Medicines needed for work in the dressing room. It is necessary to clearly understand the difference between the dressing material and the methods of its fixation. Wound dressings for dressings

The dressing room should have a large selection of antiseptics and other medicines.

Boric acid. Use a 2-4% solution for washing wounds. Suppresses the growth of Pseudomonas aeruginosa.
Rp.: Sol. Acidi borici 4% 200 m1.
D.S. For washing wounds.





A solution of alcoholic brilliant green is used as a weak antiseptic for the treatment of the skin and mucous membranes.





Hypertonic sodium chloride solution is used in the form of a 5-10% solution to create an outflow of wound and purulent discharge.
Rp.: Sol. Natrii chloridi 10% 400 m1.
D.S. External.





Dioxidine - use a 1% solution for the treatment of purulent wounds. It has a wide spectrum of action against both gram-positive and gram-negative flora.
Rp.: Sol.Dioxidini 1%. 5ml.
D td No. 10 in amp.
D.S. External.





Diocide. Use in the form of solutions 1:5000 for the treatment of the hands of a surgeon and a nurse (exposure 3 minutes), for the treatment of tools and utensils (exposure 1 hour). Issued in the form of a tab. No. 1 and No. 2. Solutions are prepared immediately before use. To prepare the solution, crush 1 tab. No. 1 and No. 2 and dissolved in 5 liters of water. The solution is ready in 15 minutes.
At a dilution of 1:5000, diocide does not cause skin irritation and creates asepticity for 2 hours (Pills, list A.).





Iodine. Used in the form of a 5-10% alcohol tincture for treating the patient's skin and the surgeon's hands. When using a 10% solution, especially for a long period of storage, iodine solution can cause dermatitis and skin burns. Store in a dark glass container with a ground stopper. A mixture of 1 part iodine, 2 parts potassium iodide and 17 parts water is called Lugol's solution. It is used for washing fistulas, purulent wounds.
Rp. T-rae lodi 5% 10 m1.
D.S. External.





Iodopyrone - 0.5-1% solution, is a compound of iodine with polyviylpyrrolidone. It has a bactericidal effect on pathogenic staphylococci, Escherichia coli, Proteus. They are washed with purulent cavities through drains or soaked tampons are left.
Rp.: Sol. lodopironi 1%.
D.S. External.





Cleol is used to fix bandages on the patient's body. Cleol does not irritate the skin. Occasionally, with repeated application of bandages in the armpit, inguinal region, a rash and slight hyperemia may appear on the neck. To avoid this, when re-dressing, the remnants of cleol should be removed with a swab dipped in ether, alcohol, gasoline.
Rp.: Resinae Pinis 30.0
Aetheri 100 m1.
Ol. Lini 1ml
D.S. Adhesive for bandages.





Potassium permanganate is used in the form of a 3% solution for the preparation of hand and foot baths; in the form of 5% - as a drying agent; 0.1% - for washing wounds. Stored in a dark bottle.
Rp.: Sol. Kalii permanganatis 5% 100 m1.
D.S. External.





Lassara pasta. Used to protect the skin from the corrosive action of intestinal, pancreatic, biliary, purulent fistulas. Apply to the skin with a spatula around the wound or fistula.
Rp.: Acidi salicylici 1.0
Zinci oxydi
Amyli tritici aa 12.0
Vaselini flavi 25.0
D.S. External.





Ointments levomekol, levosin on a water-soluble basis are used to treat purulent wounds. Tampons with these ointments do not stick to the walls of wounds.
Rp.: Ung. Laevomecoli 50.0
D.S. External.





Lysol is used in the form of a 5% solution for disinfecting instruments after purulent dressings and in the form of a 2% solution for wet cleaning of premises.
Rp.: Sol. Lysoli 2% 3000 m1.
D.S. External.





Vishnevsky's ointment is used to treat purulent wounds, ulcer cavities, bedsores, etc., in order to accelerate the regeneration process.
Rp.: Picis liguidae 3 m1.
Xerotormii 3ml.
Ol. Ricini 100 ml.
D.S. External.





Antibiotic ointments (streptocid 10%, synthomycin emulsion 5%, tegracycline 1%, etc.) are used to treat purulent wounds, ulcers, and purulent complications. Store in a cool place.
Rp.: Em. Syntomicini 5% 50 m1.
D.S. External.
Rp.: Ung. Tetracyclini 1% 20.0
D.S. External.





Sterile vaseline oil is used to lubricate catheters.
Rp.: Ol. Vasellini 100.0
Sterilization
D.S. External.





Methylene blue is used in the form of a 1-3% alcohol solution for burns, pyoderma. For cystitis, aqueous solutions of 1:5000 are used to wash the bladder. Used for chromocystoscopy.
Rp.: Methylenblau 1.0
D.S. External.





Novocaine - 0.25% -, 0.5% -, 1% -, 2% solutions are used for local anesthesia.
Rp.: Sol. Novocaini 2% 2m1.
Dt d. No. 10 in amp.
D.S. Intramuscularly, subcutaneously.





Silver nitrate (lapis) is used in the form of a 10-25% solution for cauterization of excess granulations. Store in a dark bottle, protected from light.
Rp.: Sol. Argenti nitratis 25% 50 m1.
D.S. External.





Hydrogen peroxide is used in the form of a 3% solution for wetting dried dressings and their painless removal, as well as mechanical cleaning of the wound cavity. Hydrogen peroxide readily decomposes under the influence of heat and in the presence of organic substances. The peroxide solution is better preserved if a few drops of alcohol, ether, calcium chloride (1 g per 100 ml of solution) are added to it. The drug causes corrosion of instruments, deformation of leather and rubber products.
Rp.: Sol. Hydrogenii peroxydi 3% 150 m1.
D.S. External.





Rivanol is used as a prophylactic and therapeutic agent for washing wounds, purulent cavities, abdominal and pleural cavities in the form of a 1:1000 solution. Use freshly prepared solutions, as aqueous solutions are unstable. The drug has low toxicity. Does not cause tissue irritation.
Rp.: Rivanoli 1.0
Aq. Destill. 1000 m1.
D.S. For washing wounds.





Wine alcohol. Use at a concentration of 70% to treat the hands of the surgeon and the skin of the patient. You can use both pure alcohol (Spiritus vini rectificatus), and crude (Spiritus vini crudiis) and denatured alcohol (Spiritus vini denaturatus). Denatured alcohol has the same antiseptic properties as pure alcohol, but it is more irritating to the skin and has an unpleasant odor. Some tools and materials are stored in 96% alcohol. The disadvantage of alcohol is that it promotes blood clotting and makes it difficult to toilet the wound and its edges.





Formalin. Use in the form of a 0.5% solution for disinfection of tools and rubber products; A 5-10% solution is used for formalin disinfection of optical and rubber instruments. Store with caution in bottles with ground stoppers. In case of contact with the skin and mucous membranes, it causes irritation; if large doses are absorbed, poisoning is possible.
Rp.: Sol. Formalini 5% 500 m1.
D.S. For sterilization of the cystoscope.





Furacilin is used as an antiseptic for the prevention and treatment of purulent wounds in the form of an aqueous solution of 1:5000. Furacilin solutions do not irritate tissues, promote the growth of granulations, wound healing. The drug is effective in anaerobic infections. The aqueous solution can be stored for a long time.
Rp.: Sol. Furacilini 1:5000 2000 m1.
D.S. For cleaning cavities.





Chloramine B is used as a 0.1-0.5% solution for washing the skin, mucous membranes, wounds; A 2% solution is used to prepare the surgeon's hands, a 0.5-5% solution is used to sterilize rubber gloves, catheters, drainage tubes.





Chloroethyl is used for local anesthesia by cooling during opening or puncture of superficially located abscesses. Produced in ampoules of 10, 20, 30 ml.





Technical ether is intended for cleansing the skin around the wound from crusts, flaky epidermis and cleol residues. Flammable.

In addition, the following drugs should always be in the medicine cabinet: 40% glucose solution - 1 box; 10% calcium chloride solution - 1 box; 25% magnesium sulfate solution - 1 box; 0.1% adrenaline solution - 1 box; 1% mezaton solution - 1 box; 1% diphenhydramine solution - 1 box; 1% lobelin solution - 1 box. Apply these funds to remove the patient from anaphylactic shock. Instructions for the response of a nurse to formidable complications after any injection should hang in each locker under glass.

"Handbook of a Nurse" 2004, "Eksmo"

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• Introduction
• 1. Bandage classification
• 2 . Dressings and wound dressings
• 3 . Fixing bandages
• 4 . Bandage types
• 5 . Private types of bandages on the body area

Introduction

The existing variety of dressings requires classification for a better understanding of their purpose. Currently, there is no single generally accepted classification of dressings. From our point of view, the following classification of dressings is one of the rational options.

1. Classification of dressings

Bymindappliedmaterial.

Soft:

a) bandages;

b) bandage-free (adhesive, kerchief, sling-like, adhesive plaster, T-shaped, coatings).

Solid (tire, starch, gypsum).

ATdependenciesfromgoals.

Wound dressings:

a) sorption;

b) protective;

c) activated by drugs;

d) atraumatic (promoting wound healing and protecting against drying and mechanical irritation).

Fixing - designed to fix the dressing on the wound.

Pressure bandages - creating constant pressure on any part of the body (to stop bleeding).

Occlusive (sealing) dressings - preventing the penetration of air into the pleural cavity from the outside and a violation of the act of breathing.

Compression - designed to improve the venous outflow of blood from the lower extremities.

Immobilizing dressings:

a) transport;

b) therapeutic (ensuring the immobility of the damaged part of the body).

Corrective dressings - correcting the incorrect position of any part of the body.

Soft bandages include bandages applied with a bandage, gauze, elastic, mesh-tubular bandages, cotton fabric. Soft bandages are varied. Most often, dressings are applied to hold dressings (gauze, cotton wool) and medicinal substances in the wound, as well as to immobilize the victim for the period of transportation to a medical institution. Most often, bandages are used to apply soft bandages. Less commonly, other means (without bandages) - adhesive, kerchief, sling-like, T-shaped, contour dressings; mesh-tubular bandages.

