Jun 06

Question and AnswerQuestion: It is so important to understand what a person is doing. One thing that I don’t understand and I would like to know is when you how much compression to put on when you bandage a burn.

–John & Susie Schwartz 2697 W. 450 N., Greensburg, IN 47240

Answered by John Keim: First do not use enough compression to restrict circulation. Do not apply a material that can not stretch, like tape, directly above the burn without cushion underneath. This will create an impression and produce swelling, restricting blood flow.

Without compression there is more inflammation and shifting of the bandage. This type of dressing is uncomfortable.

While bandaging a limb (arm or leg), apply the material in this order: ointment, leaves, gauze warp, ABD padding, moisture barrier,.

Now you may apply the compression wrap. We use mostly 1/2 inch wide to 1 inch wide paper tape circling around the limb approximately every 2 inches in a spiral fashion.

Draw approximately two pounds pressure as your wrap. Actually, 1 – 1/2 to 2 – 1/2 pounds according to muscle mass.

Another choice is a tubular elastic dressing retainer (stretchable net material). THis is available in ten sizes. It’s much more expensive than tape, but is by far the best choice for a head wrap.

When a chest compression wrap is needed, caution is needed to avoid excessive compression. This will cause shallow breathing, hyperventilating the body, which may cause the person to faint.

In a case of over granulation of tissue, most likely from a third degree burn, more even pressure is needed. Ace bandage, a stretchable rubberized bandage, is the best. The widest roll, suitable for the body part, should be used. Narrow rolls tend to form pressure marks along the edges.

When wrapping a body with approximately two pounds of compression with one layer, then come back with another layer to use up the balance of the roll you will be doubling the pressure. Judgment needs to be exercised to avoid to much compression.

I have seen 1/2 inch overlap of granulated tissue over undamaged skin. The cause was not enough compression. By using the Ace bandage and the correct amount of pressure, the excess tissue receded in four or five days.

–John Keim
–Published in Balm of Gilead Burn Caretakers’ Newsletter Volume 1, No. 2, Summer, 2009

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