Bandages, Dressing & Suture removal, Injection & Infusion a.
a. Place cravat over dressing in armpit so the front end is longer than the
BANDAGES
Bandage
 is a piece of material used either to support a
medical device such as a dressing, or on its own to
provide support to the body
 it can also be used to restrict a part of the body.
General Principle:
 Must not be too loose or too tight
 Must not restrict circulation
 Absorptive if necessary
 Avoid distortion of tissues
 Requires serial examination and changing
PURPOSE:
1. Wound covering - applied to the wound until complete healing
and to avoid further contamination
2. Support and immobilization of a part – applied to wounds like
fractures of extremities.
3. Special Therapeutic Agent – it has been incorporated because of
its curative properties
4. Pressure – Best method of controlling bleeding
5. Compression Therapy – make use of compression bandages
TYPES OF BANDAGES:
Gauze pads and rolls
- have the ability to hold the injury after it is dressed
-used for open wounds and abrasions
Triangular bandage
 more commonly used to secure the dressing at one place,
especially when the dressing is large
 they can also be used in almost all parts of the body from head
to toe
Triangular Arm Sling
Used for the support of fractures or injuries of hand, wrist, and forearm.
The triangular arm sling (brachio-cervical triangle) is used for the support
of fractures or injuries of hand, wrist, and forearm.
(a) In this method of applying the sling, the forearm is supported from
both shoulders by the sling.
1. bend arm at elbow so that little finger is about a handbreadth
above level of elbow.
2. place one end of triangle over shoulder on injured side and
let bandage hang down over chest with base toward hand and apex
toward elbow.
3. slip bandage between body and arm.
4. carry lower end up over shoulder on uninjured side.
5. tie the two ends, by square knot, at the neck. Knot should be
on either side of neck, not in the middle where it could cause discomfort
when patient is lying on back.
(b) If it is desirable to support the forearm without pressure on the
collarbone or shoulder of the injured side.
1. Bend arm at elbow so that the little finger is about a handbreadth
above level of elbow
2. Drape under end of triangle over uninjured shoulder.
3. Slip bandage between body and arm.
4. Carry lower end up over flexed forearm (ends of fingers) should extend
slightly beyond base of triangle ).
5. Slide lower end of bandage under injured shoulder between arm and
body and secure the two ends with a square knot.
6. Draw apex toward elbow until snug, and secure with safety pin or
adhesive tape.
Shoulder-Armpit Cravat
 Used to hold dressing in the armpit (axilla) or on the shoulder.
The shoulder-armpit cravat (bis-axillary) is used to hold dressing in the
armpit (axilla) or on the shoulder.
back. Carry the ends upwards.
b. Bring ends across each other over top of shoulders.
c. Cross ends over back and chest respectively to opposite armpit. Tie
Adhesive bandage
 used for supporting weakened joints of body such as knees or
ankles
ends just in front of uninjured armpit.
also helpful in providing support to joints for short term and can be
used in the recovery of sports or occupational injury during
rehabilitation process
. Adhesive tapes or bandages consist of winding spool along with
adhesive components which do not cause any aggravation to the
skin and hence can be directly applied to the injured site and being
stretchable is easily adaptable to any type of body contours.
ELASTIC and ELASTIC ADHESIVES
Tubular bandage
 especially meant for dressing on injured joints and fingers
 They can be used on toes or fingers but are not at all helpful in
stopping the bleeding
They can be used on toes or fingers but are not at all helpful in stopping
the bleeding
Roller bandage
 made up of muslin cloth and are so designed so they can
stretch to a small extent
 well adjusted to the shape of the injured part and contours,
keeping the dressing right at its place. You can find it in various
widths from around 11/2 inch to 4 inches. Narrower width roller
bandages are used for toes and fingers. Along with these types
of bandages, adhesive strips are also used for holding them
firmly, especially on the injury in awkward area like ankle.
ROLLER BANDAGES:
Circular
Spiral
Spiral reverse
Figure of 8
Circular Bandage
 Circular bandage used to cover cylindrical parts and to anchor
bandages.
 THE FOLLOWING TERMS ARE USED IN ROLLER
BANDAGING
 Circular bandage used to cover cylindrical parts and to anchor
bandages. As illustrated here, a turn is made around the part
and anchored. Similar succeeding turns are made, overlying
each other completely. The bandage is then terminated and
secured.