Rigid dressings use a solid material (wood, metal) or a material capable of hardening: gypsum, special plastics and starch, glue, etc.

Most often in desmurgy dressings are used to fix the dressing material in the wound to create optimal conditions for tissue healing.

It is necessary to clearly understand the difference between the dressing material and the methods of its fixation.

2. Dressing material and wound dressings

The dressing material used during operations and for dressings must meet the following requirements: be biologically and chemically intact; have capillarity and good hygroscopicity; be minimally loose; soft, elastic, do not injure soft tissues; easy to sterilize and not lose their qualities; be cheap to produce.

According to their properties, modern dressings are divided into:

sorption;

protective;

drug activated;

atraumatic.

The classical sorbents that have found wide application are cellulose and its derivatives - cotton wool, gauze, lignin.

The most common dressing material used in surgical practice is gauze. Medical bleached hygroscopic gauze can be of two types - pure cotton and with an admixture of viscose. The difference lies in the fact that gauze with an admixture of viscose is wetted 10 times slower than cotton gauze, however, medicinal substances are absorbed worse on it, and repeated washing reduces its sorption capacity. The advantage of hygroscopic gauze is its high moisture capacity. Large and small napkins, tampons, turundas, balls and bandages, cotton-gauze medical bandages, dressing bags are made from it. The annual consumption rate for a surgical bed is 200 m of gauze and 225 bandages.

A very valuable dressing material is cotton wool, which is of two types - simple (non-fat) and hygroscopic. The latter has a high suction capacity. Plain cotton wool is not hygroscopic and is used in surgery as a soft lining, for example, when applying splints, plaster bandages, and also as a material that retains heat (warming compresses, etc.). The disadvantage of cotton wool is its relative high cost.

A cheap dressing material, which also has very high suction properties, is lignin - a specially processed wood of coniferous trees, produced in the form of layers of thin corrugated paper. Due to its low elasticity and strength, as well as its insufficient popularization among medical workers, lignin has not found wide application. In general, any but absolutely clean rag can be successfully used as a dressing material in extreme conditions. However, it is completely unacceptable to use artificial fiber fabrics for these purposes.

The insufficient amount of natural cotton materials, as well as the need to take into account the phases of the wound process, determine the development of non-woven synthetic materials. An example is a medical non-woven canvas-stitched threadless fabric made on the basis of cotton fibers, which has good plasticity, with a sorption capacity of 1400-2400%. Based on the chemical modification of viscose fibers, medical surgical hygroscopic cotton wool "Viscelot-IM" with an absorption capacity of 2,000% has been developed.

Immobilization of cellulose sorbents on such tissues increases the absorption capacity up to 3400%. Low cost and ease of sterilization determine the widespread use of such materials - cellulose gauze (Russia), "ES" (Germany), "Surgipad" (USA), etc.

The disadvantage of these materials is the adhesion to the wound. This leads to granulation injury, with pain during dressings.

Cellulose-absorbing dressings do not have these shortcomings, they are represented by a non-adhesive inner and outer water-repellent layer that prevents secretion from seeping out. Currently, self-adhesive cellulose wound dressings are produced with a hydrophobic micromesh on the side of the wound, a suction pad made of clean cotton and a soft base made of non-woven material coated with hypoallergenic polyacrylate adhesive. For the treatment of small superficial wounds, non-adhesive gel dressings are available with an integrated cellulose wadding absorbent element. These dressings are highly absorbent and air permeable.

On the basis of cellulose material, combined sorption dressings with a three-dimensional suction capacity have been created. In this case, the discharge from the wound is distributed not only superficially, but throughout the entire volume of the dressing.

The range of dressings includes dressings based on carboxymethylcellulose, viscose, oxidized cellulose. Multilayer dressings made of non-woven material such as "Biatraum" (Russia) have a gauze-like structure and consist of viscose fiber and polyester.

In addition to increasing the number of layers of cellulose material, special sorbent materials are placed in the dressing for this purpose.

According to the degree of affinity for water, all sorbents are divided into water-swellable and hydrophobic.

The sorption capacity of water-swellable sorbents is comparatively higher. This group of sorbents realizes its activity due to the combined action of three main factors - capillarity, high porosity and the effect of functional hydrophilic groups that bind water and wound exudate components. Used for this purpose, "Gelevin" and others are not wound dressings in their pure form and must be used with a gauze bandage.

Hydrophobic sorbents, in comparison with water-swellable ones, have a lower ability to absorb liquid, but actively sorb microorganisms. Among the hydrophobic sorbents, carbon, organosilicon, polyurethane, etc. are distinguished. Polyurethane sponges, which have good air and water vapor permeability, are most widely used. They are elastic and soft, while their sorption capacity is 1800-2000%.

As wound sorbents of the hydrophobic type, various carbon materials are widely used - vaulene, resorb, etc. The use of carbon materials is advisable in the treatment of wounds with low exudation. Carbon sorbents are a convenient basis for the immobilization of various drugs.

Effective sorption-active dressings are hydrocolloid dressings. Dressings of this type consist of swellable colloids encapsulated in a self-locking elastomer. Hydrocolloid dressings are intended for the treatment of slightly and uninfected, as well as moderately and slightly exuding wounds, as well as wounds with areas of "dry" necrosis. Due to the properties of the hydrogel, a plasticizing effect is provided on the wound tissues, softening of necrotic formations during diffusion of the gel under them and facilitating the removal of non-viable tissues.

Protectivebandages. They perform the function of isolation, preventing the penetration of microorganisms into the wound, and also limit moisture loss. The main, and sometimes the only, structural element of such coatings is an elastic polymer film.

Protective dressings are conditionally divided into two groups:

coatings used in finished form;

coatings formed directly on the wound.

Coatings of the first group - transparent films attached to a healthy part of the body with adhesives. They allow you to monitor its condition without removing the film, but are effective only on wounds that are not accompanied by abundant exudate.

Insulating coatings of the second group are formed directly on the surface of the wound. For this purpose, aerosol compositions have been proposed, when applied to a wound for 1-2 minutes, a film coating will be created due to the evaporation of the solvent. Film-forming aerosols include BF-6 glue, furoplast, "Lifuzol" (Russia), "Plastubol" (Hungary), etc. Coatings of this group are used to protect surgical wounds from infection, protect the skin from maceration and treat small skin wounds. Their advantages are simplicity and speed of application, which do not require highly qualified medical personnel. Saving dressings, the ability to monitor the state of the wound without changing the dressing, the film is waterproof, allowing you to wash patients. The use of film-forming coatings is contraindicated in bleeding, contaminated, weeping wounds, extensive skin lesions.

With large defects in the skin, it is very important to limit the evaporation of tissue fluid. Dressings used for these purposes are presented in the form of a polymer film with controlled gas and vapor permeability. For the same purpose, dressings are made of silicone or natural rubber, polyvinyl chloride, polyurethane, polyamides, polyethylene, polystyrene, polypropylene, silicone. In recent years, wound dressing from chitosan - "Chitosan" (Great Britain, Taiwan) has been obtained. This coating consists of a derivative of lobster chitin and is a semi-permeable biological membrane.

bandages,activatedmedicinaldrugs. To increase the therapeutic effect of dressings, they include drugs of various directions of action. As carriers for the immobilization of medicinal substances, non-woven materials made of polyvinyl alcohol fibers activated with sodium dichloroisocyanurate or hydrogen peroxide, cotton dressings, fluorolone compounds, oxidized cellulose and viscose fibers, various sponges and films are used. When drugs are introduced into dressings, their combinations are often used. To combat infection, wound dressings include antiseptics (dioxidine, chlorhexidine, capatol, miramistin) - "Aseplen-K" and "Aseplen-D", sulfonamides, antibiotics, "Lincocel" (Belarus), nitrofurans - "Coletex", iodine - "Aserlen-I". Silver ions, xeroforms are also used.

As a result of the immobilization of proteolytic enzymes on the material of the polymer coating, it is possible not only to lengthen the duration of the enzyme and reduce its therapeutic concentration, but also to limit the possibility of absorption of the drug into the bloodstream. For this purpose, enzymes are used - trypsin, chymotrypsin, lysozyme, terrilitin, etc. This group of wound dressings includes: "Polypore" - a polyurethane foam composition with immobilized trypsin; "Dalceks-trypsin" - trypsin immobilized on medical gauze; "Paxtripsin" - trypsin immobilized on a nylon knitted fabric; "Teralgin" - a porous sponge containing the enzyme terrilitin; "Ferantsel" (Belarus) - contains chymotrypsin immobilized on monocarboxycellulose.

In some cases, there is a need for local application of coatings with hemostatic properties. For this purpose, it is possible to use wound dressings containing gelatin, thrombin.

Atraumaticbandages. A serious disadvantage of many dressings is their sticking (adhesion) to the wound, as a result of which the dressings become painful, and most importantly, the regenerating tissues are injured. Currently, to eliminate these shortcomings, gauze bandages impregnated with paraffin and lanolin are used. However, such dressings are impermeable to air and do not have sorption properties.

In addition to gauze, polymeric materials are widely used to create non-stick dressings. The principle of their design is that the surface of a cellulose or synthetic material facing the wound is covered with a thin film of a hydrophobic polymer, and in order for the dressing to not lose its sorption activity, the film is usually perforated. Polyethylene, polyvinyl chloride, polyamides, silicone, polypropylene are used as materials for the hydrophobic layer. To increase the rate of absorption of exudate by the sorbent, it is proposed to cover the perforated film with surfactants, as, for example, in the Aseplen dressing.

Another way to make non-adhesive dressings is to coat the surface facing the wound with a thin layer of vacuum-sprayed metal, impregnated with silicone or acrylic resin containing ZnO, silver or aluminum powder.

The simplest and longest-used atraumatic dressings are ointment dressings. The physical and mechanical properties of such dressings can vary due to the type of material used or the composition of the ointment base. Their use is indicated in patients with sensitive skin or drug intolerance.

There is a group of sticky but atraumatic sorbent coatings based on natural and synthetic polymers. Dressings of this type do not need to be removed and remain in the wound until completely absorbed. Alginates belong to this group of wound coverings. In particular, Algipor, which is a mixed sodium-calcium salt of alginic acid, a polysaccharide derived from seaweed.

