Integumentary: Applying dressings and bandages

Some of the clients you care for will have dressings on their wounds, which are used to protect the wound; absorb wound drainage, or exudate; keep microorganisms from entering the wound; promote comfort, or keep the wound dry during bathing.

Some dressings can even be used to apply pressure to control bleeding, while others can help remove dead or infected tissue: a process called debridement.

As a nursing assistant, you will have the opportunity to assist the nurse with applying dressings or bandages, and in the cases where your facility policy allows, you may be asked to apply dressings and bandages for some clients without the nurse’s assistance.

One of the most common types of dressings you will apply are gauze dressings, which are made of cotton or synthetic material. A dry gauze dressing is applied to protect a wound and absorb small amounts of exudate.

Sometimes a moist-to-dry gauze dressing is applied, which just means that the gauze is moistened first before it’s applied to the wound then a dry gauze is layered on top.

As the moist dressing dries, it helps with debridement and removal of exudate. Gauze dressings are usually secured with tape, which can sometimes irritate the client’s skin, especially as it is peeled off for dressing changes.

In cases where the dressing is large and needs to be changed frequently, it can be secured with Montgomery ties, or tape ties, which is when a wide strap is attached to the skin and then tied together over the wound.

Whenever the dressing needs changing, the ties are untied and then tied again over the new dressing, so no peeling of tape is required!

If a dressing needs to be secured over a joint, such as a wrist or knee, a bandage made of rolls of webbing, gauze, or stretchy elastic material is wrapped around the dressing.

Some small wounds, minor burns, or intravenous catheter insertion sites can be covered with a transparent dressing, which is a thin film with an adhesive coating on one side.

Transparent dressings do not absorb exudate, but they allow you to see through the dressing, so you can observe the wound, and it allows the exchange of air at the wound site while preventing water or bacteria from entering. This dressing also creates a moist healing environment for the wound.

Okay, now let’s discuss some general tips for applying dressings and bandages. First, check with the nurse and the client’s plan of care, so you know what type of wound the client has, what type and size of dressing and tape to use, how often the dressing needs to be changed, if the wound needs to be cleaned, and if there are any special concerns the nurse has about the client.

Applying dressings can be uncomfortable and even painful, so find out if the nurse plans to administer pain medication beforehand.

If pain medication is administered, wait until the medication takes effect then check with the nurse before you start or assist with the procedure.

As you apply the dressing, avoid reaching over the wound or your work area; this will help prevent contamination.

If you are removing an old dressing first and need to remove any tape, do so slowly and gently, pulling toward the wound. Remember some clients are allergic to tape so check for allergies in the client’s plan of care.

Also, if you are wrapping a bandage over a dressing, be sure to check back frequently to provide range of motion and observe the color and temperature of the extremity.

Finally, remember the dressing can stick to the wound, so ask the nurse about moistening the dressing with a saline solution before removing it.

When applying a dressing, first gather the supplies you need: clean gloves and other personal protective equipment, or PPE, like a mask or gown if needed; a towel or something to protect the client’s bed linen, like a bed protector; appropriate dressings; tape or bandages to secure the dressing; sterile 4x4 gauze squares or cotton balls and saline solution if directed by the nurse; forceps; paper towels; and a biohazard bag for disposal of soiled materials.

Cover the bedside table with paper towels and arrange your supplies. Place the biohazard bag where you can easily reach it. After performing hand hygiene, put on clean gloves and other PPE as needed.

Then raise the bed to a height that’s comfortable to work with. Make sure the wheels on the bed are locked and lower the bed rail on the side you’ll be working on.

Assist the client into a comfortable position and place the towel as needed to protect the bed linen under the area you’ll be working on. Expose the wound while keeping the rest of the client covered.

If you need to remove the existing gauze dressing, gently peel the tape by holding down the skin and pulling the tape toward the wound or, if Montgomery ties are present, untie the straps and fold them away from the wound.