Author
Nathalie Smith, RN, MSN, CNP
Reviewers
Darlene A. Strayer, RN, MBA Cinahl Information Systems Glendale, California Nursing Practice Council Glendale Adventist Medical Center Glendale, California
44 The various functions of elastic bandages are to provide tissue compression to reduce the flow of blood and lymphatic fluid to the area in order to reduce pain and swelling of soft tissue at and around an area of traumatic injury (e.g., a joint sprain) hold other bandages in place on wounds in extremities, including amputation stumps stabilize an arm or leg in a splint in order to allow time for tissue swelling to resolve prior to casting promote the return of venous blood in a limb to central circulation in patients with lymphedema or other conditions characterized by diminished venous return maintain cold or hot packs in place on a body part, such as the arm
Editor
Diane Pravikoff, RN, PhD, FAAN Cinahl Information Systems
December 7, 2012
Published by Cinahl Information Systems. Copyright2012, Cinahl Information Systems. All rights reserved. No part of this may be reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, or by any information storage and retrieval system, without permission in writing from the publisher. Cinahl Information Systems accepts no liability for advice or information given herein or errors/omissions in the text. It is merely intended as a general informational overview of the subject for the healthcare professional. Cinahl Information Systems, 1509 Wilson Terrace, Glendale, CA 91206
become dumbbell-shaped 44 Removal of saphenous veins during coronary artery bypass graft (CABG) surgery may cause significant lower leg edema and is associated with increased pain, numbness, and delayed healing of the vein removal site. In a study of 255 patients randomized to treatment with compression stockings or elastic bandages after CABG surgery, compression stockings were reported to be significantly more effective in reducing foot edema in the leg from which the vessel was obtained. These findings suggest that compression stockings are more effective than elastic bandages in promoting venous return after CABG, an advantage that may lessen pain and promote healing following CABG (Zohreh et al., 2009) 44 A number of recent controlled clinical trials have compared the use of soft immobilizer splints to traditional casting methods in children with upper extremity fractures. Prior to application of the soft immobilizer splint, the affected extremity was often wrapped in an elastic bandage for compression and support of injured tissue. Authors of a review of literature comparing outcomes of the use of such immobilizer splinting versus casting on resolution of distal tibial fractures found that soft immobilizer splints are equally as effective as plaster casts. The splints were preferred by children and parents because of the ability to remove them prior to bathing (Boutis et al., 2010; Firmin et al., 2009) In addition, children with soft immobilizer splints showed greater improvement in physical functioning and lower pain scores after initial injury compared with children who had casts plaster casts often required more frequent medical visits because of problems such as pain or the need for reapplication of the cast because it got wet. This had economic implications because more money was spent in terms of time and resource management Radiographs taken at 4 weeks of all subjects (both the cast and splint groups) confirmed that all fractures healed comparably well Overall, existing studies suggest that the use of soft immobilizer casts, which often include the use of an underlying elastic bandage, are as effective as the use of plaster casts in supporting the distal tibia and wrist in children during healing, and may offer more cost-effective care
Patients and caretakers involved in the study reported in 1982 identified the following problems with use of elastic bandages (Mueller, 1982): Elastic bandages are less likely to remain secure than plaster-impregnated dressings, especially when patients are in bed Elastic bandages may also provide poor control of edema compared with rigid dressings, cause skin breakdown, and cause the limb stump to
Clips, Velcro, or adhesive tape to secure the bandage. The type of closure chosen depends upon the needs of the patient, manufacturers Facility-approved pain assessment tool
44 44 44 44 instructions, and/or facility protocols; many commercially available elastic bandages include a closure device
3-inch-wide elastic bandages are appropriate for bandaging an adults leg 2-inch-wide elastic bandages are routinely used for an adults wrist
44 44 44
44
44 44
Other Tests, Treatments, or Procedures That May Be Necessary Before or After Applying an Elastic Bandage
44 After the bandage has been applied, the patients condition and the integrity of the bandage are evaluated at regular intervals according to facility protocols to promote patient safety and comfort and to assess the adequacy of blood flow to the affected limb During initial monitoring, the bandage should be removed at least twice for a few minutes to evaluate the condition of the skin under the bandage At regular intervals, assess skin color and temperature and the adequacy of pulses in the bandaged limb distal to the bandage, and assess for pain
Red Flags
44 If wounds or other breaks in skin integrity are noted at the site to be bandaged or manifestations of inadequate limb circulation are present, the elastic bandage should not be applied 44 Signs and symptoms indicating that excessive tissue pressure is being exerted on the site by the elastic bandage include patient reports of pain, numbness, and/or tingling under or distal to the elastic bandage blueness, paleness, and/or coolness in the area of the patients limb that is distal to the area where the elastic bandage is wrapped 44 If signs and symptoms of excessive tissue pressure develop, initiate the following: Remove the dressing because the bandage is probably too tight and is compressing muscles and nerves Gently massage the area under and distal to the bandage to relieve the muscle and/or nerve compression and to promote blood circulation Reassess the patient within 5 minutes and replace the dressing if the signs and symptoms have resolved, applying it more loosely to the affected area If the signs and symptoms are unresolved, notify the treating clinician, who will evaluate the patient and initiate appropriate interventions (e.g., discontinuing use of the elastic bandage)
Note
44 Recent review of the literature has found no updated research evidence on this topic since previous publication on April 29, 2011
References
Boutis, K., Willan, A., Babyn, P., Goeree, R., & Howard, A. (2010). Cast versus splint in children with minimally angulated fractures of the distal radius: A randomized controlled trial. CMAJ, 182(14), 1507-1512. Elastic bandage application. (2012). Lippincotts nursing procedures and skills. Retrieved from http://procedures.lww.com/lnp/view.do?pId=792162&s=p Firmin, F., & Crouch, R. (2009). Splinting versus casting of torus fractures to the distal radius in the paediatric patient presenting at the emergency department (ED): A literature review. Int Emerg Nurs, 17(3), 173-178. Mueller, M. J. (1982). Comparison of removable rigid dressings and elastic bandages in preprosthetic management of patients with below-knee amputations. Physical Therapy, 62(10) 1438-1441. Nawijn, S. E., van der Linde, H., Emmelot, C. H., & Hofstad, C. J. (2005). Stump management after trans-tibial amputation: A systematic review. Prosthetics and Orthotics International, 29(1), 13-26. Zohreh, K., Farah, A. E., Mehrab, M., Abbas, S. O., Alireza, H., Soraya, M., & Soheil, S. (2009). Comparison of compression stocking with elastic bandage in reducing postoperative edema in coronary artery bypass graft patient. Journal of Vascular Nursing, 27(4), 103-106.