The use of collagen to obtain absorbable wound dressings is associated with its properties to stimulate fibroblastogenesis, lyse and be replaced by connective tissue. On the basis of soluble collagen, the "Kombutek-2" coating was developed; "Oblekol" - collagen film with sea buckthorn oil; "Gentatsykol" - a combination drug containing gentamicin sulfate. These drugs are used to treat bedsores, donor skin areas and other wounds in the 2nd phase of the wound process. Absorbable dressings can also be made on the basis of synthetic polymers: polyglucolide, polylactide, etc.

3. Fixing bandages

The dressing material on the wound should be applied so that it does not stray and does not squeeze the damaged part of the body, providing, under certain indications, rest for the damaged organ, the most advantageous functional position and free outflow of the wound discharge.

There are a fairly large number of ways to fix the dressing, and each has certain indications.

Adhesivebandages

Adhesive dressings are applied to the area of ​​the postoperative wound and in case of small injuries. Their advantages:

by closing the area of ​​the wound directly, one can observe the state of the surrounding skin;

easy and quick to apply;

do not limit the movements of the patient;

economical.

Allocate the following adhesive bandages.

Adhesive plasters bandages

The simplest form of strengthening bandage is the adhesive bandage. Adhesive plaster is produced in the form of rolls of tape of various widths. It adheres well to dry skin and is used to fix various dressings and to seal minor wounds. Adhesive plaster is also used when it is necessary to bring together the edges of a granulating wound and keep them in this position to speed up the healing process. The sticky patch is used to treat fractures by continuous traction, especially in children. Adhesive plaster is of great importance when it is necessary to eliminate the communication of any cavity with the atmosphere, for example, with penetrating wounds of the chest. To apply such a bandage, a piece of adhesive tape is taken that is larger than the wound. The first strip is placed at the lower edge of the wound, bringing its edges closer. The second strip of plaster and each subsequent one in such a way that they seal the previous one 1/3 of the width, like tiles on a roof, hence the name "tiled" dressing. Adhesive dressings come off when wet, irritate the skin, and are laborious and expensive when used in large volumes.

Cleol bandage

Currently, cleol is used for sticker bandages, which does not tighten and irritate the skin less. Its composition: rosin - 40 parts, alcohol 96 ° - 33 parts, ether - 15 parts, sunflower oil - 1 part. The procedure for applying an adhesive bandage: a dressing is applied to the wound, and the skin around the wound is smeared with a cotton swab with a thin layer of glue. After 30-60 seconds, when the glue begins to dry out a little, a gauze napkin of the required shape and size is glued, pressing it tightly against the skin and stretching along the edges. The free edges of the gauze napkin that do not stick to the skin are cut off.

collodion bandage

Collodium is a solution of colloxylin in ether and alcohol. The solution is applied with a brush to the edges of a gauze pad applied over the dressing. When the solvents evaporate, the collodion solidifies, tightly fixing the bandage to the skin. The disadvantages of this dressing are skin irritation and discomfort as a result of skin tightening at the site of lubrication with collodion, in addition, collodion is highly flammable. Currently, collodion dressings are used quite rarely.

kerchiefbandages

A kerchief is a common first aid bandage, since it does not require complex devices, it can be quickly applied using a headscarf, sheet, gauze flap, canvas, etc. A kerchief is a piece of triangular-shaped fabric in which a base is distinguished (long side ), the top (the angle lying against the base) and the ends - the other two corners.

When providing first aid, a scarf made from a headscarf can be used to apply a bandage and fix the dressing on almost any part of the body. However, most often the kerchief bandage is used to suspend the upper limb, especially for injuries of the forearm and hand.

dressing material

To fix the arm (Fig. 1), the latter is bent to a right angle, and the scarf is brought in so that the upper end fits under the collarbone on the side of the affected arm, and the second end hangs down, the top of the scarf comes out from under the elbow. Having wrapped the upper end up in front of the forearm of the diseased hand, it is carried out on the shoulder girdle of the healthy side and behind the neck, where it is connected to the other end of the scarf. The top of the scarf is bent around the elbow and secured in front of the elbow with a pin.

Rice. 1 . Using a scarf to immobilize the shoulder girdle and upper limb

With the help of a scarf, bandages can be applied to the mammary gland (Fig. 2), foot, hand (Fig. 3) and head. When bandaging the head, the scarf is placed on the back of the head and crown, the top is lowered onto the face, the ends are tied on the forehead, then the top is bent in front of the tied ends and secured with a pin.

Rice. 2 . Using a scarf to apply a bandage to the mammary gland

Rice. 3 . The imposition of a scarf bandage on the brush. 1,2,3 - bandaging steps

sling-likebandages

A sling in desmurgy is a piece of gauze in the form of a ribbon 50–60 cm long, both ends of which are notched in the longitudinal direction so that the middle 10–15 cm long is uncut (Fig. 4).

Rice. 4 . sling bandage

This bandage has 4 ends; the middle part is designed to cover the damaged area over the dressing and secure the latter. The sling bandage is most often used on the face in the area of ​​the nose, forehead, neck, chin as a temporary measure for holding tampons and temporary immobilization. Like a kerchief, it does not seal the hermetically damaged area and is fragile.

The technique of applying a sling-like bandage on the nose to the chin is shown in Fig. 5 (a, b), and on the back of the head and crown - (c, d). A prerequisite for applying a sling is to cross its ends before tying.

T-shapedbandages

This bandage is convenient for holding the dressing on the perineum, scrotum and anus. It is easy to manufacture, if necessary, can be quickly applied and removed. It consists of horizontal and vertical (wider) bandage strips, with the horizontal part going around the waist in the form of a belt, and the vertical part - from the waist through the crotch forward and tied to the same belt (Fig. 6).

Rice. 5 . Options for applying sling dressings

The T-shaped bandage can successfully replace the so-called suspensory used to support the scrotum, for example, after surgery for dropsy of the testicle, with orchitis, orchiepididymitis, etc.

Rice. 6 . T-shaped crotch bandage

BandagesWithusingelasticmesh-tubularbandages

To hold the sterile material on the wound, tubular knitted bandages and elastic mesh-tubular bandages "Retilast" are widely used, which, having great extensibility, tightly fit any part of the body, do not unravel when incised, and at the same time do not restrict movements in the joints.

They look like a tube woven from cotton and rubber thread and come in different diameters.

Depending on the size, five numbers of tubular bandages are distinguished: 1 - on the finger, 2 - on the forearm or lower leg, 3 - on the shoulder, 4 - on the thigh and head, N 5 can stretch so much that it can be worn on the chest or stomach person.

Having a mesh structure, elastic mesh-tubular bandages provide the possibility of aeration and monitoring of the state of peri-wound tissues.

Bandagebandages

Bandage bandages are the most common, as they meet the requirements for a modern rational bandage (strength, elasticity, porosity, creation of the necessary pressure, etc.). At present, soft gauze, which has good elasticity, is almost exclusively used for bandaging. Gauze bandages do not prevent the evaporation of moisture from the bandage. Bandages made of denser fabrics (flannel, canvas, calico) are not currently used. The use of soft bandages remains to date one of the most common ways to strengthen the dressing, despite the widespread use of adhesive tape, glue, polymerizing plastics, synthetics, etc. This is due to the versatility of bandages, their adaptability to any type of body surface and any pathological processes. If we add to this the possibility of their combination with other methods of fixation, then the scope of their application becomes limitless.

The rolled up part of the bandage is called the head, and its beginning is the free end. Bandages can be single-headed and double-headed (rolled from two ends to the middle), the latter are used in exceptional cases (headband). The back of the bandage, i.e. the surface facing the bandaged part of the body is called the back, and the opposite side is called the abdomen, and when bandaging the abdomen should be turned outward so that the bandage can easily and freely roll out on the surface of the bandaged body area. The bandage is narrow (up to 5 cm), medium (7-10 cm) and wide (12 or more cm). Each part of the body requires its own bandage width.

Basic requirements for a bandage bandage:

cover the affected area of ​​the body;

do not disturb blood and lymph circulation;

hold securely on the body area;

be as neat as possible.

Rules overlays soft bandage bandages

Despite the high prevalence of bandage dressings, their imposition requires a certain skill, knowledge and skill. A properly applied bandage does not disturb the patient, it is accurate, firmly and for a long time fixes the dressing material. In order for the bandage to lie correctly, bandages of the appropriate width should be used, depending on the size of the anatomical region being bandaged. So, for the torso, wide bandages are needed, for the head - medium, for the hand and fingers - narrow.

Bandaging consists of the following steps:

imposition of the initial part of the bandage;

the imposition of the actual moves of the bandage;

fixing the bandage.

Rules bandaging

When starting bandaging, care should be taken to ensure that the patient is in a comfortable position for him, and the bandaged part of the body is accessible from all sides.

A prerequisite is the application of a bandage with the patient in a horizontal position in order to prevent complications (shock, fainting).

The exception is minor damage.

The bandage is applied in such a position of the limb, which is functionally the most beneficial, especially when applying a bandage for a long time.

It is very important that the application of the bandage, like the bandage itself, does not cause discomfort in the patient, which largely depends on the skill of the bandager. During bandaging, he must face the patient in order to constantly monitor his condition.

Bandaging is very tiring and uncomfortable if the health worker has to bend over or raise his arms up, so it is best to position the bandaged part of the body at the level of the lower chest of the bandager.

Bandaging should begin with the peripheral parts, gradually covering the central areas of the body with bandage tours.

The exception is bandages on the hand, foot and fingers of the hand and foot, when the bandage tours are located from the center to the periphery.

Bandaging begins with the first two fixing rounds of the bandage.

The head of the bandage is held in the right hand, the beginning of the bandage is in the left, the bandage is rolled from left to right with the back on the bandaged surface of the body, without taking your hands off it and without stretching the bandage in the air.

In some cases, bandaging from right to left can be carried out, for example, when bandages are applied to the right area of ​​​​the face and chest.

The bandage should roll smoothly, without wrinkling; its edges should not lag behind the surface and form "pockets".

