Securement Strategies for Challenging Wound Locations
by Laurie Swezey RN, BSN, CWOCN, CWS, FACCWS
We've all experienced difficulty in getting dressings to stay on for as long as we need them to, especially when there are many commercial dressings that could (and should) remain in place for several days before they require changing.
The following are some materials that may prove helpful in keeping dressings in place:
- Net retainers (i.e., burn net): Net retainers resemble fishing net and are made of cotton and other stretchy materials. They come in a variety of sizes and can be used to secure dressings for individuals who are allergic to the adhesives in tapes. They are reusable, which can help to defray dressing costs, and are generally comfortable as they do not compress the tissue when sized correctly. They can be small enough to fit around a hand or large enough to fit around the torso.
- Gauze bandage rolls: These can be helpful in securing dressings over hard-to-dress areas, such as the hand or the heel. They come in a variety of widths and have the added advantage of being very absorbent.
- Shaped dressings: There are several dressings designed to fit those hard-to-dress areas, including butterfly-shaped dressings for the coccyx and sacrum and dressings that form a cup around the heel.
- Tubular gauze: Tubular gauze can be used to dress fingers and toes. Tubular meshed cotton (tube gauze) is stretched over a rigid cylindrical tool, which is used to apply the gauze to the entire length of the digit. The dressing is secured by tying two ends of the dressing around the patient's wrist or ankle, which prevents the dressing from coming off. An impregnated gauze dressing (i.e., jelonet) may be used under the cotton so that the gauze does not adhere to the wound.
The following are some specific tips for dressing hard-to-dress areas of the body1:
- Wrap each finger individually.
- Cover wounds with appropriately-sized gauze squares, then secure in place with a gauze roll.
- Keep bandaging to a minimum so that the patient retains some functioning of the hand
- Tubular gauze dressings can be used instead of gauze rolls to secure the dressing (they are easier to apply and may stay in place better, but cannot be used if sterile technique is required).
- Occlusive dressings may be used for small wounds due to their flexibility.
- For wounds that are infected or that are relatively large, gauze rolls wrapped in a figure-eight pattern around the hand and wrist may be used.
- Use occlusive dressings for relatively small and uninfected wounds.
- Use non-adherent dressings if hair is present or if skin integrity is poor.
- Dressings may be secured with roll gauze, net retainers, or self-adherent elastic wraps (tensor bandage).
- Wrap dressings on a slight angle securely but not tightly to avoid constricting circulation.
- Montgomery straps, which are adhesive strips with ties, can be used on either side of an abdominal wound to anchor a dressing.
- Alternatively, to prevent having to apply tape across the abdomen, use a hydrocolloid dressing on either side of the abdominal wound, then place the primary dressing and apply tape from the primary dressing to the hydrocolloid dressing on either side of the wound.
- Burn vests, made from netting that has a hole for the patient’s head and a non-adherent contact layer, are secured with ties located at the midaxillary lines.
- Alternately, gauze rolls or compression bandages may be used to secure a primary dressing in place (stretching too tightly may impede respiration).
- Because these wounds are more dependent in positioning, they may drain more than wounds to the arms or hands.
- Thick foams or gauze pads can be used to cushion weight.
- Remember that the patient will need to wear a shoe - allow enough room for a shoe to fit over the dressing.
- Temporary footwear may be required, such as a cast shoe or boot.
- The patient may need to use a cane or other assistive device to ambulate if their balance is altered, especially for patients with digital or plantar wounds.
Want to learn more "tricks of the trade"? Search our blog to read current evidence-based articles on a variety of wound care topics.
1. Meyers B. Wound management: principles and practice. Upper Saddle River, New Jersey: Pearson Education, Inc; 2008.
About The Author
Laurie Swezey RN, BSN, CWOCN, CWS, FACCWS is a Certified Wound Therapist and enterostomal therapist, founder and president of WoundEducators.com, and advocate of incorporating digital and computer technology into the field of wound care.
The views and opinions expressed in this blog are solely those of the author, and do not represent the views of WoundSource, Kestrel Health Information, Inc., its affiliates, or subsidiary companies.