Spiral Bandage
 Used to bandage cylindrical parts of the body that are fairly
uniform in circumference, such as upper arm and upper leg.
 A spiral bandage is also used to cover a cylindrical part, but
covers a larger area than that covered by the circular bandage.
It is applied to the arm; however, it can be used on other parts.
 Anchor at wrist.
 Apply succeeding spiral turns up the forearm, with each turn
overlapping one-third of preceding turn.
 Terminate and secure just below elbow.

Figure-of-Eight of Hand
 Used to hold dressings on back or palm of hand.
 This bandage is used to hold dressings on back or palm of
hand.
 Anchor the bandage on hand with circular turns near ends of
fingers. Carry obliquely across back of hand to thumb. Bring
under thumb and across palm to back of hand
 Carry obliquely across back of hand to bottom of primary turn
and across palm.
 Follow with several similar turns, each one overlying sufficient
turns, terminal with circular turns around wrist and secure.

DRESSINGS
 When it comes to wound healing, it is vital to ensure that
healing is as fast and effective as possible.
  For this using the right dressing is crucial.
 The type of dressing used for dressing a wound should always
depend on various factors, including the type of injury, the size,
location, and severity.
 It is a sterile pad or compress applied to a wound to promote
healing and prevent further harm.
 It is designed to be in direct contact with the wound, as Calcium Alginate
distinguished from a bandage, which is most often used to hold
a dressing in place
Purpose of dressing
 Reduce pain   Low allergenic
 To apply compression for hemorrhage or venous stasis Hydrogels dressing
 To immobilize an injured body part
 To protect the wound and surrounding tissue
 To promote moist wound healing
HOW?
 a dressing mimics the barrier role of epithelium and prevents
further damage.
 application of compression provides hemostasis and limits
edema.
 Occlusion of a wound with dressing material helps healing by
controlling the level of hydration and oxygen tension within the
Hydrocolloid dressing
wound.
 It also allows transfer of gases and water vapor from the
wound surface to the atmosphere.
 Occlusion affects both the dermis and epidermis, and it has
been shown that exposed wounds are more inflamed and
develop more necrosis than covered wounds.
 Occlusion also helps in dermal collagen synthesis and
epithelial cell migration and limits tissue desiccation. Since it
may enhance bacterial growth, occlusion is contraindicated in
infected and/or highly exudative wounds.
Characteristics of an ideal wound dressing
a) provide or maintain moist environment
b) enhance epidermal migration Bioactive Dressings
c) promote angiogenesis and connective tissue synthesis
d) allow gas exchange between wounded tissue and environment
e) maintain appropriate tissue temperature to improve the blood flow to
the wound bed and enhances epidermal migration
f) provide protection against bacterial infection
g) should be non-adherent to the wound and easy to remove after
healing
h) must provide debridement action to enhance leucocytes migration and
support the accumulation of enzyme
i) must be sterile, non-toxic and non-allergic.
CLASSIFICATION OF DRESSING
PRIMARY DRESSING
 placed directly on the wound
 provide absorption of fluids
 prevent desiccation and infection
 
SECONDARY DRESSING
 placed on the primary dressing
 provides protection, absorption, compression, and occlusion.
Semi-permeable Medicated dressings
 The hydrophobic properties of outer layer protect from the
liquid but allow gaseous exchange and water vapor.
 Reduces pain
 Barrier to external contamination
 Allows inspection
2 types: Film and foam dressing
Film:
 These dressings are recommended for epithelializing wound,
superficial wound and shallow wound with low exudates, e.g.
Opsite™, Tegaderm™, Biooclusive ™.
 Commercially available film dressings differ in terms of their
vapour permeability, adhesive characteristics, conformability
and extensibility
Foam:
 primary dressings for absorption and secondary dressings are
not required due to their high absorbancy and moisture vapour
permeability.
 Disadvantage of foam dressing is requiring frequent dressing
and is not suitable for low exudating wounds, dry wounds and
dry scars as they depend on exudates for its healing.
e.g. Lyofoam™, Allevyn™ and Tielle™.
Non adherent
 Moist
-Reduces adhesion to wound
-Moist environment aids healing
 Dry
-Low wound adherence
-Absorb light exudate
 Forms gel on wound
 Absorbent in exudative wounds
 Promotes hemostasis
 Hydrogels are insoluble hydrophilic materials made from
synthetic polymers.
 The high water content of hydrogels (70-90 %) helps
granulation tissues and epithelium in a moist environment.
