College of 3$f)p&imn& anti ^urgeonsi ICibrarp H2.IC Nellie n ' "^ I SURGICAL DRESSINGS COMMITTEE National Civic Federation, Woman's Department, New England Section Peter Bent Brigham Hospital STANDARD SURGICAL DRESSINGS BY NELLIE A. MACKENZIE, R. N PRICE, 30 CENTS NET STANDARD SURGICAL DRESSINGS DIRECTIONS FOR MAKING BY Nellie A. MacKenzie, R. N. SURGICAL DRESSINGS COMMITTEE Mrs. Frederick S. Mead, Chairman PETER BENT BRIGHAM HOSPITAL BOSTON, MASS. SURGEONS ADVISORY COMMITTEE Harvey Gushing, M.D. John W. Elliot, M.D. Robert B. Greenough, M.D. Charles Allen Porter, M.D. Hugh Williams, M.D. SECOND PRINTING WHITCOMB & BARROWS Boston, 191 6 Copyright 1916 By Whitcomb & Barrows Thomas Todd Co., Pkinteks 14 Beacon Street, Boston, Mas; PREFATORY NOTE The contents of this treatise are concise and accurate. Such knowledge is indispensable to all beginners in making dressings. It may be useful to makers of dressings to know in a general way how they are used. Dry dressings are com- monly used. When the wound is closed with stitches or otherwise they are laid on the surface, and usually remain undisturbed until the wound is healed. When a wound is open and infective the soft, elastic, absorbent sterile gauze is packed in so that it comes in con- tact with the whole wound surface, leaving no pockets where discharge might collect. Such dressings are changed at periods varying according to the condition of the patient and the amount of discharge. Continued use of sterile gauze on an infected wound tends to clean the wound and stop the infection, the gauze mesh having a stimulating effect on the granulations. As the wound becomes healthy, less and less gauze is packed in until finally the wound closes. Wet dressings are sometimes used, in which case they are changed often to keep them moist and clean. When a wound is gangrenous and foul, or faecal with a great amount of discharge, oakum dressings are useful, because they ab- sorb and deodorize the discharge. Sphagnum moss is also used in such cases. John W. Elliot, M.D., Chairman of Surgeons Advisory Committee. Boston, September, 1916. Digitized by tine Internet Arciiive in 2010 witii funding from Open Knowledge Commons http://www.archive.org/details/standardsurgicalOOmack INTRODUCTION In the making of surgical dressings for war relief, changes were imperative from the ordinary methods of preparation and storage. In hospitals, dressings are ordi- narily used within a few days ; for European war relief, an ocean journey of over three thousand miles involves handling from six to eight times before use, and it was found that sterilization could not be insured for any length of time unless the dressings were wrapped in air-proof paper and sealed in tins. Many details in the methods of making, and especially of wrapping and packing, were worked out by the committee, by the advisory surgeons, and by the help of surgeons returned from the front. When I began to teach the making of surgical dressings in connection with this work, I very soon felt the need for authoritative descriptions of the different dressings and for a simple account of the ways in which they are used ; in other words, a text-book was needed for my classes, and I was surprised to find that practically nothing of the kind has ever been written. This little treatise has been prepared under pressure of work, and it is intended only to meet the present need. After the war is over I hope to make a revi- sion that shall be more worthy of the scientific subject it is my ambition to explain. It is a subject that should be in- cluded in the course of study of every nurse and surgeon. Besides following these descriptions literally, it is advisable in class work to have a graduate nurse as instructor. The perfectly made and thoroughly sterilized dressing which is 5 6 STANDARD SURGICAL DRESSINGS the safe product will probably be made only under such direction. Speaking generally, the term "surgical dressings" is given to all materials and appliances used for dressing or protecting wounds. Such appliances as splints, frames, etc., are important surgical dressings, but they are not included here. Nellie A. MacKenzie. CONTENTS Chapter I. The Materials to Use for Making and Pack- ing Surgical Dressings. Chapter II. Important Points to be Considered in Making Surgical Dressings. Chapter III. How to Make Dressings that will be Used Sterile — Sponges, Compresses, Pads, Drains, Gauze Rolls, Meter Gauze. Chapter IV. How to Make Dressings that will be Used Non-Sterile — Abdominal Bandages, T Bandages, Tri- angular Bandages, Muslin Bandages, Sheet Wadding Bandages, Crinoline Bandages, Head Bandages, Scul- tetus Bandages. Chapter V. How to Make Dressings into Packages. Chapter VI. How and Why Surgical Dressings are Sterilized. Chapter VII. Preparation of Dressings for Storage and Shipment. CHAPTER I The Materials to Use for Making and Packing Surgical Dressings Surgical or hospital gauze forms the largest part of surgical dressings. It is chosen because of its particular weave and texture, its elasticity and its softness. These qualities render it absorbent. Gauze that