Client Education Key to Bandage Care
Iatrogenic problems resulting from inappropriate bandage technique or care are common but avoidable. Bandage functions include protection of the wound from the environment; prevention of further tissue damage; provision of a moist, warm environment; pressure and pain relief; immobilization of skin edges; delivery of topical agents; absorption of exudate; debridement of wounds; and stabilization of concurrent orthopedic injuries.
Client education about proper bandage technique and home care will help ensure high-quality care.
Bandage-related injuries are either primary or secondary; primary injuries occur while the bandage is still in place and often result from interrupted blood flow to the tissues, causing direct pressure necrosis, whereas secondary injury occurs 24–48 hours after bandage removal and is caused by an inflammatory reaction when blood flows back into ischemic tissue.
Causes of injury related to bandage placement include bandages that are too tight (upon placement or later because of swelling or a wet dressing), bandages that are too loose, inadequate padding or protection of sensitive areas (eg, joints), or skin damage from adhesive materials. Injuries can also be related to lack of client compliance (eg, allowing bandages to become wet, leaving bandages on too long, allowing the patient to over-exercise).
Client education about proper bandage technique and home care will help ensure high-quality care. Clients should be instructed to return the patient for veterinary care if chewing or excessive licking are noted, because this may indicate injury. Most injuries are sustained within 24–48 hours of bandage placement, and removal at this time is preventive.
The most common bandaging complications appear to be bandage slippage or bandage application that is too tight; the latter is most likely to occur when highly extensible materials are used. In the cited review of ischemic injury,1 pain was the most common sign, typically occurring within hours to one day after bandage application, but it was often not reported by clients for days. Pain and swollen, discolored, or cold toes should be stressed by the veterinary team as emergency situations needing immediate attention.
All team members should make sure clients feel comfortable contacting the practice with any questions or concerns. Clients may want to avoid “bothering” a busy veterinarian or may assume problems not included in the list of home-care instructions are not noteworthy.—Eric R. Pope, DVM, MS, DACVS