 Exudate accumulation leads bacterial proliferation that
produces foul smell in wounds.
 Low mechanical strength of hydrogels making it difficult to
handle .
 Some examples of hydrogels are Aquaform polymers, sheet
dressings, impregnated gauze and water-based gels.
 Hydrocolloid dressings are among the most widely used
interactive dressings and are consist of two layers, inner
colloidal layer and outer water- impermeable layer.
 These dressings are made up of the combination of gel
forming agents (carboxymethylcellulose, gelatin and pectin)
with other materials such as elastomers and adhesives
 permeable to water vapor but impermeable to bacteria and
also have the properties of debridement and absorb wound
exudates
 For pediatric wound care management, as no pain on removal
 Disadvantage = not indicated for neuropathic ulcers or highly
exudating wounds and mostly used as a secondary dressings
 play a significant active role in wound healing because it
enhance granulation tissue formation
 Reduce slough formation
 Inhibits bacteria
 Some provide growth factors
 bioactive dressings and is produced from biomaterials which
play an important role in healing process. These dressings are
known for their biocompatibility, biodegradability and non-toxic
nature and are derived generally from natural tissues or
artificial sources [34] such as collagen [35], hyaluronic acid
[36], chitosan [37], alginate and elastin.
EXAMPLES:
Antimicrobial dressings
Interactive dressings
Single-component biologic dressings
Combination products
Paper adhesive tapes
 Non allergenic
 Provides wound support
 Incorporated drugs plays an important role in the healing
process directly or indirectly by removal of necrotic tissues.
 This has been achieved by cleaning or debriding agents for
necrotic tissue, antimicrobials which prevents infection and
promotes tissue regeneration.
1. Holding gentle traction on the skin, loosen the tape by pulling
the ends toward the wound, and then remove the dressing.
Discard in the plastic bag.
2. From then on other dressings and wound itself are touched
only with sterile instruments and supplies.
3. The wound and surrounding skin are painted with alcohol or
any colored antiseptic
 4. Pick up sterile dressings, holding them only by the corners.
Center them over the wound.
5. Tape the dressing securely in place, or cover with a bandage.
You may remove your gloves to apply the tape or bandage, if
desired.
Suture removal
INJECTION
 A sterile method of introducing drugs or fluid, usually with a
syringe which directly across the body’s barrier defenses into
systemic circulation or other vascular tissue.
SYRINGES
 Made of plastic or glass, design for ONE-TIME use only and
must be discarded in a special puncture-resistant container.
PARTS OF A SYRINGE
■ Barrel: A hollow cylinder that holds the medication. It has calibrations
on the outer surface.
■ Plunger: Fits in the barrel and is moved back and forth. Pulling back
on the plunger draws medication or air into the syringe. Pushing in the
plunger forces air or medication out of the syringe. 
■ Tip: The end of the syringe that holds the needle. The needle slips
onto the tip or can be twisted and locked in place.
PARTS OF A NEEDLE
Hub- Which attaches to the syringe.
Shaft- The long part of the needle that is embedded in the hub.
Bevel- The slanted portion of the tip.
Length- The distance from the point to the hub.
Gauge- Refers to the thickness of the inside of the needle.
Routes Of Drug Administration
1. Intramuscular Injection
2. Subcutaneous Injection
3. Intradermal Injection
4. Intravenous Injection
INTRAMUSCULAR INJECTION
 Use-Rapid absorption than subcutaneous. Few nerve endings
and highly vascular.
 Preferred Site-Gluteus and Deltoid muscles
 Gauge-20/22
 Length-1”-1 1/2
INTRAMUSCULAR INJECTION
Technique
1. Same aseptic technique precaution with additional procedure
of including a small air bubble of 0.2-0.3 ml in the syringe.
2. Using thumb against the index finger and middle finger. Hold
the skin firmly.
3. The needle is quickly thrusted in at 90 degree. Aspirate if there
is no blood, the solution is slowly injected and flushed with air
bubble. The needle is then removed and massaged.
Subcutaneous Injection
• Use- For slower absorption of medication. (e.g. Insulin)
• Site-areas of fat in the body. (e.g. upper arm and thigh)
• Gauge-25-30
• Length-1/2-5/8 inch
Subcutaneous Injection\
Subcutaneous Injection
Technique
1. Clean the site with alcohol on a cotton ball.
2. The skin is pinched to raise the subcutaneous tissue.
3. The needle is introduced at 45 degree angle. Once the needle
is within the area of injection, the pinch is released and the
plunger is pulled back, if no blood is aspirated. Slowly inject the
solution and withdrawn thereafter.
