APPLICATION OF

BANDAGES AND BINDERS

BANDAGES
 bandage
-a piece of gauze or other material to be
applied to fit body and used to cover a
wound
-usually dispensed in rolls of various widths
(most commonly 1.5 – 7.5 cm (0.5 – 3 in))
-before applying a bandage, the nurse
needs to know its purpose and to assess
the area requiring support. When
bandages are used to secure dressings,
the nurse wears gloves to prevent contact
with body fluids.
Binders
-is a type of bandage
specifically designed
to fit a large body
area, such as the
abdomen, chest or
breast
-A binder is a type of bandage designed for a
specific body part; for example, the triangular
binder (sling) fits the arm
-used to support large areas of the body, such as
the abdomen, arm, or chest.
-can be simple, inexpensive and customizable by
using plain material such as the triangular sling,
or they can be of commercial design which are
often easier to use, more expensive, and slightly
less modifiable such as the hook and loop
(Velcro) binder
 Purpose
1. To create pressure over an area to stop
bleeding
2. To immobilize part of the body to restrict
its motion
3. To support a part of the body
4. To prevent or reduce swelling as well as
to assist in the absorption of tissue fluid
5. To correct a deformity
6. To secure a limb to a splint or posterior
mold
7. Used to hold dressings in place
8. To protect wound from contamination
9. To apply and retain warmth over a joint as
in rheumatoid arthritis
10. To apply pressure to lower extremities
and aid in venous return
EQUIPMENT
ASSESSMENT BEFORE APPLICATION OF
BANDAGES OR BINDERS

• Inspect and palpate the area for swelling

• Inspect for the presence of and status of wounds
(open wounds will require a dressing before a
bandage or binder is applied)
• Note the presence of drainage (amount, color,
odor, viscosity)
Inspect and palpitate for adequacy of circulation
(skin temperature, color, and sensation). Pale or
cyanotic skin, cool temperature, tingling, and
numbness can indicate impaired circulation
• Ask the client about any pain experienced
(location, intensity, onset, quality)
• Assess the ability of the client to reapply
the bandage or binder when needed.
• Assess the capabilities of the client
regarding activities of daily living (eg. To
eat, dress, comb hair, bathe) and assess
the assistance required during the
convalescence period.
 Types of Bandages
1. ROLLER BANDAGES- a continuous strip
of material wound on itself to form a
cylinder or roll.
-The free end of the roll is called the
initial extremity; the end of the roll is
called the terminal end. The rolled
portion is called the body

