) by using bandage material that is too narrow
       b) by using uneven pressure when applying bandages
   2) Increasing bandage pressure over joints and bony protuberances,            which can lead to necrosis of tissue at these pressure points
   3) Creating ridges or lumps in bandage which can lead to necrosis of           tissue below the ridges.
   4) Using non-porous materials which do not allow oxygen to the wound          or exudates to escape.
   5) Using non absorbent bandage materials that do not wick away                exudates from the wound site.

D) Client education and compliance is essential for successful treatment:
   1) Clients judge the treatment by the appearance of the bandage and how         well it stays in place (not the unseen tedious work of applying the inner        layers).
   2) Clients should be told the importance of noting the condition of the          bandage at least twice a day.
   3) Signs of improper fit and problems (from B above) should be explained         to clients
   4) Clients should be told how to protect bandage from moisture and dirt        when exercising patient.

E) Types of bandages
   1) The three-layered bandage with stirrups (see diagram for description of    application in text):
      a) most common bandage type used for wounds on extremities and          trunk
      b) slight variations in technique and materials common
      c) the wound must be prepared (clipped, debrided, cleaned etc.) before           bandage applied
      d) adhesive tape strips are placed (extremities only) on each side
          wound. The tape length is estimated at twice the length of the finished
          bandage.

      d) primary or contact layer is next to skin or wound and includes various           types of dressing materials (wet/dry)
      e) secondary layer is supportive and can be padded and absorptive
       f) third or outer layer is protective and holds previous layers in place
      g) stirrups decrease bandage slippage and "lock" bandage in place

Legend has it that a veterinary technician working at the Bergh Animal Hospital in Boston "invented" stirrups.

   2) Robert Jones bandage and modified Robert Jones: (pages 107-109)
      a) used as immobilizing and stabilizing device
      b) pre or post surgery
      c) in some cases can be used in the same manner as a cast
  
  
3) Specialized bandages and explanation of application:

a) Trunk bandage: When might this bandage be used?

1) STERILE DRESSING OVER WOUND
2) GAUZE (REGULAR OR ELASTIC)
3) ADHESIVE TAPE/Gauze - attach to fur/skin front and back
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b) Stockinet: What could this be used for?


1) GAUZE DRESSING
2) STOCKINet
3) ELASTIC ADHESIVE TAPE
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c) Ear - hematoma (post-surgical) for long and upright ears

ERECT EAR BANDAGE
1) Make cone (ear shaped) from cotton.
2) Place inside ear
3) Anchor with several short pieces of elastic tape placed around the ear.
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PENDULOUS EAR.
1) Ear dressing, ear lifted over head.
2) Gauze or elastic gauze wrapped over ear and behind opposite ear to anchor.
3) Continue below jaw, bring wrap over ear again & in front of opposite ear this time. Repeat 2-4 more wraps until ear secure.
4) Apply finishing tape to secure.
* Check for tightness
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d) Tail bandages -keeping bandages on the tail is very difficult. Here are 2 different styles of bandages that you might want to try.
The many tailed Bandage

"Many tailed bandage"
1) Lightly dress tail tip
2) Make two X bandages (cut slits in regular one inch bandage) twice the length of tail (or shaved area). Bandages should be -1/2 the circumference of the tail.
3) Place first bandage on tail, space each tail of the tape slightly apart. '
4) Place other bandage at right angle, most of the tail should be covered with bandage.
5) Place single tape around base of tail to skin or fur- sometimes additional layers of tape around this last tape wrap are applied, but the hair is "shingled"- meaning that a small amount of hair at the cranial edge of  the tape is brought out and allowed to overlap the tape, then the next tape is wrapped over that and also slightly overlaps the previous tape wrap. 


 

Syringe cover tail bandage
1) Use appropriate sized syringe cover with needle cap removed
2) Prepare tail. Place cover over tail.
3). Tape sides of cover and secure with tape around base of tall.
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e) Limb Bandage


LIMB BANDAGE using "stirrups"
1) Apply 2 strips
of adhesive tape on sides of the leg (or front & back) to provide a "grip" for following bandages. About double the length of the bandaged area
2) Tab the ends. Can use tongue depressors on ends to prevent tangling of bandage.
3) Cover leison with dressing.
4) Using gauze or elastic gauze, start (distally) at the paw, leaving middle two paws out, wrap
upward with even pressure
over lap each wrap
~ 1/3.
5) Bring the stirrup ends up and turn them so the sticky side comes over
the gauze, this helps lock the bandage in place.
6) Cover this with finishing tape. Add inter-digital cotton.
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f) Feline paw -post operative (declaw), using rubber finger exam glove

Finger glove bandage
1) Dress area with LARGE amount of cotton it should be about 2-3 times the size of paw, this acts as pressure bandage.
2) Gently, roll finger clot over dressing, to its full length.
Latex should not be torn on top or bottom.
3) Place wide piece of tape (with tab) at the top
of the bandage.
4) To remove bandage cut top tape, the cat
will usually finish removing it.