INTRADERMAL / INTRACUTANEOUS INJECTION
  When the patient is unable to swallow, e.g. unconscious
patient.
 When it is undesirable for the patient to take fluids or food by
mouth e.g. post operative patients.
 To keep the vein open for administration of drugs or when
waiting for blood transfusion.
 To maintain and correct electrolyte’s of the body when the
patient is losing fluids or salts in excess like in persistent
diarrhoea and vomiting , in severe burns
TYPES OF INTRAVENOUS INFUSIONS
Types of IV fluid
1. Colloid
2. Crystalloid
Colloid
Fluids with large molecules which do not pass the cell membranes, when
infused remain mainly in the intravascular compartment.
It expands intravascular volume and draw fluid from extra vascular
spaces. E.g.. Albumin, hemacel, dextran.
Crystalloid
It contains small molecules flowing easily through cell membranes,
• Use- diagnostic purposes, determine sensitivity to allergic allowing for transfer from blood stream into cells and body tissues.
substances. It increases the blood volume in both interstitial and intravascular spaces.
• Common site- inner aspect of the forearm. Crystalloid
• Gauge- 26-30 It is further divided into the following-
• Length- 1/4 inch 1. Isotonic solutions
• Angle- 10-15 degree 2. Hypotonic fluids
INTRADERMAL / INTRACUTANEOUS INJECTION 3. Hypertonic fluids
Technique Isotonic solutions
1. The skin is cleansed with antiseptic, the area of the forearm to  They have the same osmotic pressure as that found within the
be injected is pulled taut. cell.
2. The needle is bevel up and held almost horizontal to the skin  Used to expand intravascular compartment and thus
so it can inject just below the skin. increasing circulating volume.
3. The solution is injected slowly to form a ½ cm in diameter  e.g.. normal saline(0.9% Nacl) and Ringers lactate.
wheal.  They are also known as plasma expanders.
Intravenous injection Hypotonic fluids
 Introduction of a drug in solution directly into the blood-stream  Have less osmotic pressure than the cell, when infused it
through a vein. raises serum osmolarity pressure than the cell, causing body
Common site- superficial veins of the cubital fossa, other site fluids to shift out of blood vessels.
during surgery –veins at the dorsum of the hand or ankle.  e.g. 5% dextrose in water.
Intravenous injection Hypertonic fluids
INDICATIONS  Have great osmotic pressure than the cell
1. When drugs are very irritating. The IV route allows rapid  When infused it raises serum osmolarity pressure, pulling fluids
dilution. from cells and interstitial tissues into vascular space.
2. When the quickest action of a drug is desired as in emergency  e.g 5% dextrose in normal saline , 5% dextrose in ringers
cases. lactate.
3. Used in the administrations of certain anesthetics such as EQUIPMENT FOR INTRAVENOUSINFUSION
sodium pentothal.  Containers
4. Used for diagnostic purposes such as in x-ray of kidney,  Drip chamber
ureters and urinary bladder using dyes as medium.  Tubing
Intravenous injection  Filters
Technique  Spikes
1. Prepare materials; tourniquet, cotton, alcohol and syringe with  Needle
solution.  Adhesive tape
2. The tourniquet is placed around the arm and tied while the skin  Constricting band
over the vein is cleansed aseptically.  Antiseptic and 2 x 2 gauze
3. The vein which is selected is anchored by placing the thumb Step 1- Gather the materials
directly on it distal to the site and the skin over the area is  Sterile disposable gloves
pulled out.  Appropriate size IV catheter (typically 14 - 25 gauge)
4. The needle is thrusted directly along the side of the vein, as  Bag of IV fluid
soon as the needle is securely in the vein and blood flows back  IV administration tube
freely into syringe the tourniquet is released.  tourniquet
5. Inject the solution slowly thereafter the needle is withdrawn  Sterile bandage or dressing
quickly then apply pressure. (hemostasis)  Gauze
INFUSION  Alcohol wipes
Definition  Medical tape
 Intravenous is the term means “into the vein”  container
 An IV infusion is a slow drip of medication into the vein over a Step 2- Prepare the IV Tubing
set period of time to deliver a constant volume of therapy.  Prepare the IV tubing by suspending the IV bag from an
 It is an effective and efficient method of supplying fluid directly elevated stand, filling the tubing with saline solution, and
into the intravenous compartment producing rapid effect with checking for any bubbles.
