Wound care involves two distinct components: the dressing and the securement material. A dressing is the primary layer placed directly on the wound bed, designed to absorb discharge, maintain a moist healing environment, and protect against contamination. The bandage or securement material is the secondary layer whose function is to hold that primary dressing firmly in place. Proper securement is important for maintaining the sterile barrier, ensuring the dressing functions correctly, and promoting uninterrupted wound healing. Selecting the correct bandage type and applying it with precision are necessary steps in effective wound management.
Primary Categories of Securement Materials
Securement materials fall into three major categories, each offering different characteristics based on material composition and adhesion.
Adhesive Tapes
Adhesive tapes are a common choice. Paper or micropore tape is gentle, breathable, and ideal for sensitive skin or frequent dressing changes. Cloth or fabric tape provides a stronger, more durable hold, suitable for securing dressings on areas that experience low movement or for medical devices requiring firm fixation. Plastic or transparent film tapes offer waterproof protection and high strength, though they are less breathable and may be unsuitable for fragile skin.
Conforming Rolls
Conforming rolls are long strips of woven material like standard gauze or synthetic stretch gauze often sold under names like Kling or Kerlix. These materials are highly flexible and conform closely to the body’s contours, making them excellent for securing dressings on limbs and joints. Conforming rolls do not stick to themselves or the skin, meaning they require an external fastener, such as medical tape or metal clips, to remain secure.
Cohesive and Self-Adherent Wraps
This category includes elasticated materials designed to stick only to themselves, not to the skin or hair. Materials like Coban provide compression and a high degree of flexibility without the need for tape or pins to maintain their position. This self-adhesion makes them simple to apply and remove, offering a secure hold for areas that undergo significant movement.
Choosing the Right Bandage Based on Wound Location and Size
Selecting the proper securement material depends heavily on the wound’s location, the amount of movement in that area, and the patient’s skin condition. For wounds located over highly mobile areas, such as the knee or elbow joints, a flexible option like a cohesive wrap or an elastic bandage is preferable. These materials move with the joint, preventing the dressing from becoming dislodged, whereas rigid adhesive tapes tend to peel or cause skin shearing. For areas with minimal movement, such as the torso or a flat section of a limb, standard adhesive tapes or conforming rolls secured with tape are generally sufficient.
Skin sensitivity is another determining factor, requiring the choice of hypoallergenic materials like paper or silicone tape to minimize irritation and trauma. Stronger adhesives, such as zinc oxide or cloth tape, should be reserved for extended wear or for securing heavier dressings on non-sensitive skin. The need for compression dictates the use of elasticated materials, such as crepe bandages, which can provide support and help manage swelling, unlike simple gauze rolls used only for retention.
The size of the dressing also influences the choice of securement. Small dressings may only require narrow strips of tape, while large or bulky dressings require greater coverage. For large surface areas, wide retention sheets or large-area adhesive films can cover the entire dressing without requiring multiple overlapping strips of tape. The securement material must provide an adequate margin of protection around the dressing.
Essential Application Techniques
The effectiveness of any securement material is directly tied to the precision of its application, especially concerning tension management.
When applying elastic or cohesive wraps, it is important to use even tension to ensure a snug fit without restricting blood flow. Over-tightening can impede circulation, leading to symptoms like numbness, swelling, or discoloration in the extremity, which requires immediate loosening of the bandage. A general guideline is to ensure two fingers can still slide easily under the wrap to confirm adequate circulation.
For securing dressings on joints, the figure-eight wrapping technique is frequently employed, which allows for movement while maintaining continuous pressure and coverage. This method involves overlapping the bandage in an ‘8’ pattern, crossing over the joint to provide stability and conformability.
When using adhesive tapes, proper anchoring and framing are necessary, where the tape is applied smoothly to secure the dressing’s edges without pulling the skin taut. Minimizing tension on the skin prevents blistering, especially around surgical incisions where tension can increase the risk of wound dehiscence.
Tapes should be removed carefully, often by pulling them back over themselves parallel to the skin to prevent skin shearing or trauma. When bandaging a limb, it is recommended to start the wrap distally, or further from the body’s center, and work proximally, moving toward the heart. This helps to encourage drainage and reduce swelling.