.
1.1. Circular Turns- used to anchor
bandages and to terminate them.
- not usually directly
applied to a wound
1.2. Spiral turns- used to bandage parts of
the body that are fairly uniform in
circumference, for example, the upper arm
or upper leg, or when the part being
bandaged is cylindrical such as the area
around the wrist, the trunk.
1.3. Spiral reverse turns- a spiral turn in
which reverse are made halfway through
such turn
- used to bandage
cyclindrical/cone-shaped parts of the body
that are not uniform in circumference, for
example, the lower leg, thigh,or forearm.
1.4. Recurrent turns- also called the stamp
bandage
-after a few circular turns to
anchor the bandage, the initial end of the
bandage, is placed in the center of the part
being bandaged, from the well back from the tip
to the covered. The body is passed back and
forth over the tip. First one side and then in the
other side of the center piece of bandage
-used to cover distal parts of the body, for
example, the end of a finger, the skull, or
the stump of an amputation, and for head
bandages.
1.5. Spica – consists of
ascending and
descending turns with all
turns overlapping and
crossing each other to
form an angle.
- particularly
useful for bandaging the
thumb, breast, the
shoulder, the groin and
the hip.
1.6. Figure-of eight turns – consists of making an
oblique overlapping turns that ascend and
descend alternately. Each turn crosses the one
proceeding it so that it appears like the figure
eight
-used to bandage around joints such
as the elbow, knee, wrist or ankle, because they
permit some movement after application
-
 Circular Turns
1. Hold the bandage in your dominant and,
keeping the roll uppermost, and unroll
the bandage about 8 cm (3 in). This
length of unrolled bandage allows good
control for placement and tension
2. Apply the end of the bandage to the part
of the body to be bandaged.Hold the end
down with the thumb of the other hand
3. Encircle the body part a few times or as often as
needed, making sure that each layer overlaps
one-half to two-thirds of the previous layer. This
provides even support to the area
4. The bandage should be firm but not too tight.
Ask the client if the bandage feels comfortable.
A tight bandage can interfere with blood
circulation, whereas a loose bandage does not
provide adequate protection
5. Secure the end of the bandage with tape
or a safety pin over an uninjured area.
Pins can cause discomfort when situated
over an injured area
 Spiral Turns
1. Anchor the bandage with two circular
turns, and bring the bandage upward at
about a 30-degree angle
2. Place the thumb of your free hand on the
upper edge of the bandage. The thumb
will hold the bandage while it is folded on
itself
3. Unroll the bandage about 15 cm (6 in), nf
then turn your hand so that the bandage
falls over itself
4. Continue the bandage around the limb,
overlapping each previous turn by two-
thirds the width of the bandage. Make
each bandage turn at the same position
on the limb so that the turns of the
bandage will be aligned
5. Terminate the bandage with two circular
turns, and secure the end as described for
circular turns.
 Recurrent Turns
1. Anchor the bandage with two circular
turns.
2. Fold the bandage back on itself, and bring
it centrally over the distal end to be
bandaged.
3. Holding it with the other hand, bring the
bandage back over to the right of the
center bandage but overlapping it by two-
thirds the width of the bandage.
4. Bring the bandage back on the left side,
also overlapping the first turn by two-thirds
the width of the bandage.
5. Continue this pattern of alternating right
and left until the area is covered. Overlap
the preceding turn by two-thirds the
bandage with each time.
6. Terminate the bandage with two circular
turns. Secure end appropriately.
 Figure-Eight Turns
1. Anchor the bandage with two circular
turns.
2. Carry the bandage above the joint,
around it and then below it, making a
figure-eight.
3. Continue above and below the joint,
overlapping the previous turn by two-
thirds the width of the bandage.
4. Terminate the bandage above the joint
with two circular turns, and then secure
the end appropriately.
 Key Points on Bandaging
1. Hold the roll of bandage in the dominant
hand, with the loose end on the distal
portion of the area to be bandaged. This
end is held with the non-dominant hand.
2. When applying the bandage, hold the
rolled bandage so that it unrolls from the
bottom of the roll, making application
easier
 Cont. key points
3. The roll of the bandage id then unrolled
proximally, applying slight tension as it is
unrolled around the body part. Bandages
are applied starting at the distal and
moving toward the proximal body part
4. The first or three turns of the bandage
should overlap to secure the loose end, to
prevent the bandage from unwrapping.
 Cont. key points
5. The roll of bandage can be transferred
from hand to hand and should be applied
evenly and firmly, but caution should be
taken to avoid the bandage being so tight.
An uneven or too tight application can
create a tourniquet effect, reducing
circulation, with the possibility of causing
skin breakdown and nerve damage.
 Types of Bandage
1. BINDERS
2.1. T-binder-is used for securing
dressings in the perineum and in the
groin. It is so named because it looks like
a letter T