The bandage should be applied not too tight (unless a pressure bandage is required) so that it does not interfere with blood circulation, but not too loose so that it does not slip from the wound.

The hand of the bandager should follow the course of the bandage, and not vice versa.

When applying a bandage, except for a creeping one, each subsequent round covers the previous one by 1/3 or 1/2 of the width of the bandage.

To fix the bandage at the end of bandaging, the end of the bandage is torn or (better) cut with scissors in the longitudinal direction; both ends are crossed and tied, and neither the cross nor the knot should lie on the wound surface.

Sometimes the end of the bandage is folded over for the last circular move or pinned to previous rounds with a safety pin.

When removing the bandage, the bandage is either cut or unwound.

Start cutting the bandage away from the damaged area or from the side opposite to the wound.

When unwinding, the bandage is collected in a lump, shifting it from one hand to another at a close distance from the wound.

Mistakes at overlay soft bandages

If the bandage is applied tightly, cyanosis, edema occur, the temperature of the distal limb decreases, and throbbing pains appear. When transporting a patient with a tightly applied bandage in winter, frostbite of the distal limb may occur. In the event of the appearance of the described symptoms, the injured limb is given an elevated position. If after 5-10 minutes there is no improvement, the bandage must be loosened or replaced.

With a weak bandage tension, the bandage quickly slips. In this case, it is better to change it, ensuring the complete passive position of the injured limb during bandaging.

The integrity of the bandage is easily broken if the first fixing rounds are not made. To correct the error, the bandage must be bandaged, strengthening it with glue and adhesive tape.

4. Types of bandages

In order to properly apply any bandage, it is necessary to know the anatomical features of a particular part of the body and the so-called physiological positions in the joints. Different parts of the limbs have a different shape (cylindrical - shoulder, conical - forearm, lower leg), which must be taken into account when applying bandages.

The nature of bandaging (more kinks in the bandages) can also be influenced by more pronounced musculature in men and greater roundness in women.

Taking into account these provisions, various types of bandage dressings have been developed.

circular,orcircular,bandage (fascia circularis )

This is the simplest form of a bandage dressing, in which all the tours of the bandage fall on the same place, completely covering each other. They begin with it and finish the bandage with it, less often it is used as an independent one on areas of the body of a cylindrical shape. In this case, the moves of the bandage, going from left to right, cover each other completely in an annular fashion. At the beginning of bandaging, the first move of the bandage can be given an oblique direction by bending the edge, which is then fixed with the second move (Fig. 7). A circular bandage is convenient for bandaging small wounds and is more often applied to the shoulder, wrist joint, lower third of the lower leg, abdomen, neck, forehead.

Rice. 7 . circular bandage

Spiralbandage (fascia spiralis )

It is used if it is necessary to bandage a significant part of the body. It, like any other bandage, begins with circular bandages (2-3 layers), then the bandage is led from the periphery to the center. At the same time, the tours of the bandage go somewhat obliquely from the bottom up and each next tour closes 2/3 of the width of the previous one. As a result, a steep spiral is formed (Fig. 8).

Rice. 8 . spiral bandage

Rice. 9 . creeping bandage

creepingorserpentine,bandage (fascia serpenses )

Such a bandage is used mainly for the rapid and temporary strengthening of the dressing over a considerable length of the limb. A creeping bandage is started with a circular bandage, which is then transferred into a helical bandage, from the periphery to the center and back. So that the turns of the bandage do not touch (Fig. 9). After fixing the dressing with a creeping bandage, further bandaging is continued in the usual way, applying a spiral bandage.

cruciform,oreight-shaped,bandage (fascia cruciata ceu octoidea )

A bandage in which the tours of the bandage are applied in the form of the number 8 (Fig. 10). In this case, the bandage moves are repeated several times, and the cross is usually located above the affected area. This bandage is convenient for bandaging body parts with an irregular surface shape (ankle, shoulder, hand, occipital region, perineum, chest).

Rice. 10 . Cross bandage. a - brush; b - chest; c - perineum; g - foot

A variation of the eight-shaped bandage is spike-shaped (fascia spica). Its difference from the cruciform is that the cross does not pass at the same level, but gradually moves up (ascending bandage) or down (descending). The place where the bandage crosses in appearance resembles an ear, hence the name of the bandage (Fig. 11). Usually, a spica bandage is applied to the area of ​​\u200b\u200bthe joints.

A variant of the 8-shaped bandage is also turtlebandage,converginganddivergent (fascia testudo inversa or reversa). Such a bandage is applied to the area of ​​​​large joints (elbow, knee). It consists of bandage moves that cross on the flexion side of the joint and diverge in the form of a fan on the extensor side.

Rice. 11 . Spica bandage on the hip joint

A diverging bandage begins with a circular motion through the center (the most protruding part) of the joint. Subsequent bandage moves are above and below the previous ones, crossing on the flexion side of the joint and covering 2/3 of the previous moves until the affected area is completely closed (Fig. 12).

A converging turtle bandage is started with circular bandages above and below the joint and also crossing on the flexor side of the latter.

Further moves bring them closer to each other to the convex part of the joint until the affected area is closed.

Rice. 12 . Turtle bandage. a - divergent; b - convergent

Rice. 13 . Returning bandage on the stump

Return bandage ( fascia recurens )

It is usually applied to rounded surfaces (head, limb stumps). Such a bandage is reduced to the alternation of circular bandage moves with longitudinal ones, going sequentially and returning back, until the stump is completely closed (Fig. 13).

It should be emphasized that a bandage bandage on any part of the body cannot be only circular or only spiral, etc., since such a bandage can easily be displaced, therefore it must necessarily be reinforced with 8-shaped passages in order to fit snugly against the surface of the bandaged part body. When bandaging a limb of unequal thickness, for example, the forearm, it is advisable to use a technique called an inflection. The bend is performed in several rounds and the steeper, the sharper the difference in the diameters of the bandaged part.

Improvisation and a combination of different types of dressings are possible when bandaging large areas of the body. So, when bandaging the entire lower limb, all 7 basic bandage options can be used.

5. Particular types of bandages on the body area

HEADBANDS

To apply a bandage bandage on the head, bandages 5-7 cm wide are used. The most commonly used are: "hat", "Hippocratic hat", "cap", "bridle", bandage on one eye, on both eyes; on the ear, cruciform on the back of the head.

Simplebandage (cap)

This is a return bandage that covers the cranial vault (Fig. 14). Two circular passages lead around the head, capturing the region of the glabella and the region of the occiput (1). Then an inflection is made in front, and the bandage is led obliquely along the lateral surface of the head, slightly higher than the circular one (2). Going to the back of the head, make a second bend and cover the side of the head on the other side (3). After that, the last two oblique moves are fixed with a circular bandage and then again two oblique returning moves (5 and 6) are made slightly higher than the previous ones (2 and 3) and it is fixed again.

This relatively simple dressing requires very good application technique. It is important that the bends of the bandage lie as low as possible and are better fixed in circular motions. Due to its low strength, it is not applicable for imposition in severe patients.

Rice. 14 . Headband "hat"

HatHippocrates

Facing the victim, the bandager takes one head of a double-headed bandage in each hand and, deploying them, applies one or two circular moves around the head. Having brought both heads of the bandage to the back of the head, the left head is brought under the right one and a kink is made, the right head continues its circular course, and the left one, after the kink, goes in the sagittal direction through the crown to the forehead. In the forehead area, both heads meet: the right one goes horizontally, while the left head again returns through the crown to the back of the head, where it again intersects with the horizontal course of the right head, etc. Longitudinal returning passages gradually cover the entire head. Thus, anteroposterior moves are made with one part of the bandage, and circular with the other. The bandage is fixed with circular passages of both heads around the head (Fig. 15).

Cap

A piece of bandage 50-75 cm long is placed in the transverse direction on the crown of the head so that the ends descend vertically down in front of the auricles, where an assistant holds them in a taut position (sometimes the patient himself does this). On top of this bandage, the first horizontal moves are carried out around the head so that their lower edge goes over the eyebrows, over the auricles and over the occiput. Having reached the vertical tie on one side, the bandage is wrapped around it (a loop is made) and then on the forehead area somewhat in an oblique direction, covering half the circular course. Having reached the opposite tie, they again make a loop and again lead in an oblique direction to the occipital region, half covering the underlying passage, etc. So each time, throwing the bandage over a vertical tape, they lead it more and more obliquely until they cover their entire head.

Rice. 15 . Bandage "hat of Hippocrates"

Rice. 16 . Bandage "cap"

The bandage is finished with circular moves of the bandage, tying a knot in front (Fig. 16). The ends of the vertical tape are tied under the chin to securely fix the entire bandage.

Bandagetypefrenulums

It is used for damage to the lower jaw, after reduction of dislocation, etc. (Fig. 17). First, two horizontal circular moves are applied around the head from left to right. Next, the bandage is led over the ear of the left side obliquely upward through the back of the head under the right ear and under the lower jaw in order to grab the jaw from below and go from the left side in front of the left ear up to the crown.

Then the bandage behind the right ear is again led under the lower jaw, covering the front half of the previous move. Having made three such vertical moves, the bandage is led from behind the right ear forward to the neck, then obliquely up through the back of the head and a circular move is made around the head, strengthening the previous rounds.

Rice. 17 . Bandage "bridle"

Then they again go behind the right ear, then almost horizontally cover the entire lower jaw with the bandage and, having come to the back of the head, repeat this move again. Then they go under the right ear under the lower jaw obliquely, but closer to the front, then along the left cheek up to the crown and behind the right ear. Having repeated the previous move, and then, having rounded the neck in front, they go to the back of the head above the right ear and finish the bandage with a circular horizontal bandage.

Bandageon theoneeye

The bandage begins with circular moves around the head, and for the right eye, the bandage is led from left to right, for the left, on the contrary, from right to left (Fig. 18). Having strengthened the bandage with horizontal moves, lower it from behind down to the back of the head and lead it under the ear from the diseased side obliquely up through the cheek, closing the sore eye. An oblique move is fixed in a circular way, then an oblique move is made again, covering half the previous one. So, alternating oblique and circular moves, they cover the entire area of ​​\u200b\u200bthe eye.

