Bandaging

Dressings - treatment by wounds, ulcers and other violations of the skin. Armband (see) protects the wound from harmful external influences and first of all from microbial contamination.
Frequency of change depends on the nature and course of the process. When the net operating wounds, proceeding without complications (no temperature, pain in the wound, leukocytosis), the first ligation produce 7-9 days for the removal of the stitches. As seldom dressings do in surface wounds healing under a scab. In other fresh wounds frequency of change depends on the nature of primary surgical treatment of wounds (see the Wounds, the wounds), the nature imposed seam (primary or delayed), the presence of complications. Pain in the wound and fever require changing bandages to inspect the wound. Purulent wounds and ulcers, if the bandage soaked and there is no need to inspect the wound bandage is done in 2-3 days. Over the same period, sometimes less, change the wax and oil-balsamic dressing (see). When the wet-drying bandages, heavily drenched with pus bandage is done daily or every other day. When soaking bandages any other detachable (urine, stomach or intestinal contents), especially if irritation of the skin around the wound, bandaging produce 2-3 times a day. Also several times a day, changing the top layers of bandages when introduced into the wound antibiotic or antiseptic and with continuous irrigation of the wound through the drains.
Before bandage prepare all necessary. If assistance is outside the facility, individual dressings are used packages (see) or sterile cloth; in an institution - sterile dressings and sterile instruments. Bandage must be made carefully, observing the rules upgrades (see), in masks, after appropriate processing of hands, with the use of sterile gloves. To save time, and given the difficulty of achieving full disinfection of hands at their contamination with pus in dressing apply instrumental ligation.
Removing the bandage, manipulation on the wound bandage is made with the help of tweezers, scissors, korzenkov, not touching a hand to the wound and dressing material. The tools are changing at each dressing change. When working in a sterile gloves change them if touched something unclean. Much more difficult and requires experience instrumental ligation with the introduction of drainage, with the imposition clervoy or adhesive bandage, etc.
At the first dressing change after accidental injury must be open wound, removing or cutting clothes and shoes, and make her toilet, i.e. delete tweezers from wounds visible on the eyes pollution (foreign bodies, sand, hair). Then proceed to the toilet (purification) of the skin around the wound, wiping her balls with gasoline or 0.5% solution of ammonia, then ethyl alcohol. When wounded on hairy parts of body hair cut and shave around the wound. Shaving need from wounds, no soap, moistening the skin with alcohol. During the toilet skin wound should be covered with a sterile gauze pad or ball. Lubricate the skin 5% alcoholic iodine solution, then remove the cloth and put a sterile dressing. At a superficial abrasions and small wounds alcohol solution of iodine grease and the wound. With extensive wound can lubricate alcohol solution of iodine and particularly contaminated sites injured tissues. In ligation net (uninfected), the healing primary intention wounds imposed sutures are removed on the 6-7 days, after brushing the skin and joints alcoholic iodine solution.
When you re-bandaging wounds healing by second intention, it is necessary to remove the bandage, so as not to smear detachable around the wound, i.e., to lift the blindfold as turning a page of the book. Great importance is the careful attitude to the tissues of the wound. When prishani bandage to the wound should not rudely to tear it, and, removing the upper layers, to moisten the remaining hydrogen peroxide, or if the wound limb) soak the bandage in the tub in the solution of potassium permanganate (1 : 1000) or 2% solution of sodium bicarbonate. In ligation is not necessary to wipe granulation. Delete tampons and enter the new one must carefully as possible without damaging granulation, as even a small injury can serve as a gate for the infection. When bleeding from granulation, it is stopped by pressing sterile gauze soaked in hydrogen peroxide.
Around the wound produce toilet skin. To avoid irritation pus skin wash gauze balls lightly moistened with 0,5% solution of ammonia, ether or gasoline, so that the applied fluid does not get into the wound. After that, the skin around the wound treated with alcohol. If irritation of the skin cuticles paste Lassara or zinc ointment. After going to the toilet skin produce toilet wounds, i.e. removed from it separated necrotic tissue and apply a new patch. When applying tamponade (see) or drainage (see) wounds consider the number entered tampons and drains to prevent them from leaving in the wound at bandaging. When washing the wound solution injected using a syringe in her depth so that they do not get on skin before entering the wound.
During bandaging conduct and therapeutic measures for speeding up the healing of wounds. When infected wounds - physical methods of treatment (dry suction bandages, plugging and drainage); for wounds with poor purulent discharge to enhance drainage of pus from the wound shown wet bandages from hypertonic solutions (10% solution of sodium chloride, 2% solution of sodium bicarbonate). At strongly contaminated wounds and, when infection is shown introduction to the depth of the wound hydrogen peroxide to suppress the development of anaerobic bacteria and mechanical leaching formed foam foreign phone Application proteobacteria solutions of etakrydina (1 : 1000), furatsilina (1 : 5000), chloramine (0,5-1%) is appropriate when there are large areas of necrosis. If it is very dirty wounds and development in her infection apply introduction to the wound antibiotics (neomycin, emulsion of syntomycin and others).
When purified from decay and infection well granulating wound shown ultraviolet irradiation, long term use of protective (oil-balsamic and other ointment) bandages. Under the excessive growth of granulation them burn the 20% solution of nitrate of silver.

Bandaging and practical activity in the treatment of wounds, which consists in the removal of old contaminated dressings, inspection wounds, toilet surrounding skin, cleaning wounds, the use of different drugs to the wound, the imposition of a new dressing.
Dressings produced in a special room - dressing (see Operationally dressing unit), with strict rules of aseptics.
Nurse involved in Petrograd, processes hands as before donning sterile gown, mask, sterile rubber gloves. Sister on a special table should be prepared sterile anatomical and surgical tweezers, scissors, stupid hooks of different sizes, hemostatic clips, needle holders, needles with suture material, galabovci and Pugovkina probes, spatulas, different rubber tubing, syringes etc., and also dressings.
Doctor (medical assistant, nurse) are producing bandaging in the mask and sterile instruments, not touching the hands of eczema, wounds and bandaging materials. At the beginning of the work in the dressing room produce a pure manipulation, then bandaged granulating wounds and finally, purulent.
If there is a vast, painful Paradise for 30 minutes until P. injected drugs, in some cases P. performed under anesthesia.
Dressings produced when there is sufficient light, at the dressing table. Only in some cases (for example, with a little wound on the upper extremities) sick during pastels can sit.