2.1.1. Single T-binder- has a tail
attached at right angles to a belt. It is
used for females
 2.1.2. Double T-binder- has two tails
attached to the belt, it is used for males.
The belt is passed around the belt and
secured with safety pins.
2.1.3. Four-tailed binder- used for
securing dressings on the nose and chin.
It has four tails, two on each side.
2.2. Many tailed binders- also called
scultetus binders which provides
abdominal support often an abdominal
operation or delivery. It is made of muslin
strips, 3-4 inches wide and 4 ft. long sewn
in layers overlapping each other by one
inch. The middle section is sewn together,
with about 20 inches left free at each end
Steps in Applying Scultetus Binder
1. Expose the abdominal and pubic area, but not
before ensuring the patient’s privacy by
screening the bedside unit
2. Move the patient near the side of the nurse.
3. Raise the hip or help the patient raise her hip
4. Quickly slip the scultetus binder under the hips
with the solid portion under the patient’s body
and the top edge at the level of the waist
 Cont. scultetus
5. Extend the tails out
6. Position the binder properly and let the
patient assume the supine position
7. The bottom tail is brought across the
patient with the start of application at the
level of the pubic region. Pull the end
tightly. If it is too long, fold the end back
itself
 Cont. scultetus
8. Continue applying tail toward the waist,
slanting slightly forward and strips from
each side of the abdomen alternating with
each other.
9. Secure firmly at the waist with safety pin .
2.3 Triangular binder
- is commonly a sling to support an injured
arm. It can be made from alarge diaper about
40 inches square. It can be used as a large arm
sling, a small sling, to support the patient’s wrist
hand, and as a triangular sling to support his arm
with his hand elevated. It is also useful for
retaining dressing on the elbow hand shoulder,
hip, knee and foot.
 Triangular Arm Sling
1. Ask the client to flex the elbow to an 80-degree
angle or less, depending on the purpose. The
thumb should be facing upward or inward
towards the body. An 80-degree angle is
sufficient to support the forearm, to prevent
swelling of the hand, and to relieve pressure on
the shoulder joint (e. g. to support the paralyzed
arm of a stroke client whose shoulder might
otherwise become dislocated) . A more acute
angle is preferred if there is swelling of the hand
 Triangular Arm Sling
1. With the apex of the triangle pointing
toward the elbow, place one end of the
triangle over the shoulder of an uninjured
side, then carry it around the neck so that
it hangs over the shoulder on the injured
side, then carry it hangs over the shoulder
on the injured side.
 Cont. triangular
2.Place the sling against the body and under
the injured arm (the apex of the triangle is
now behind the elbow of the injured side)
3. Assist the patient to flex his elbows with
his thumbs upward until it is at right angle
of his upper arm
4. Bring the lower corner of the triangle up
cover the arm to the shoulder of the
injured side.
 Cont. triangular
5. Make sure the wrist is supported, to
maintain alignment.
6. Fold the sling neatly at the elbow, and
secure it with safety pins or tape. It may
be folded and fastened at the front.
7. Remove the sling periodically to inspect
the skin for indications of irritation,
especially around the site of the knot
2.4. Straight binders
- straight piece of material usually
about 15-20 cm or 6-8 inches wde and long
enough to move than circle the torso. It generally
is used for the chest and abdomen. It must be
applied to fit the contours of the body. This is
usually done by making small tucks in the binder
as necessary. In some instances, these tucks
can be secured with safety pins. A straight
binder for the chest often is provided with a
shoulder strap so that it will not slip down the
trunk
 Straight Binder
1. With the client in a supine position, place
the binder smoothly under the body, with
the upper border of the binder at the waist
and the lower border at the level of the
gluteal fold. A binder placed over the waist
interferes with respiration; one placed too
low interferes with elimination and walking
 Cont. straight
2. Apply padding over the iliac crest if the
client is thin.
3. Bring the ends around the client, overlap
them, and secure them with pins or Velcro.
Place the top pin horizontally at the waist
to allow for comfort when moving.
 Securing Peritoneal Dressings
-previously, T-binders were used to secure
dressings to the peritoneal area. T-binders
have been replaced with sanitary
disposable garments that fit like briefs.
Placing an appropriate sized abdominal
pad or sanitary napkin in the garment
allows the wound to be protected and
drainage to be collected for either males
or females.
3. Stockinette- is a stretchable tubular
bandage constricted so that a body part
may be inserted into it such as finger, a
foot or an arm. It is useful for making caps
for securing dressings in the head.
4. Elasticized stockings
- the stockings help to promote venous
return and to avoid stagnation of blood
and possible clot formation.
- It provides pressure on the legs of
persons with varicose veins, those with
circulatory disturbances and for women
during pregnancy.
 Lifespan Considerations in
Applying Bandages and Binders
 CHILDREN