Rice. 18 . One eye patch

Rice. 19 . Bandage for both eyes

Bandageon thebotheyes

After fixing the bandage with circular moves (Fig. 19), it is led from the back of the head under the ear and an oblique move is made from the bottom up, closing the eye on one side. Then they continue to lead the bandage around the occipital region of the head and through the forehead obliquely from top to bottom, closing the eye on the other side, then they carry out the bandage below the ear and across the back of the head, come out from under the ear from the opposite side and make another upward oblique move. So, alternating with each other, the oblique moves of the bandage gradually close both eyes. Fix the bandage with a circular bandage.

Bandageon theregionear (Neapolitanbandage)

It begins with circular tours around the head (Fig. 20). On the affected side, the bandage is lowered lower and lower, covering the ear area and the mastoid process. The last move is located in front along the lower part of the forehead and behind the occiput. Finish the bandage with a circular bandage.

eight-shapedbandageon theback of the head

It begins in circular tours around the head (forehead-back of the head), then over the left ear descends to the back of the head, then goes under the right ear to the front surface of the neck from under the left corner of the lower jaw up through the back of the head over the right ear to the forehead (Fig. 21). Repeating these tours, close the entire back of the head.

Quite often, "sling-like bandages" are used on the chin and nose, as well as kerchief bandages, the technique of applying which can be found in the relevant sections.

Rice. 20 . Ear band "Neapolitan hat"

Rice. 21 . Eight bandage on the back of the head

BANDAGESON THEUPPERLIMB

Most often, the following dressings are applied to the upper limb: spiral - on one finger, spike-shaped - on the first finger, "glove"; returning and cruciform - on the brush; spiral - on the forearm; turtle bandages - on the elbow joint; spiral - on the shoulder; spike-shaped - on the shoulder joint; bandages Deso and Velpo.

Spiralbandage

It is used for trauma to one finger (Fig. 22). First, the bandage is strengthened with two or three circular moves in the wrist area. Then the bandage is led obliquely through the back of the hand (2) to the end of the diseased finger, from where the entire finger is bandaged to the base with spiral passages. Then (8) the bandage is brought back to the wrist, where it is fixed.

Rice. 22 . Spiral bandage for one finger

Rice. 23 . Thumb bandage

Bandage on thebigfingeris being donespike-shaped ( eight-shaped) (Fig. 23). It starts in the same way as above. Next, the bandage is led along the back surface of the thumb to its top (2) and the palmar surface of this finger (3) is covered with a semicircular stroke.

Then the bandage is led along the back of the hand to the wrist and the eight-shaped move is repeated again, each time going down to the base of the finger. Attach the bandage to the wrist.

Rice. 24 . Bandage on all fingers "knight's glove"

Rice. 25 . Bandage on the brush "mitten"

Bandageon theallfingers " knightlyglove"

It is used when you need to bandage several fingers or all fingers individually. It begins as a bandage on one finger (see Fig. 23). Having bandaged one finger spirally, the bandage is led along the back surface through the wrist and the next one is bandaged in this way until all fingers are bandaged (Fig. 24). On the left hand, the bandage begins with the little finger, and on the right hand, with the thumb. Finish the bandage with a circular motion around the wrist.

Bandageon thebrushreturning " mitten"

It is applied when it is necessary to bandage the hand (Fig. 9-25) together with the fingers (with extensive burns and frostbite). The bandage begins with circular moves around the wrist (round 1). Then the bandage is led along the back of the hand (2) onto the fingers and all fingers are covered with vertical strokes from the palmar and back sides (3,4,5). Then in horizontal circular strokes, starting from the ends of the bandage on the wrist.

Turtlebandage

Superimposed on the area of ​​​​the joints in a bent position (Fig. 26). They are divided into divergent and convergent. The convergent dressing begins with peripheral tours above and below the joint (1 and 2), crossing in the cubital fossa. Subsequent moves are similar to the previous ones, gradually converging to the center of the joint (4, 5, 6, 7, 8.9). Finish the bandage with a circular stroke at the level of the middle of the joint. A divergent bandage in the area of ​​the elbow joint begins with a circular move through its middle, then similar moves are made above and below the previous one. Subsequent moves diverge more and more, gradually closing the entire area of ​​the joint. The moves intersect in the subulnar cavity. Fasten the bandage around the forearm.

Rice. 26 . Turtle elbow bandage

Rice. 27 . Spiral bandage on the forearm

Spiralbandage

It can be performed with or without kinks (Fig. 9-27). The second is convenient for bandaging parts of the body that are uniform in thickness (shoulder, lower leg, thigh, etc.). They start the bandage with two or three circular moves, and then the bandage tours go in a spiral, partially covering the previous tours by two thirds. Depending on the direction of bandaging, the bandage can be ascending or descending.

A bandage with kinks is applied to the conical parts of the body. After two or three circular moves, they begin to bandage with kinks. To do this, the bandage is led obliquely upwards, pressing down its lower edge with the thumb and bending the bandage so that its upper end becomes the lower one, then the bandage is led obliquely downwards, circled around the limb and the bend is repeated again. The greater the degree of expansion of the limb, the steeper the bends. All folds are made on one side and along one line. In the future, if necessary, either make a simple spiral bandage or continue to bend the bandage.

Spikebandage

It is a kind of eight-shaped (Fig. 28). It is applied to the area of ​​the shoulder joint as follows. The bandage is led from the side of a healthy armpit along the front surface of the chest and further to the shoulder (stroke 1). Having bypassed the shoulder in front, outside and behind, the bandage is led through the armpit and raised obliquely to the shoulder (stroke 2), the previous round is crossed on the front surface of the chest and shoulder. Next, the bandage goes along the back of the back to a healthy armpit. From here begins the repetition of moves 1 and 2 (3 and 4). At the same time, each new move lies slightly higher than the previous one, forming an ear shape at the intersection.

BandageDeso

Superimposed with fractures of the humerus and collarbone. The patient is seated, the arm is bent at the elbow at a right angle (Fig. 29). The first moment consists in bandaging the shoulder to the body, which is achieved by imposing a series of circular spiral moves from the healthy arm to the patient (1). Next, the second part of the bandage is started with the same bandage: from the axillary region of the healthy side along the front surface of the chest, the bandage is led to the shoulder girdle of the diseased side (2), from here vertically down the back of the shoulder under the elbows, grabbing the elbow with a bandage, obliquely through the forearm into the armpit of the healthy side (3). From here, a bandage is led along the back to the sore shoulder girdle down the front side of the shoulder (4). Having bypassed the elbow in front, the bandage is led obliquely through the back into a healthy armpit, from where the repetition of moves begins (2, 3.4).

Rice. 28 . Spike bandage on the shoulder joint

Rice. 29 . Bandage Deso

Rice. 30 . Velpo bandage

Such moves are repeated several times to obtain a good fixation. Then they hang the hand with a piece of bandage of sufficient width, strengthening it to the back (see Fig. 29).

BandageVelpo

It is used for temporary immobilization for fractures of the clavicle, after reduction of dislocations of the shoulder joint (Fig. 30). The arm from the damaged side is bent at the elbow joint to form an acute angle, and the palm is located in the deltoid region on the healthy side. In this position, the limbs are bandaged. First, the arm is fixed with a circular bandage from the diseased arm to the healthy one (1), which covers the shoulder and forearm of the diseased side, goes back through the healthy axillary fossa. From here, the bandage is lifted obliquely along the back from the damaged deltoid region, go around it from back to front, lower the bandage down the shoulder (2) and, grabbing the elbow from below, direct it to the axillary fossa from the healthy side (3). The bandage moves are repeated several times, with each vertical bandage move placed inside the previous one, and each horizontal one below it.

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Dressings for the treatment of bedsores

Bedsores are a serious problem for bedridden patients and the disabled. Necrosis soft tissues, formed during prolonged compression of certain parts of the body, brings significant inconvenience and worsens well-being.

Currently, many modern means have been developed to combat pressure sores, involving local treatment.

Wound care products in our assortment are presented in various types. The most common release form These are dressings.

All dressings can be divided into several groups.

1.Gel and hydrocolloid dressings.

In this capacity, hydrogel dressings act, which reduce pressure on the protruding parts of the body and reduce the likelihood of necrosis. They are also shown at the stage of wound healing for the same purpose.

Hydrogel dressings are produced in various forms, as a rule, corresponding to the anatomical shape of body parts, they are equipped with fixation elements - an adhesive edge or protrusions with an adhesive surface.

The names of these funds are Gidrotak, Gidrosorb-comfort, Hydrocoll, Komifil-plus and others.

2. Wound healing bandages.

The use of these dressings is required in the event of the development of a wound process, with the formation of bedsores or trophic ulcers.

A feature of such dressings is the content in them of a medicinal substance that has a specific effect.

Wound healing dressings can be divided into several types.

o Dressings with proteolytic enzymes. Necessary for cleansing the wound from necrotic masses and pus, partly replace the primary surgical treatment. This is ParaPran with chymotrypsin, Proteox-T and Proteox-TM,

o Bandages with antibacterial action. This includes dressings with miramistin and other substances. These dressings can be not only flat, but also in the form of pads, providing additional drainage functions and contributing to comfort in deep wound defects.

An example is ParaPran with chlorhexidine, Pectinar wipes.

o Dressings with substances that stimulate regeneration. These are dressings with beeswax, methyluracil and other substances that can stimulate wound healing. Among these products are VoskoPran with Levomekol, VoskoPran with beeswax, Multiferm, Litatsvet 1.

o Often, manufacturers combine the presence of an antibacterial or enzymatic and wound healing component in a dressing for wound treatment. These are preparations such as Branolind with Peruvian balsam, VoskoPran with levomekol, and Multiferm, which combines the presence of enzymes and chitosan, which stimulates the regeneration.

o Bandages with silver ions. Silver has a powerful bactericidal effect. Bandages with silver are presented in the form of flat bandages and in the form of pads with the function of absorbing wound discharge. Dressings of this group include napkins and pads Bimaten Ag and Atrauman Ag

o Protective dressings. These are thin, usually transparent dressings that are fixed to the wound in order to protect fresh granulations and prevent reinfection. They have an adhesive edge, which avoids the participation of additional dressings. This is Komifil, Kosmopor.

o Some wound healing dressings also have protective features, such as those based on wax-impregnated cotton. These include VoskoPran dressings.

