Applying a Figure-Eight Bandage

Skill 9-14

Applying a Figure-Eight Bandage

Bandages are used to apply pressure over an area, immobilize a body part, prevent or reduce edema, and secure splints and dressings. Bandages can be elasticized or made of gauze, flannel, or muslin. In general, narrow bandages are used to wrap feet, the lower legs, hands, and arms, and wider bandages are used for the thighs and trunk. A roller bandage is a continuous strip of material wound on itself to form a roll. The free end is anchored, and the roll is passed or rolled around the body part, maintaining equal tension with all turns. The bandage is unwound gradually and only as needed. The bandage should overlap itself evenly and by one half to two thirds the width of the bandage. The figure-eight turn consists of oblique overlapping turns that ascend and descend alternatively. It is used around the knee, elbow, ankle, and wrist.

Delegation Considerations

The application of a figure-eight bandage may not be delegated to assistive personnel (AP). The application of a figure-eight bandage may be delegated to licensed practical/vocational nurses (LPN/LVNs). The decision to delegate must be based on careful analysis of the patient's needs and circumstances as well as the qualifications of the person to whom the task is being delegated. Refer to the Delegation Guidelines in Appendix A.

Equipment

Elastic or other bandage of the appropriate width
Tape, pins, or self-closures
Gauze pads
Nonsterile gloves and/or other PPE, as indicated

Assessment

Review the health record and plan of care and assess the situation to determine the need for a bandage. Assess the affected limb for pain and edema. Perform a neurovascular assessment of the affected extremity. Assess body parts distal to the site for evidence of cyanosis, pallor, coolness, numbness, tingling, and swelling and absent or diminished pulses. Assess the distal circulation of the extremity after the bandage is in place and at least every 4 hours thereafter.

Actual or Potential Health Problems and Needs

Many actual or potential health problems or issues may require the use of this skill as part of related interventions. An appropriate health problem or issue may include:

Acute pain
Risk for impaired peripheral neurovascular function
Altered skin integrity risk

Outcome Identification and Planning

The expected outcomes to achieve when applying a figure-eight bandage are that the bandage is applied correctly, and the patient maintains adequate circulation to the affected body part and remains free of neurovascular complications.

Implementation

Action	Rationale
1. Review the health record and plan of care to determine the need for a figure-eight bandage.	Reviewing the health record and plan of care validates the correct patient and correct procedure and reduces risk for injury.
2. Perform hand hygiene. Put on PPE, as indicated.	Hand hygiene and PPE prevent the spread of microorganisms. PPE is required based on transmission precautions.
3. Identify the patient. Explain the procedure to the patient.	Patient identification validates the correct patient and correct procedure. Discussion and explanation help allay anxiety and prepare the patient for what to expect.
4. Close the curtains around the bed and close the door to the room, if possible. Place the bed at an appropriate and comfortable working height (VHACEOSH, 2016).	Closing the door or curtains provides for privacy. Proper bed height helps reduce back strain.
5. Assist the patient to a comfortable position, with the affected body part in a normal-functioning position.	Keeping the body part in a normal-functioning position promotes circulation and prevents deformity and discomfort.
6. Hold the bandage roll with the roll facing upward in one hand, while holding the free end of the roll in the other hand. Make sure to hold the bandage roll so it is close to the affected body part.	Proper handling of the bandage allows application of even tension and pressure.
7. Wrap the bandage around the limb twice, below the joint, to anchor it (Figure 1).	Anchoring the bandage ensures that it will stay in place.
8. Use alternating ascending and descending turns to form a figure eight (Figure 2). Overlap each turn of the bandage by one half to two thirds the width of the strip (Figure 3).	Making alternating ascending and descending turns helps to ensure the bandage will stay in place on a moving body part.
9. Unroll the bandage as you wrap, not before wrapping.	Unrolling the bandage with wrapping prevents uneven pressure, which could interfere with blood circulation.
10. Wrap firmly, but not tightly. Assess the patient's comfort as you wrap. If the patient reports tingling, itching, numbness, or pain, loosen the bandage.	Firm wrapping is necessary to provide support and prevent injury, but wrapping too tightly interferes with circulation. Patient complaints are helpful indicators of possible circulatory compromise.
11. After the area is covered, wrap the bandage around the limb twice, above the joint, to anchor it (Figure 4). Secure the end of the bandage with tape, pins, or self-closures. Avoid metal clips.	Anchoring at the end ensures the bandage will stay in place. Metal clips can cause injury.
12. Place the bed in the lowest position, with the side rails up. Make sure the call bell and other necessary items are within easy reach.	Repositioning the bed and having items nearby ensure patient safety.
13. Remove PPE, if used. Perform hand hygiene.	Proper removal of PPE reduces the risk for infection transmission and contamination of other items. Hand hygiene prevents the spread of microorganisms.
14. Elevate the wrapped extremity for 15 to 30 minutes after application of the bandage.	Elevation promotes venous return and reduces edema.
15. Assess the distal circulation after the bandage is in place.	Elastic may tighten as it is wrapped. Frequent assessment of distal circulation ensures patient safety and prevents injury.
16. Lift the distal end of the bandage and assess the skin for color, temperature, and integrity. Assess for pain and perform a neurovascular assessment of the affected extremity after applying the bandage and at least every 4 hours thereafter, or per facility policy.	Assessment aids in prompt detection of compromised circulation and allows for early intervention for skin irritation and other complications.

Evaluation

The expected outcomes have been met when the patient has exhibited a correctly applied bandage, and the patient has maintained adequate circulation to the affected body part and remained free of neurovascular complications.

Documentation

Guidelines

Document the time, date, and site that the bandage was applied and the size of the bandage used. Include the skin assessment and care provided before application. Document the patient's response to the bandage and the neurovascular status of the extremity.

Sample Documentation

Developing Clinical Reasoning and Clinical Judgment

Unexpected Situations and Associated Interventions

After you have applied a figure-eight bandage to a patient's elbow to hold dressings in place, the patient reports tingling, numbness, and pain in his hand during a routine assessment: Remove the bandage, wait 30 minutes, and reapply the bandage with less tension. Continue to monitor the neurovascular status of the extremity. Symptoms should subside fairly quickly. If symptoms persist, notify the health care team.
You remove the bandage on a patient's ankle and note the bandage is limp and less elastic than when it was applied: Obtain a new bandage and apply it to the ankle.

Special Considerations

Keep in mind that a figure-eight bandage may be contraindicated if skin breakdown or lesions are present on the area to be wrapped.
When wrapping an extremity, elevate it for 15 to 30 minutes before applying the bandage, if possible. This promotes venous return and prevents edema. Avoid applying the bandage to a dependent extremity.
Place gauze pads or cotton between skin surfaces, such as toes and fingers, to prevent skin irritation. Skin surfaces should not touch after the bandage is applied.
Include the heel when wrapping the foot, but do not wrap the toes or fingers unless necessary. Assess distal body parts to detect impaired circulation.
Avoid leaving gaps in bandage layers or leaving skin exposed, because this may result in uneven pressure on the body part.
Remove and change the bandage at least once a day, or per prescribed intervention or facility policy. Cleanse the skin and dry thoroughly before applying a new bandage. Assess the skin for irritation and breakdown.

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Skill 9-14