availability of injecting large volume of fluid more than any Step 3- Choose a suitable gauge and length of catheter for the
other method of administration. situation
 Intravenous therapy is frequently used with hospitalised Step 3- Choose a suitable gauge and length of catheter for the
patients to prevent , or treat fluid and electrolyte imbalances. situation
PURPOSE OF INTRAVENOUS INFUSION Step 5: Look for prominent veins
 To provide patient with fluid when adequate fluid intake cannot  For most patients, the most accessible veins are on the
be achieved through oral route. underside of the forearm or the back of the hand, though any
 accessible vein can be used to start an IV (this includes veins  Rapid administration of solution Avoids first pass metabolism
on the feet, which are often used for children). 100% bio available.
Step 6: Apply a tourniquet  Prevent the growth of cancerous cells.
 To get your chosen veins to swell up for easy insertion, apply a  Rapid delivery of the drug/fluid to target sites.
tourniquet behind (in the direction of the torso) the intended IV
site.
 Don't tie the tourniquet too tight — this can cause bruising,
especially in the elderly.
Step: 7 Disinfect the IV site
 Tear open a fresh alcohol wipe and apply it to the skin in the
area that the IV will be inserted and wipe it gently but
thoroughly.
 This kills bacteria on the skin, minimizing the chance of
infection when the skin is punctured
Step 8: Prepare the Catheter for insertion
 Remove the catheter from its sterile packaging.
 Briefly inspect it to ensure that it is intact and working.
 Remove the protective cap and inspect the needle, taking care
to ensure the needle doesn't touch anything.
 Don't allow the catheter or needle to come into contact with
anything other than the patient's skin in the IV site.
 This can compromise their sterility and increase the risk of
infection.
Step 9: Insert The needle
 Use the non-dominant hand to stabilize the patient's limb with
gentle pressure, taking care not to touch the IV site directly.
 Take the catheter in your dominant hand and insert the needle
(bevel facing up) through the skin.
 Flashback of blood at the catheter hub suggests you've
successfully hit the vein then advance the needle one more
centimeter (cm) into the vein
Step 10: Remove and discard the needle
 Maintaining pressure on the skin, pull the needle about 1
centimeter (0.4 in) back out of the vein. Slowly advance the
catheter into the vein while maintaining pressure on the vein
and skin.
 When the catheter is seated in the vein, remove the tourniquet
and secure the catheter by placing a sterile bandage or over
the lower half of the catheter hub.
 Be sure not to block the IV tubing connection with your
dressing
Step 11: Remove the needle and insert the tubing
 Hold onto the catheter hub with your thumb and index finger.
 Keep it securely seated in the vein. Using your other hand,
carefully pull the needle (and only the needle) out of the vein.
 Dispose of the needle in a proper sharps container.
Step 12 Secure the IV
 Place a piece of tape over the catheter hub, then make a loop
in the catheter tubing and tape this down with a second piece
of tape over the first.
 Secure the other end of the loop above the site of the IV with a
third piece of tape.
 Putting loops in the tubing reduces the strain on the IV
catheter, making it more comfortable for the patient and less
likely to accidentally be removed from the vein.
 Check the flow of fluid into the IV
 Open the IV roller clamp and look for drips forming in the drip
chamber. Check that the IV is infusing into the vein by
occluding the vein (pressing down on it to block its flow) distal
to the site of the IV (away from the torso). The flow of drips
should slow and stop, then restart flowing when you stop
occluding the vein.
 Main reason for giving a drug by slow iv infusion
 When drug is administered rapidly, it tends to increase the
volume of the blood . As a result, hypervolemia may occur,
thereby slowly infused.
 Slow IV infusion may be used to avoid side effects due to rapid
drug administration .e.g.: Intravenous immune globulin may
cause a rapid fall in blood pressure when infused rapidly.
Main reason for giving a drug by slow iv infusion
 The rate of infusion is particularly important in administering
anti- arrhythmic agents in patients.
 The rapid IV bolus injection of many drugs that follow the
pharmacokinetic of multi-compartmental models, may cause
an adverse response due to the initial high drug conc.eg: If
heparin is injected or infused at a faster rate, cardiac arrest
may arise.
Advantages