3. Dressing material designed to absorb wound discharge.

These wipes have a bulk layer that absorbs exudate and performs drainage functions. In our assortment they are represented by the names Biaten, Tsetuvit E, Tsetuvit plus, Kosmopor "Advance".

4. Dressing material without special properties, intended for fixation.

This group includes non-sterile bandages and means for attaching dressings with an adhesive edge, not intended for contact with the wound surface.

Our range is distinguished by a wide variety and affordable price for many types of dressings. You can buy in our store the necessary dressings on your own, or after consulting with our specialist.

Delivery is carried out in Moscow within a day after the order.

Ointment bandages;

1. "Branolind" (USA), ointment dressing on a woven basis, impregnated with Peruvian balsam;
2. "Atrauman", hydrophobic material impregnated with neutral fat;
3. "Grassolind neutral" - large-mesh fabric impregnated with an indifferent fatty base;
4. "Pyolysin" (Germany).

• Levomikol, Levosin (Russia), Dermazin (Slovenia), Dalacin (USA), D-Panthenol (Croatia).
• Alginins;

Produced from marine brown algae. They are hydrophilic materials and, when combined with wound exudate, turn into a gel-like material.

"Sorbalgon" (Germany).

absorbent dressings;

1. "VoskoSorb" (Russia) - polyester non-woven fiber coated with pure beeswax and propolis in combination with a sorbent layer of cotton and viscose.
2. "Mepilex lite" (Sweden) - absorbent soft coating made of porous silicone.
3. "Mepitel" (Sweden) - an atraumatic bandage with a soft silicone coating of a mesh structure, on top of which an exudate-absorbing bandage is applied.
4. "Aktisorb Plus 25" (USA) consists of a 2-layer sheath made of non-woven nylon, between the layers of which activated carbon saturated with silver is laid.

Gel coatings;

1. "Gelepran" (Russia) - atraumatic, thermo- and shape-resistant wound gel dressing. Available in pure form and with miramistin.
2. Hydrocolloids:

Transparent hydrogel dressings with a top layer of a breathable film that prevents the penetration of microorganisms and moisture. The bottom layer of the dressing is hydrogel:

• Hydrosorb (USA), Hydrocoll (USA)
• Lita-Tsvet (Russia) - gauze bandage impregnated with exolin solution.
• "Giaplus" (Russia) - dressings based on hyaluronic acid and fibrin coatings.
• Aguacel Ag (England). A dry dressing based on Hydrofiber technology adsorbs exudate and turns into a gel with silver ions.
• Films;
• Semi-permeable polyurethane films, permeable to gases and impervious to liquids. The surface has pores about 2 µm in size. Through these pores, gas exchange occurs between the wound surface and the environment, but they are too small for the penetration of microorganisms.
• Silon-TSR, Telfa, Protective Dressing (USA).
• "Op-Site", "Tegaderm", "Cutinova hydro", Omiderm (USA).
• Film-forming aerosols: Lifusol, Statizol, Naxol.

When wounds are covered with films impervious to water and bacteria, which allow normal gas exchange, a moist environment is created in the wound, which stimulates the removal of autolysis products of necrotic tissues and the destruction of excess collagen.

A culture of keratinocytes and fibroblasts is also grown on the films. Such cell compositions are applied cell down to the wound. Thanks to the action of cytokines, high-quality and rapid epithelialization occurs.

Films: "Biokol", "Foliderm" (Russia).

• foam;

Panthenol, Olazol, Dioxysol, (Russia).

• Combined funds;

Collagen sponges:

Wound dressings on collagen, which include various biostimulating, antiseptic, bactericidal components, do not require daily dressings and lyse on their own.

1. Collagen sponge with sanguiritrin (Russia).
2. "Meturakol" (Russia). - collagen sponge with methyluracil
3. "Algikol" (Russia) - collagen sponge with furagin.
4. Porous plate "Kombutek" (Russia) with collagen, boric acid, etc.
5. "Digispon" (Russia) - a plate with collagen, dioxidin. glutaraldehyde, etc.
6. "Algipor" (Russia) - a sponge with alginates.
7. Sponge "Kolotsil" (Russia), with collagen, furacillin, novocaine, etc.
8. Collahit-FA (Russia). The composition includes a collagen-chitosan complex with the addition of furagin and anilocaine.
9. VoskoPran (Russia). Ointment dressings on an elastic mesh base, impregnated with beeswax and propolis. Several options are available: without an additional drug, with 10% methyluracil ointment, with levomikol. Patients with allergies to bee products are not recommended to use!
10. "ParaPran" (Russia). Atraumatic bandage made of cotton fiber, impregnated with paraffin. It is produced in several versions: in its pure form without drugs, with chlorhexidine, chymotrypsin, lidocaine.
11. "Kollost" (Russia). collagen membrane.

• Gels.

Gels are one of the options for treating skin scars after resurfacing. Gel treatment forms are fat-free moisture-absorbing compositions, which, in addition to the hydrophilic base, include various components. Gels that can be used to treat wound surfaces are subject to special requirements. It is known that wounds kept in a moist, antiseptic state have optimal conditions for epithelialization. Moreover, in experiments on animals and on human fetal embryos, the possibility of scarless healing of wounds that are carried out in a humid environment has been proven.

Gel compositions that can be used as wound dressings should be absolutely biologically compatible with tissues, not cause toxic-allergic reactions, have antiseptic and immunostimulating properties, keep the wound surface moist for some time, after which it will turn into a breathable film. To date, in our opinion, only the drug Curiosin gel (Gedeon Richter A.O., Hungary), based on zinc hyaluronate, has such properties. The main active ingredient of the drug is zinc hyaluronate. Hyaluronic acid (HA), which is part of the preparation, is a natural mucopolysaccharide that forms the basis of mucopolysaccharides in the human dermis. In addition, hyaluronic acid is not a species-specific substance, therefore, obtained by any method and from any type of tissue, it is perceived by the body as its own. The hyaluronic acid in curiosin is derived from chicken scallops. It is known that 1 molecule of hyaluronic acid holds about 500 water molecules near itself, due to which it is a superhydrophilic substance. Hyaluronic acid, like the trace element zinc, has an immunomodulatory effect. In addition to all the listed properties, the attractiveness of curiosin for the treatment of surfaces after grinding or after the removal of various benign skin formations, or after surgical interventions lies in the fact that patients can use this drug themselves. This is especially true when visiting a doctor for dressings is impossible for some reason. We recommend that patients gently squeeze the gel onto the wound surface several times a day and distribute it with a corner of a sterile napkin, and they successfully cope with this task.

Immediately after the operation of scar dermabrasion, washing and drying the wound surface, we lubricate the entire erosive surface with a thick layer of gel and let the patient go home in this form or, if the surfaces are large (the whole face), leave in the hospital. Of course, such management of wound surfaces is possible only in open areas of the body. The wound surface looks unprotected, but this is not to be feared, since the gel, as we have already said, has a protective and immunostimulating effect. On this day and the next, it is recommended to treat the grinding surface every 1.5-2 hours in order to create the most favorable conditions for skin cells to interact and exchange information. By the end of the second day, as a rule, an elastic crust begins to form at the site of grinding. Despite this, we continue to process it, but more rarely - 2-3 times a day until the crust completely falls off in 6-8 days.

• "Solcoseryl (actovegin) jelly" (Bulgaria).
• Chitosan gel, Argovasna (Russia).

Russian scientists have developed a unique technology for converting chitosan from a linear to a microgranular form, which made it possible to reduce the size of the molecule by more than 8 times. Thus, the permeability of chitosan through the skin was increased many times over. By chemical structure, it is related to cellulose and is a natural polysaccharide 1,3-beta-glucan. By binding to the cell wall of bacteria, fungi and viruses, it exhibits its fungicidal, antiviral and bactericidal activity. When applied to the skin, it also exhibits a regenerating, immunostimulating and hemostatic effect. There is evidence of its antitumor properties. Due to its high water-retaining capacity, chitosan, interacting with proteins and lipids of the epidermis, forms a film associated with them. As a result, transdermal loss of skin water is stopped and a moist environment is created in the wound, which is necessary for optimal cellular interaction and epithelialization. Chitosan compositions are very effective after various types of grinding and postoperative sutures. Chitosan gel can be used not only by application to the skin, but also by microelectroplating and electrophoresis from the positive pole. It is recommended to use the method similar to curiosin.

• Aloe Vera Gel (USA).

The immunostimulating, adsorbing, bactericidal, regenerating and moisturizing properties of Aloe Vera have long been known. Thanks to the unique properties of aloe, it creates conditions in the wound for quick reparation. It is used by analogy with curiosin.

• Allogeneic leather and its substitutes.

Allogeneic fresh and cadaveric skin would be an ideal biological coating, were it not for the difficulty of obtaining. It can be stored frozen for a long time. This type of wound dressing belongs to the biological, compatible with the tissues of the recipient. After the onset of epithelialization of the wound, the coating is torn off.

• "AlloDerm", (Integra).
• Xenoderma (Russia).

From xenogeneic skin, pig skin is used, since the tissues of a pig and a person are similar in structure. As well as cadaveric skin, it is rejected after the epithelialization of the wound surface.

Of the wound dressings close to this group and having a very high wound healing potential, amnion films should be noted. They also belong to biological wound dressings, have a bacteriostatic effect, stimulate the synthesis of procollagen, are elastic, easily fit on the wound surface, and are transparent, which makes it possible to observe the state of the wound surface and re-epithelialization.

Cultivated skin substitutes: "Fibrodermis", "Fibropor" (Russia).

• Other technologies.
  • It is possible to care for wound surfaces in an open way with repeated washing with water or saline. Can be combined with treatment with panthenol, bepanthen, solcoseryl.
  • It is also possible to conduct wound surfaces under sterile vaseline, bismuth powder, etc.
  • There are even reports in the scientific literature of the use of boiled potato skins as biological wound dressings, which are processed, sterilized and widely used to treat burns in developing countries (138).
  • Treatment of wounds with local antiseptics can also be considered as one of the simple options for caring for wound surfaces. In connection with the emergence of new strains of microorganisms resistant to antibiotics in the prevention and treatment of wound infection, the practical importance of chemical disinfectants is increasing.

