APPLY THE RIGHT BANDAGE THE RIGHT WAY
After you've chosen an appropriate bandage, keep these tips in mind to ensure you've applied a comfortable bandage.
Obtain sufficient coverage
When you bandage extremities, the bandage should always begin at the toes and extend proximally. If you place a bandage around
only a stifle or an elbow without including the distal extremity, you risk causing lymphatic or venous compression, and edema
commonly occurs distal to the bandage. Other examples include wounds in the midfemoral or midhumeral areas. It is often difficult
to keep a bandage in place that is wrapped only around the limb, so in these situations, you may have to encompass the pelvis
or thorax, respectively, in the bandage.
Apply snugly, pad appropriately, and be neat
Apply the bandage snugly but not too tightly. Many bandaging materials can cause a tourniquet effect if you inadvertently
overtighten them. Applying a bandage too tightly can result in the loss of the limb. Some materials are easy to overtighten,
such as self-adherent bandages (e.g. Vetwrap—3M) and stretch or elastic gauze (e.g. Elastikon—Johnson & Johnson). Be prepared for any swelling that may occur, and monitor frequently.
Appropriate padding varies depending on the circumstances. A soft-padded bandage with appropriate immobilization to protect a healing skin graft may have just a few layers of synthetic
cast padding in the secondary layer, but a Robert-Jones bandage contains several layers of rolled cotton to provide compression
and temporary splintage. If too much padding is placed, you may lose needed support for the condition you're treating or you
may make the bandage cumbersome.
Be neat. An appropriately placed bandage looks good. It is snug and tidy, not loose and sloppy. The bandage should stay solidly
in place when the patient walks out the door.
Monitor frequently and provide timely changes
Whether the patient is hospitalized or at home, someone needs to check the patient and its distal extremities for swelling
several times a day. A bandage may be placed correctly, but because of the underlying condition, swelling may ensue and the
bandage becomes too tight. Tell owners to monitor a bandage extra closely when it has been newly changed. That is a time when
problems commonly arise.
Bandages should be changed in a timely manner. In some cases, a bandage should be changed every day or even twice a day (e.g. a wet-to-dry bandage placed on a degloving wound). In other cases, the bandage may need to be changed only once a week or
longer. For example, bandages that incorporate a splint to protect a healing fracture that has been surgically repaired or
to protect various skin grafts after the initial adherence phase may need to be changed only once a week. Keep in mind that it is seldom appropriate to leave the same bandage on for two or more weeks. Full-cylinder casts placed
for treatment of certain fractures are one exception—they may be kept in place for six to 10 weeks. But they still need the
diligent monitoring required of all bandages.
Assess for comfort
A young dog may chew on any bandage you place, no matter what. But if a patient is chewing at its bandage, consider whether
the bandage is uncomfortable and creating a problem for the patient. Did the bandage slip or twist? Or is something beneath
the bandage causing pain or discomfort? The problem may or may not be easily identified, but if any doubt exists about the
cause, remove the bandage and start over.
Some small animals, especially puppies or kittens, may chew at a bandage out of boredom. You can use various deterrents such
as safe chew toys, or you can apply bitter apple or orange products to the bandage. Sometimes you'll need to place Elizabethan
or BiteNot (Bite Not Products) collars.
Jayce Lineberger, DVM
5914 Johnson Drive
Mission, KS 66202