Bandage Wrapping - Bandaging Techniques

Specific bandaging techniques target a particular area or a particular ailment. Here are
some techniques of bandage wrapping, which can assure you a relatively speedy
recovery.

A bandage is a material used to provide support either to a medical dressing or an

injured part of the body. Bandages, ranging from cloth strips to specialized bandages
used for a particular body part, are important components of your first aid kit. Very often
the word bandage is used to refer to a dressing used on a wound. There are various
bandaging techniques, each specifically targeting a particular area or a particular type of
ailment.

BandageWrapping
Bandage wrapping is the process wherein a circular role of bandage is firmly rolled
around the limb, most often to support dressing, or stop bleeding. To wrap the bandage
on the limb, hold it transversely in the hand, and start rolling it around the limb with the
outer side of the bandage roll applied to the inner side of the limb. The bandage has to
be rolled from the inner side to the outer side. Though rare, in some cases, it is rolled
upwards from below. The pressure on the part of the body being bandaged should be
uniform. Once the rolling is done, the end of the bandage can be secured either by
applying a safety pin or by giving it a slit and tying it around the limb.

The various reasons for applying bandages are:

 Bandaging helps the dressing to stay firmly on the wound.

 Bandaging is an effective technique to support a hurt joint.
 Bandage wrapping helps to reduce swelling.
 In case of a wound, bandaging helps to stop bleeding.
 Bandaging helps to restrict the movement of an injured body part.

Bandaging Techniques
The use of various bandaging techniques are determined based on the reason for which
bandaging is required. The three most commonly used techniques of bandaging are
spiral technique, ascending spica technique and diverging spica technique.

Spiral Bandaging
Spiral bandaging is the simplest of the roller bandaging techniques. While rolling the
bandage, in this method, the turns are done in spiral method, wherein each turn covers
the two-third part of the preceding turn. Spiral technique of bandaging is most often
used on body parts with uniform circumference, such as leg or forearm.

Diverging Spica or Reverse Spiral Bandaging

Diverging spica technique is most often used on body parts with varying circumference.
Although the turns are made in spiral direction in this technique, the bandage is
reversed on itself so that it stays firm on body parts with varying perimeters. Once the
bandage is secured, after a few spiral binds, the bandage is rolled with the thumb being
placed over the lower border of the bandage on the outer side of the limb. Eventually
the bandage is reversed downwards, and after passing it over the fixed thumb it is
carried to the opposite side from under the limb, and rolled in reverse spiral technique
above the preceding bandage wrap.

Ascending Spica or Figure Eight Bandaging

Ascending spica is considered to be the most useful roller bandaging technique. In this
method, the bandage is alternately passed upwards and downwards over and under the
limb, roughly resembling the figure 8 with each double turn. This bandaging technique is
most often used over the joints, in case of problems such as joint sprains.

Basic knowledge about how to wrap bandage in various techniques, and the utilization
of each of these techniques, can prove to be of great help in situations of emergency.
Most often, we tie the bandage in circular method, wherein each turn covers the
preceding turn, until the bandage is firmly secured, but the above mentioned bandaging
techniques prove to be much more effective, when it comes to a speedy recovery.

http://www.buzzle.com/articles/bandage-wrapping-bandaging-techniques.html

12 February 2010

Evidence Summary: Bandaging: Basic

Principles
Evidence Summary Author: Priyanka Pamaiahgari, BDS

Summary

QUESTION:

What is the best available evidence regarding bandaging techniques?

CLINICAL BOTTOM LINE:

Historically bandaging has been the forte of nursing staff but in the last
decade attention given to training and education surrounding this skill has
declined.1 Bandaging is used to reduce swelling, increase venous inefficiency
and to hold dressings in place without the use of tapes.2 Inappropriate
bandage selection and/or application can lead to sub-optimal results and in
the extreme, amputation.
THEORY
The aim of all bandaging is to provide a graduated pressure gradient.2 (Level
IV)

 Bandages can be classified into three groups: 1 (Level IV)

o Conforming stretch: Holds dressings in place,
o Light support: Providing support but no compression,
o Compression: Exerting a level of pressure measured in degrees
of mercury from light 14mmHg to very high 60mmHg
 The pressure a bandage exerts on the skin is determined by:
o The number of layers of bandaging (i.e.1-4 layers).2 (Level IV)
o The tension placed on the bandage when it is applied (i.e. the
percentage of stretch applied to bandage).2 (Level IV)
o The bandage width (the narrower the bandage the greater the
pressure).1 (Level IV)
o The limb circumference to which the bandage is being applied.2
(Level IV)
o The degree of overlap applied in the bandaging technique.2 (Level
IV)
o The duration of bandage application.2 (Level IV)