"Lavasept" (Russia) - local antiseptic, diluted 1 ml. in 1 liter of distilled water (0.1% solution). The wound is treated by the aspiration-washing method, after which the napkin soaked in the solution is left in the wound until the next dressing.

dressing wound treatment antimicrobial

Dressings are really first aid. They have been known since ancient times. During the time of Hippocrates (460-377 BC), sticky plaster, resins, canvas were used to hold the dressing. Galen (AD 130-200) wrote a manual for bandaging. A significant step forward in expanding their use was the decision of the Roman Senate that every soldier should be provided with a strip of linen with which he could help himself or a wounded comrade. It is possible that in prehistoric times, people used for medicinal purposes a variety of materials that were applied to the affected areas: grass and leaves due to their inherent healing properties, valuable physical qualities (softness, flexibility, elasticity, smooth surface), and sometimes pharmacological action. (astringent, analgesic, etc.). Some of the plants (plantain leaf, baked onion, etc.) are still used for dressings in folk medicine.

In the Middle Ages, the adhesive bandage became famous in Europe, and dressings were most developed in the era of capitalist production. In scientific medicine of the pre-antiseptic era (XVIII century and the 1st half of the XIX century), the position on the importance of the suction effect of dressings was firmly strengthened. The main means for them were materials with capillarity, mainly lint - cotton rags plucked into threads, linen and hemp hemp. With the advent of the era of antiseptics, these materials were replaced by gauze, absorbent cotton and lignin.

A few years ago, the range of dressings in pharmacies was rather poor:

• medical bandages;
• Adhesive plasters coil and bactericidal in the form of plates;
• medical gauze wipes;
• pads cotton-gauze medical.

To date, the pharmacy range of dressings has grown significantly. This was facilitated by the powerful development of the domestic pharmaceutical industry, and the massive entry of foreign manufacturers' products into our market.

Dressings are divided into simple and complex; sterile and non-sterile. But the basic principle of division is according to the purpose of application:

• Means for closing wound surfaces (bandages, napkins, dressings, wound dressings and a bactericidal plaster);
• for fixing dressing material;
• For fixation of joints or compression of limbs;
• compression bandages.

A mandatory requirement for all means for closing wound surfaces is their sterility.

A significant step forward in the production of dressings was the use of new technologies and the production of modern materials - elastic, perforated, non-woven fabrics on polymer bases and metallized coatings.

Pros and cons

Despite all today's variety of dressings, most patients and even doctors use cotton and bandage in the old fashioned way. How justified is this?

Dressings are used for tamponade of wounds, dressing after operations, bandaging of wounds and burns. Their main goal is to create a reliable barrier to the penetration of microbes and maintain an optimal environment for the natural process of wound healing. Modern dressings:

• Maintain optimum humidity
• provide gas exchange;
• remove excess moisture and wound exudate;
• Prevent secondary infection
• Ensure painless and atraumatic removal.

Modern dressings create conditions for rapid wound healing, and therefore insure against scars, the appearance of which is possible due to prolonged epithelization of the wound when using traditional dressings.

Many people use the price difference as an argument. However, health is not the case when the price should be decisive. Moreover, in fact, the use of modern means is more cost-effective than the use of traditional dressings, which have to be applied again and again, because. they don't have the desired effect. Let's look at how the cotton-gauze bandages familiar to us differ from modern dressings.

Disadvantages of cotton-gauze dressings:

• Pronounced hairiness of gauze - leads to the ingress of material particles into the wound, they irritate the tissues and interfere with wound healing;
• fine-mesh structure of gauze and its increased mass capacity - lead to an increase in contamination (the number of microorganisms seeding products), reduced air and vapor permeability, especially when applying a gauze bandage in several layers, which worsens the process of granulation and epithelialization of the wound surface and, accordingly, lengthens wound healing time;
• · adhesion to the wound (adhesion) - gauze impregnated with wound discharge tends to harden easily when dried. Capillary loops and granulations grow through the dressing, which causes injury to the wound and significant pain when the bandage is removed. Damage to the surrounding skin during dressings also causes pain in the patient and slows down the wound healing process;
• gauze napkins and cuts, as a rule, are produced packed in several pieces - when the package is opened, only the first napkin is sterile, the rest are no longer sterile;
• To give the required size, the gauze must be cut, to increase the sorption capacity, it must be folded into several layers, which violates sterility and is also inconvenient for the patient;
• · cotton-gauze dressings require fixation on the wound, which leads to additional costs for the fixing material and is an additional manipulation for the patient.

Thus, the use of obsolete dressings leads to an increase in the time of wound healing. The solution to this problem is the use of modern dressings, devoid of these shortcomings. Modern dressings are advanced, atraumatic, highly absorbent wound dressings that self-fix on the wound with a hypoallergenic adhesive.

Advantages of modern dressings:

• Issued on a non-woven basis and on the basis of a transparent film (allows you to monitor the progress of the wound process);
• waterproof (allows you to take water procedures without fear of water entering the wound);
• Provides secure fixation
• do not stick to the surface of the wound, do not injure the surface of the healing wound;
• are removed painlessly;
• self-adhesive - do not require additional fixation;
• · equipped with absorbent atraumatic tampon - adsorb wound exudate;
• protect against secondary infection and mechanical irritation during the healing process;
• hypoallergenic;
• have high air and vapor permeability (prevent maceration);
• Ready to use, do not require pre-treatment;
• The packaging is easy to open
• are sterile.

Ours or imported?

Often, a buyer who needs dressings has another question: maybe it is worth buying the same plaster or bandage, but imported? Do not try to convince the client of something, just provide him with full information about the product, and let him make his choice.

Russian-made products have packaging that is understandable to the consumer - it is easy to open it, which is extremely important in a critical situation. All information on the package is completely in Russian. Imported analogues have a maximum of a sticker with instructions printed in small print. In addition, modern Russian plasters and dressings are sold with an application scheme that is not available for imported analogues. And, finally, domestic products are produced by a well-known manufacturer - the leader in the plaster market, which guarantees high quality.

Types of dressings and sutures

The main purpose of dressings is to protect wounds from secondary infection and drain it, that is, to create the necessary conditions for speedy healing. Suture materials are designed to tighten (approach) the edges of the wound, which also helps to accelerate the healing process. Sutures are applied in order to sew up the stump of the resected organ or part of it (suturing), to impose an anastomosis (suturing). For suturing, various suture materials are used, and the process itself is carried out using special tools and apparatus.

dressings

Dressings are made from materials of organic origin - cotton, paper and cotton-viscose yarn, wood. Cotton wool, gauze and gauze bandages are made from cotton fibers, alignin, viscose are made from wood. The main dressing materials and products made from them are mass-produced products and the requirements for them are determined by GOSTs.

Cotton wool. Medical cotton can be hygroscopic and compressive. For dressings, medical absorbent cotton is used, made from the best varieties of cotton with an admixture of viscose, properly degreased, bleached and washed until a neutral reaction is obtained. The compress cotton is creamy in color, does not absorb water well and is used for warming compresses and for splinting. It is packaged in bags of 50, 100, 250 and 500 g and packed in bales of 50 kg.

The quality indicators of medical hygroscopic cotton wool are determined by GOST 5556--75. Cotton wool should be well combed, have high absorbency and capillarity, i.e. absorb water well and draw moisture from the wound into the upper layers of the dressing, like a micropump.

Absorption capacity, or the degree of water absorption of cotton wool, is determined by weighing dry cotton wool and the same cotton wool after being in water for 10 minutes. The ratio of the mass of wet cotton wool (when absorbing the maximum amount of water) to the mass of dry cotton wool is called the water absorption coefficient.

Cotton wool of standard quality has a water absorption coefficient of at least 19-20, i.e., a sample of cotton wool with absorbed moisture should be 19-20 times heavier than a sample of dry cotton wool. The test is carried out 3 times and the average of the three measurements is taken as the true water absorption coefficient of the wool used.

Capillarity is determined by the height to which the liquid rises (eosin solution 1: 1000) in a glass tube with cotton wool placed in it. The inner diameter of the tube is 7 mm. A sample of cotton wool (0.5 g) is placed in a tube from 0 to 85 mm. For reliability, the test is carried out in 10 tubes and the average of 10 readings is taken. The capillarity of high quality cotton wool is in the range of 66--77 mm. When testing for 10 minutes, it is necessary to ensure that the lower end of the cotton column is not immersed in water, but only touches its surface.

Absorbent cotton should be chemically neutral t-, flax, so as not to have an effect on body tissues. The neutrality of cotton wool is checked with litmus paper. First, a weighed portion of cotton wool (20 g) is boiled for 15 minutes in 200 ml of distilled water, after which the water is squeezed out and the reaction is determined with litmus paper. You can determine the pH of water using a pH meter, the pH of the extracts should be in the range of 7.0--7.5.

The standard also regulates the moisture content of wool, controlled by an electric moisture meter.

In accordance with the standard, cotton wool is produced in three types:

I) medical ophthalmic - from cotton of the 1st grade; 2) surgical - from pure cotton of at least 3rd grade and with viscose-staple fiber (up to 30%); 3) hygienic household - from cotton not lower than the 5th grade. In table. 6 shows the quality indicators of cotton wool.

Cotton wool is produced in bales of 20, 30, 40, 50 kg and in packages (rolls) of 25, 100 and 250 g. Cotton wool in rolls is made sterile and non-sterile (in parchment paper) for direct use. The packaging indicates the type and weight of cotton wool, sterility, method of opening, standard number, name of the manufacturer and its trademark.

Alignin. Alignin medical is produced in the form of thin crepe (having a wrinkled surface) paper. It is a complex organic substance that is part of wood and imparts strength to plant cells. Alignin is chemically separated from wood during pulp production.

Alignin is produced in two grades: A - for dressings, B - for packaging medicines and medical instruments. Produced in the form of multilayer sheets 600--700 mm wide and 600 to 2600 mm long, placed in packs of 5 kg, in which alignin is pressed and packed in wrapping paper. Each bundle is tied with twine. Weight of 1 m 2 crepe alignin sheet 37 g.