• Allow the child to help with the procedure by

holding supplies, opening boxes, counting turns
and so on.
• If a young client is apprehensive, demonstrate
the procedure on a doll or stuffed animal.
• Encourage the child to decorate the bandage
• Teach the caregivers to apply bandage and
binders safely
 Elderly
• Older clients may need extra support
during the procedure, especially if arthritis,
contractures, or tremors are present
• Avoid constricting the client’s circulation
with a tight bandage or binder. Observe
skin and bony prominences frequently for
signs of impaired circulation. The risk for
skin breakdown increases with age.
Home Care Considerations
• Assess the client’s or caregiver’s
knowledge level of reason for bandages or
binders. Assess ability and willingness to
perform the bandaging procedure.
• Ensure that the client has the proper
supplies; assess for adequate and safe
storage of supplies in the home, and
ensure client knows how to obtain
replacement supplies
• The client should have two binders so that
there is one to wear while the other is
being washed. Bandages and binders
should be washed inside a mesh laundry
bag to keep them from becoming twisted
and to prevent Velcro or hooks from
catching on other laundry.
• Instruct the client’s caregiver on the
importance of and how to:
2. Wash hands thoroughly before handling
dressing supplies and applying the
bandage.
3. Report skin breakdown, redness, pain or
pallor of the affected area.
4. Check for adequate peripheral circulation
after applying bandage.
PERFORMANCE EVALUATION FOR
APPLICATION
OF BANDAGES AND BINDERS
• Definition:
• Application of strip of material such as
gauze used to protect, immobilize,
compress, or support a wound or injured
body part
Purpose
• To create pressure over an area to stop bleeding
• To immobilize part of the body to restrict its motion
• To support a part of the body
• To prevent or reduce swelling as well as to assist in the
absorption of tissue fluid
• To correct a deformity
• To secure a limb to a splint or posterior mold
• Used to hold dressings in place
• To protect wound from contamination
• To apply and retain warmth over a joint as in rheumatoid arthritis
• To apply pressure to lower extremities and aid in venous return
• Equipment
– bandage
– binder
1. Observe medical asepsis when applying
bandages and binders. When an open
wound is present, apply the bandage over
the sterile dressing. (The area which
bandage and binders are applied should
be clean and dry. They are washed and
sterilized between uses on different
patient when recleaned for use)
2. Use porous rather than non-porous
materials when possible. (Porous
materials allow for evaporation of
perspiration and the escape of heat by
allowing air to circulate)
3. Apply small amount of powder to the
unbroken skin. Make very certain that the
powder does not enter a wound if one is
present. (Powder helps the skin dry and it
decreases friction in the skin. Powder on
an open wound irritates tissues and delays
healing)
4. Do not allow two skin surfaces to touch each other under
the bandage or binder. Use absorbent material such as
cotton wadding or gauze between touching skin
surfaces. For example, when toes or fingers are
bandaged together, place padding between then first to
prevent skin from rubbing against the skin. Similar
protection is needed in the axillary area, the breasts, and
folds in the groin or abdomen (Skin surfaces touching
each other will cause rubbing and friction when the
patient moves materials placed between the skin
surfaces absorbs moisture to further reduce skin irritation
and injury)
5. Pad bony prominces over which
bandages and binders are placed. Hollow
contours may be filled with padding
(These techniques increase comfort for
patient and help maintain equal pressure
on bony parts)
6. Place the part to be bandaged
comfortably at rest in its normal anatomic
alignment. For example, when bandaging
the foot, support it so that the bandage will
not force in the foot drop position. Joints
should be slightly flexed rather than
extended or hyperextended.(If the part to
be bandaged is not in proper alighnment,
the part may be forced into an improper
position and a deformity could result)
7. Apply a bandage or binder with sufficient but
with neither too little not much pressure.
(Applying a bandage or binder with sufficient
pressure provides for the amount of
immobilization or support desired, ensured that it
remains in place and secures a dressing if one is
present. Too little pressure defeats the purposes
of the bandage or binder and allows it to slip
about on the skin. Too much pressure may
interfere with circulation and cause discomfort)
8. Apply a bandage over a wet dressings or
draining wound less rightly than usual. (If a
bandage or binder becomes wet, it is likely
to shrink when it dries and become too
tight for safety and comfort )
9. Do not apply a binder on the chest too
snugly. (A binder applied too snugly on the
chest wall interferes with breathing
allowing exposed fingers and toes on
bandage extremity permits nurse to
observe for sign of change in circulation
in the extremity)
10. Leave a small portion of an extremity,
such as the fingers or toes exposed.
11. Observe for signs of impaired circulation which includes
coldness, numbness of the part, swelling, bluish coloring
of the skin and nailbeds and tingling pain. Report sign
promptly. A test of circulation can be done by applying
pressure on the nailbeds with four fingers. In normal
circumstances, the area will blanch first and then return
to its original nailbed is released. If the bandage is too
tight the blood neither leaves nor return to the area
quickly. (Corrective action should be taken if signs of
impaired circulation is present. Prolonged can result in
the death of tissue cells)
12. Do not leave a considerable portion of the end
of an extremity uncovered. For example, start
bandaging an arm or leg, the foot or hand rather
than begin the bandage somewhere at midarm
or midleg. The heel should not be left exposed
when the foot or legs are bandaged. (Swelling is
likely to result if a large exposed area of an
extremity is left uncovered below a bandage.
After a swelling occurs, tension on the lower
border of the bandage increases making the
situation worse)
13. Bandage an extremity towards the body.
(Bandaging towards the body helps prevent
congestion and interference with circulation in
the distal part of the extremity. Heavy and
extensive bandaging makes the area
unnecessarily warm and it will not be
comfortable for the patient. Pressure from pins,
clips and knots is uncomfortable, may interfere
with circulation and may cause injury to skin and
nerve tissues)
14. Avoid unnecessary thickness per
extensive bandage
15. Place pins, clips and knot used to
secure the bandage or binder well away
from a wound or a tender and inflamed
area. Also, place them so that they do not
cause unnecessary pressure on a part of
the body. For example, a knot to secure a
sling should be placed near the shoulder
rather than over the cervical position of the
spine.
16. Check the bandage and binders at regular
intervals, including the times when the patient is
asleep. Note the circulation and see that the
patient is in proper body alignment. If a bandage
or binders has loosened or slipped out of place,
reapply it when necessary. (It is important to
assess the patient’s condition at regular intervals
in order to determine the effectiveness of a
bandage or binder and to note any signs of
problems promplty)
 PERFORMANCE EVALUATION FOR
APPLICATION
OF SCULTETUS BINDER
• Definition:
A scultetus binder is a many-tailed binder
or bandage with an attached central piece.
The tails are overlapped. The last two, tied
or pinned, act to secure the others. A
Scultetus binder may be opened or
removed without moving the bandaged
part of the body. Also called Scultetus
bandage.
Purpose
• abdominal support dressing
• hold dressings in place
Equipment
• -scultetus binder
• -safety pin
1. Expose the abdominal and pubic area,
but not before ensuring the patient’s
privacy by screening the bedside unit
2. Move the patient near the side of the nurse