PRACTICE

 Conforming stretch bandages can be used for awkward areas

(ie.elbows, head) and are of benefit to the older person with sensitive
skin where adhesive tapes are inappropriate.3 (Level IV)
 Light support bandages are used to support sprains and strains.3 (Level
IV)
 Compression bandages have several clinical applications but all require
exhaustive assessment of the person prior to their use. These
assessments involve Doppler ultrasound to determine arterial
sufficiency and their use depends on the judgement of specifically
trained clinicians.1 (Level IV)
  Nursing assessment should include skin integrity, palpable pulse and
colour/sensation.2 (Level IV)
 Application of compression bandaging in older people with peripheral
vascular disease, diabetes, rheumatoid disease or small vessel disease
may be contraindicated.4 (Level II)
 Compression bandage systems are highly elastic being used for venous
leg ulceration.1 Compression increases leg ulcer healing compared to
no compression and multi-layered systems are more effective than
single-layered systems.5 (Level I)
 In clinical practice a padding layer should always be applied underneath
the bandaging layers.4 (Level II)
 If the older person experiences any changes in sensation, colour,
warmth, movement or an increase in discomfort the bandaging should
be removed.2 (Level IV)
 Additional padding should be used around the Achilles tendon as it has
been identified as an area of high pressure concern.4 (Level II)
 When comparing the figure eight bandaging technique with spiral
technique studies have shown that figure eight is preferred as it exerts
less pressure on the Achilles tendon.4 (Level II)
 No current studies are available to evaluate the therapeutics of
combining figure eight and spiral techniques.4 (Level II)
 Lymphatic therapy incorporates the use of compression bandaging for
an initial time frame until a stable reduction in lymphedema has taken
place. Following this compression garments are applied in preference.6
(Level IV)
 It is essential that the person applying the compression bandage
understands the physical properties of the bandage type, including its
effect on the limb. Added to this is the importance of bandaging
techniques and the pressure differences this brings on the skin and
underlying tissues.7 (Level II)
 In a cohort study comparing interface pressure between elastic
stockings and bandages during posture changes and exercise, it was
found that short-stretch bandages showed a significantly greater
pressure difference between muscle contraction and relaxation than
long-stretch bandages and short-stretch stockings.8 (Level III)

COMPLICATIONS
  The most common mistake with bandage application is a technique
and/or bandage choice causing the tourniquet effect.2 (Level IV)
 Poor technique in applying bandaging can lead to areas of high applied
pressure and tissue necrosis.4 (Level II)
 The elderly may require modified compression therapy for
lymphedema.6 (Level IV)
 In the frail elderly patient the ankle protrusion, tibial plateau, posterior
tendons of the ankle and the dorsum of the foot may require particular
attention as they are prone to receiving high pressure and may require
additional padding.1,4 (Level IV & II)
 Research has found that insufficient knowledge of bandage types,
difficulty in applying theory to practice and unsatisfactory standards of
bandaging techniques were common errors in nursing.1 (Level IV)

CHARACTERISTICS OF THE EVIDENCE:

This evidence summary is based on a structured search of the literature and
selected evidence-based health care databases. The evidence in this
summary comes from:

 Articles based on expert opinion and relevant literature.1,2,3,6

 A cross-sectional study and relevant literature.4
 A systematic review including 22 randomised controlled trials.5
 An observational study.7
 A cohort study.8

BEST PRACTICE RECOMMENDATIONS

 Training and education should be a priority for those nurses involved in

bandaging, and in particular compression bandaging. (Grade B)
 When applying a bandage, the practitioner must be aware of the
different types of bandages available, their suitability for different clinical
situations and understand the implication of their application. (Grade B)
 Before any person receives compression bandaging they must undergo
vigorous assessment by trained clinicians including Doppler studies to
approve the intervention. (Grade B)
 If the older person experiences any change in warmth, colour,
movement, sensation or an increase in pain, the bandaging should be
removed. (Grade B)
  Short-stretch bandages have more benefits for augmenting muscle
pump than long-stretch bandages and short-stretch stockings. (Grade
B)

References
1. Penn E. Nurses' education and skill in bandaging the lower limb. Br J Nurs.
2002;1(3):164-169. (Level IV)
2. Love C. Bandaging skills for orthopaedic nurses. J Orthop Nurs. 2000;4:84-
91. (Level IV)
3. Baxter H, Ballard K. Bandaging: a vital skill. NT. 2001;97(28):56-61. (Level
IV)
4. Coull A, Tolson D, McIntosh J. Class 3-c compression bandaging for
venous ulcers: comparison of spiral and figure of eight techniques. J Adv
Nurs. 2006;54(3):274-283. (Level II)
5. Cullum N, Nelson EA, Fletcher AW, Sheldon TA. Compression for venous
leg ulcers. Cochrane Database Syst Rev. 2001;2. (Level I)
6. Konecne S. Lymphedema in the elderly. Top Geriatr Rehabil.
2004;20(2):98-113. (Level IV)
7. Lee AJ, Dale JJ, Ruckley CV, Gibson B, Prescott RJ, Brown D.
Compression therapy: effects of posture and application techniques on initial
pressures delivered by bandages of different physical properties. Eur J Vasc
Endovasc Surg. 2006;31:542-552. (Level II)
8. Hirai M, Niimi K, Iwata H, Sugimoto I, Ishibashi H, Ota T, Nakamura H. A
comparison of interface pressure and stiffness between elastic stockings and
bandages. Phlebology. 2009 Jun;24(3):120-4. (Level III)

JBI Levels of Evidence and Grading of Recommendations

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