Alignin brand A has a fairly high capillarity (85 mm in 30 minutes) and water absorption (12 g per 1 g of alignin). In the state of delivery, the moisture content of alignin is not more than 6%. Alignin is cheaper than cotton wool and is widely used in medicine. Its disadvantages are aging during long-term storage, destruction (turning into powder) and spreading when moistened. Alignin is not elastic enough, therefore it is used for dressings in combination with cotton wool.

Gauze. Medical gauze is a rare mesh-like fabric. Available in two grades: bleached hygroscopic and harsh. Each of these varieties is of two types - pure cotton and with an admixture of viscose staple fabric (cotton in half with viscose or 70% cotton and 30% viscose). The difference is that cotton gauze is wetted within 10 s (sinks in water), while gauze with an admixture of viscose is wetted 6 times slower (within 60 s). Its advantages are increased moisture capacity, high ability to absorb tissue exudate, better ability to absorb blood. However, gauze with an admixture of viscose retains medicinal substances worse than cotton gauze, and repeated washing reduces the suction capacity. The strength of cotton gauze is about 25% higher than gauze with an admixture of viscose. The capillarity of both types of gauze is high and is at least 10-12 cm/h. With regard to neutrality, gauze is subject to the same requirements as for cotton wool. Gauze is produced with a web width of 69–73 cm, 50–150 m in a piece. They produce gauze cuts 10 m long and 90 cm wide, three pieces in a pack (for non-standard surgical dressings). Gauze, like cotton wool, is tested for absorbency (wettability), capillarity, and neutrality.

Wettability is tested by the immersion method. A sample of hygroscopic gauze (5x5 cm), lowered onto the surface of the water, without touching the walls of the vessel, should be immersed in water in 10 s, and a harsh gauze - in 60 s.

Capillarity is checked by lowering a strip of gauze 5 cm wide at one end into a Petri dish with eosin solution. Within an hour, the solution should rise from the liquid level by at least 10 cm.

Neutrality is checked with litmus paper on a water extract. Three pieces of gauze, 3 g each, from three of its samples are boiled for 15 minutes in 60 ml of distilled water. After removing the gauze, it is cooled and checked for neutrality. If you want to check the gauze for the absence of starch, then first 10 ml of a water extract is poured into a test tube and one drop of 0.05 N is added to it. iodine solution. In the presence of starch, the solution turns blue.

Special types of gauze include hemostatic and hemostatic gauze.

Hemostatic gauze - obtained by treating ordinary gauze with nitrogen oxides. Such gauze has a hemostatic effect and within a month it dissolves in the wound without residue. Apply in the form of napkins (13x13 cm).

Hemostatic gauze -- contains calcium salt of acrylic acid. Quickly stops the blood (after 2-5 minutes), but does not dissolve. Apply in the form of napkins, balls, tampons. Gives savings of dressing material up to 15%.

Cotton-gauze pads (GOST 22379--77) are intended for dressing wounds and burns. Five numbers are produced sterile, differing in size: No. 1 - 32x29 cm; No. 2--25x25 cm;

No. 3--17x16 cm; No. 4 - 15x15 cm and No. 5 - 10x10 cm. The pads have one layer of cotton wool and two layers of gauze - one on each side of the layer. The layers are stitched with threads. The pads are folded in half (large - four times) and packed in 2 pieces (No. 3 - 5 - 10 pieces each) in parchment paper bags. Pillows No. 5 are also packed in a film sheath made of polyethylene or polyethylene cellophane, the edges of which are welded. Released sterile; sterility is maintained for 5 years.

Cotton-gauze tape for making pads on site is available in non-sterile width 29 cm and length 2 m in cylindrical packs packed in parchment. Package diameter 9 cm, length 30 cm.

Gauze bandages are made from gauze tape 5, 7 and 10 m long and 3 to 16 cm wide, rolled up with a roller. According to GOST 1172--75 bandages are produced: sterile 5 cm wide and 5, 7 and 10 m long, as well as 14 and 16 cm wide and 7-10 m long, respectively; non-sterile 5 m long and 3, 5, 7, 8.5 and 10 cm wide; 7 m long and 5, 7, 8.5, 10, 12 and 14 cm wide; 10 m long and 5, 7, 8.5, 10 and 16 cm wide. Sterile bandages are individually packaged - parchment or film; non-sterile - individually wrapped in a wrapping or film casing and in a multiple of five, but not more than 30, placed in cardboard boxes or in packs and fastened with a parcel post.

Bandages made from cotton-viscose gauze, and not from ordinary gauze, have better functional properties. Wound healing when using these bandages is faster. Guaranteed shelf life of bandages is 5 years from the date of manufacture.

Gypsum non-shrinking bandages are used for plastering in traumatology. Gypsum on gauze is fixed with methylcellulose; setting -- 4--5 min. The bandage is stronger and has less mass than with conventional plastering.

Elastic medical bandage (GOST 16977--71) is intended for applying pressure bandages. Produced from harsh "cotton yarn. Allows stretching of at least 50%. - They produce a bandage 3 m long, 50 and 100 mm wide. These bandages are very strong (breaking load of a bandage 50 mm wide is not less than 30 kgf). Bandages wrapped in a label, stacked in cardboard boxes of 18 (100 mm) or 36 pieces (50 mm).

Bandages medical tubular are intended for fixings of medical bandages. They are a knitted sleeve made of a harsh viscose fabric. Release two;

rooms -- No. 5 and No. 9; the number indicates the sleeve width in centimeters (tolerance ±1 cm). Produced in rolls in film packaging of 25 m per roll. A piece of bandage (when cut off, the bandage does not dissolve), put on over the applied bandage and fix it well. Extensibility is at least 450% for bandage No. 5 and 650% for bandage No. 9. This means that bandage No. 5 with a perimeter of 100 mm is stretched into a ring with a perimeter of 450 mm and can fix bandages on the upper and lower extremities. Bandage number 9, in addition, can be applied to the head and buttocks.

Elastic tubular medical bandages are designed for the same purposes as knitted bandages, but their extensibility is much higher - up to 800%. They belong to the "tepermat" type (knitted elastic dressing). They are made from an elastomeric thread braided with synthetic fibers and cotton yarn. Having a mesh structure, they do not interfere with the aeration of the area of ​​the body on which they are applied, and the observation of this area of ​​the body. Bandages are produced in seven numbers with a free sleeve width of 10, 20, 25, 30, 35, 40 and 75 mm. Weight of 1 m 2 bandage 280 g. The use of tubular bandages saves dressing material and time when applying bandages. It should be noted that when washing elastic bandages, do not use synthetic products. Bandages are washed in soapy foam at a temperature not exceeding 40 ° C, followed by rinsing in warm water and wringing in a towel without twisting. Lay them flat to dry.

Dressing bags are designed to provide self-help and mutual assistance in case of injuries and burns. Four types are produced:

• 1) individual - consists of a gauze bandage (10 cm x 7 m), fixed and movable gauze pads (17.5x32 cm);
• 2) ordinary - has the same composition as the individual. The only difference is in the packaging: the outer shell of an individual bag is rubberized, and an ordinary one is parchment.

Both types of bags are equipped with safety pins to secure the end of the bandage;

• 3) first aid with one pad - consists of a bandage (10 cm x 5 m) and one pad (11x13.5 cm);
• 4) Double pad first aid -- has pads of the same size (11x13.5cm) and gauze bandage 7cm wide (narrow bandage) or 10cm wide (wide bandage). First aid bags are wrapped in plastic film.

Bandages fixing contour are used instead of a gauze bandage when applied to the limbs and torso. Ready-made standard dressings (GOST 22380--77) significantly save staff time and dressing material. They are produced in a set, which includes three bandages for the limbs: large (80x65x45 cm), medium (65x65x45 cm), small (55x35x25 cm) and a bandage for the body (30x78x45 cm). Packed 2 sets in a pack. Bandages are released non-sterile.

Gauze napkins are rectangular pieces of gauze folded in half. Their edges are wrapped inside so that the threads do not fall into the wound. Napkins are made in two sizes: large - 70x68 cm (sterile 5 pieces in a pack and non-sterile 50 pieces in a pack); medium - 33x45 cm (sterile, 10 pieces per pack, non-sterile, 100 pieces per pack); small - 14x16 cm (sterile 40 pieces per pack, non-sterile 100 or 200 pieces per pack). Pack napkins in parchment paper. The wrapper should indicate: sterility, size, quantity, date of manufacture and name of the manufacturer.

Styrofoam wipes are intended for the treatment of burns, postoperative wounds, trophic ulcers and bedsores. Replace cotton wool in dressings of various types. They have high hygroscopic properties, effectively absorbing wound contents and not sticking to the wound. Also used in the form of balls (2x2x1 cm).

Gauze balls are produced sterile (16x14 cm) unfolded and folded (7x4 cm). Sterile balls are produced 40 pieces per pack, non-sterile 200 pieces.

Dressings are sterilized in a steam sterilizer at a temperature of 120°C, at a pressure of 1.1 kgf/cm 2 for 45 minutes. Dressings are placed in metal boxes - biks and after sterilization are stored in the same biks. Sterility in biks with a filter (see Chapter VI) is maintained for at least 8-10 days.

Finished dressings are sterilized in factories, where they are tested for sterility in bacteriological laboratories.

The storage of dressings is carried out in wooden boxes, in dry, ventilated rooms, well protected from dust and rodents. Allow storage of non-sterile material in an unheated room. At the same time, one should strive to ensure a stable temperature, to avoid dampness and the formation of mold. Sterile materials should be stored in a room where the temperature does not fluctuate too sharply so that the packaging does not “breathe” with temperature changes. The fact is that when the temperature rises, the air expanding in the bag partially comes out of it, and when the temperature drops, on the contrary, it enters the bag; microbial penetration is possible with the air flow.

When storing a sterile dressing in a warehouse, it should be laid out according to the years of procurement, since after 5 years, if the package is intact, it is necessary to selectively check it for sterility every year. In case of violation of integrity or wetted packaging, the material is non-sterile.