3. Raise the hip or help the patient raise her hip

4.Quickly slip the scultetus binder under the hips

with the solid portion under the patient’s body
and the top edge at level of the waist.
5. Extend the tails out.

6. Position the binder properly and let the patient

assume supine position.

7. The bottom tail is brought across the patient

with the start of the application at the level of the
pubic region. Pull the end tightly. If it is too long,
fold the end back itself.
8. Continue applying tail toward the waist
slanting slightly forward and strips from
each side of the abdomen alternating with
each other.

9. Secure firmly at the waist with a safety

pin.
 PERFORMANCE EVALUATION FOR
APPLICATION
OF LARGE ARM SLING
Purpose
• To immobilize part of the body to restrict its
motion
• To support a part of the body
• To correct a deformity
• To secure a limb to a splint or posterior mold
• Used to hold dressings in place
• To protect wound from contamination
Equipment
• - triangular bandage
1. With the apex of the triangle pointing
toward the elbow, place one end of the
triangle over the shoulder of an uninjured
side, then carry it around the neck so that
it hangs over the shoulder on the injured
side, then carry it hangs over the shoulder
on the injured side.
2.Place the sling against the body and under
the injured arm (the apex of the triangle is
now behind the elbow of the injured side)

3. Assist the patient to flex his elbows with

his thumbs upward until it is at right angle
of his upper arm
4. Bring the lower corner of the triangle up
cover the arm to the shoulder of the
injured side.
5. Tie the end together with a square knot
6. Fold the apex of the triangle forward the
elbow and secure with safety pins
7. Adjust the height of the sling by adjusting
the knot at the back.
 THE END

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