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G) Padded hip bandage

 

PADDED HIP BANDAGE (DONUT).
1) Double layer of thick cotton (combine roll) with appropriate
size hole cut to place dressing
2) Elastic tape or gauze around thigh and over hip to secure cotton roll in place
3) Sterile dressing applied through
hole to decubital ulcer.
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II) Splints: Splints are used to support and protect legs and allow some weight bearing. A carpal or front leg splint is described below. Splints (slings and casts) are usually applied by veterinarians.

A) Carpal or metacarpal splint (spoon splint)
   1) A very common splint that can be fashioned in-house by using fiberglass casting materials or it can be purchased (usually made of plastic with foam padded)
   2) Various sizes can be made or purchased.
   3) The distal end is spoon shaped to fit the bottom of the paw.
   4) The splint should not extend proximally beyond the elbow or it will rub     against the chest
   5) The splint is usually applied over two layers of material and stirrups          can be used to lock the splint in place.
  
6) It is sometimes used  to protect fractures or dislocations of the lower        leg for young or very small animals.
   7) A similar splint can be used on the metacarpal region of hind leg for         fractures or problems of the lower hind leg (below the hock joint).

B) Thomas splint: This splint is rarely used in small animal medicine now, see text for photo (pg. 126) and explanation of itsí use in livestock.

III) Slings: Slings are used to immobilize a leg and prevent movement or weight bearing. Photos and descriptions of the following slings are in the text.
   A) Ehmer sling: This sling is used on the hind leg, primarily after                   luxation/dislocation of the hip. Application is done by the veterinarian to cause adduction of the coxo-femora joint.
   B) Velpeau (Val-paw) sling: This sling used on the front limb after fracture or dislocation of the scapula.
   C) 90-90 flexion sling: Both the knee and hock joints are placed in 90 degree flexion and taped. Used after surgery of hindlimb to decrease quadriceps contracture and stifle stiffness.
   D) Carpal sling: The carpus is bandaged then flexed and figured eight taped above and around the radius and ulna.Promotes non weight bearing.

VII) Casts: Casts are used to protect legs after surgery and to allow some weight bearing. They are used as primary fracture stabilization in some cases and are less expensive than bone plating or other orthopedic procedures.
Patients that are sent home with casts should be rechecked frequently because problems can develop under that cast often without the owner realizing it.
A) Plaster vs. fiberglass: These days almost everyone uses fiberglass casting material. It is lighter, stronger and dries quickly.
B) Application of casts:
   1) With the patient under anesthesia the leg can be adjusted and held at the proper angle.
   2) Cast padding and stockingnette are applied to decrease pressure sores. Excessive padding or incorrectly applied padding can actually cause pressure sores also.
   3) Moistened casting tape (usually dunked in a bucket of warm water for a few seconds) is applied and overlapped up and then down the leg. Gloves are worn.
   4) The warmer the water used to moisten the faster the cast will set.
   5) Depending on the size of the patient more layers of fiberglass casting can be used, with more layers the cast is heavier and stronger but takes longer to dry and set.
   6) A hair dryer can be used to dry the cast faster.

C) Removal: Casts are best removed with an autopsy saw (Stryker) which uses a high speed vibrating blade that doesnít cut the skin unless lots of pressure is applied. Because of the sound of the saw some patients may require tranquilization. Casts are usually left in place 4-8 weeks. Radiographs can be taken with casts on a patient.

What changes in radiographic settings are needed if x-raying a fracture with a cast?

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Writing assignment
Answers to be e-mailed to Dr. Bidwell: abidwell@nvcc.edu

1) Give an example of materials that could be used for each of the 3 layers of a 3-layer bandage.

2) Why are non-occlusive bandage materials especially important?

3) What is the difference between the regular and modified Robert Jones bandage?

4) In lay terms, what is a cranial dorsal coxofemoral luxation?

5) Why should the protective plastic bags applied to protect a bandage from moisture or dirt not be left in place for more than about 30 minutes.

6) List 2 differences between the 3 layered bandage used in small animals and the lower leg wound bandage described for horses.

7) Why is a lower limb support bandage used? (2)

8) What is the most popular splint material for large animals?

9) What type of splint is commonly used in cattle with lower leg fractures?

10) What is a major problem with this device related to patient injury?

11) What is meant by the term "shingled"?