is very soft and free from sizing is more absorbent and of greater value to the surgeon, although it is more difficult to cut and fold. There are several grades of gauze in the market, and the grade is marked according to the number of threads woven in the sc^uare inch. The following table gives the grades of gauze and the number of threads they contain : Gauze No. 3A has 20 x 12 threads to the square inch. " No. 3 " 20 X 14 " No. 2 A " 20x16 " No. 2AA " 22 X 18 " No. 2 " 24 X 20 " No. I A " 28 X 24 " No. I " 32 X 24 After this it is not numbered and is too heavy to use for dressings, but is desirable for gauze bandages. All gauze is woven one yard wide, and usually one hun- dred yards in a piece. It can be obtained in flat fold, which means the entire length is folded back and forth in one- yard turns, or in double fold, which means that it is doubled lengthwise through the middle and rolled on cardboard. This grade is also spoken of as booked, rolled, or bolted 9 10 STANDARD SURGICAL DRESSINGS gauze. INIanufacturers will cut gauze to any desired size for dressings, but by doing it for yourself you save expense, which is considerable, and at the same time develop your own skill. From the cotton plant we get absorbent cotton. The raw cotton contains oil, and in order to make it absorbent this oil must be removed. To do this the cotton is soaked in caustic soda and then thoroughly washed. This process not only removes the oil but makes the cotton soft and white. There are several grades of absorbent cotton, that having the longest fiber being the most valuable. The finer quality is used for pledgets or wipes for surgery of the eye, nose, and ear. The coarser grades are used in making pads for dressings where there is a discharge to be absorbed. The very finest grade of absorbent cotton is known as jewelers' cotton, and is used to pack about jewelry and silverware. Sheet wadding also comes from the cotton plant. The cotton is pressed into thin sheets and then sized, which ren- ders it tough and non-absorbent. It is used for the padding of splints, and also is made into cotton wadding bandages. These bandages are used over dressings before the ordinary cotton or gauze bandage is applied. Oakum originally came from ropes and cordage that had been used about the decks of ships and were saturated with tar. After these ropes became frayed and were of no more use as such, they were picked apart and the strands, or oakum, as it was called, were used for the calking of the leaking seams of the ship. The work of picking the ropes apart was given to convicts as a penal service, each being obliged to pick a certain amount a day. Much of the oakum used at present is made from the waste ends of hemp and STANDARD SURGICAL DRESSINGS II jute left from the manufacture of rope. This waste is sat- urated with pine tar and makes a vakiable surgical dressing. It is absorbent, antiseptic, and deodorant, and when made into pads is used on foul-discharging and gangrenous wounds. Sphagnum moss, also known as peat moss, or turf, is a plant found in the woods, especially in the wet sections. It is very valuable as a surgical dressing because of its ab- sorbent properties. It will absorb tenfold its weight of fluid, while cotton will absorb but sixfold its weight. It is inex- pensive and can be obtained at any florist's. Unbleached muslin for bandages may be of any texture that can be torn and rolled neatly. Gauze bandages are much used, but are very difficult to tear and roll because of the thin texture of the gauze. Unbleached cotton used for covering sterile dressings must be of a heavy, closely woven material, so that dust can- not easily penetrate through its meshes and carry with it germs which render the dressings unsterile. Filter paper and a heavy, tough quality of brown paper are also used for the covering of sterile dressings. Cotton flannel and domet flannel, as well as unbleached cotton, are used for abdominal binders. Unbleached cotton, firm and of medium weight, is used for triangular bandages or slings. Safety pins. No. 2-|, and dressmakers' pins. No. 5, are the most convenient size for general use. Scissors eight inches long and of medium weight can be used for all ordinary cutting. CHAPTER 11 Important Points to be Considered in Making Surgical Dressings Because surgical dressings are such an important part of the surgeon's equipment, we should aim to be accurate, neat, clean as to person and appliances used in connection with their making, careful in every detail, however unimpor- tant it may seem, and the mind should always be on the work. A room should be set apart for this work, and sliould be kept as free from dust as possible. The table on which dressing's are folded, if made of wood, should be covered with enamel cloth, a gray color being preferred to white as less trying to the eyes in the glare of light. Pins must never be allowed to lie about loose on the tables, as they easily become caught in the meshes of the gauze, and might be carried away in the dressings and finally be lodged in an open wound. All folding should be done accurately, and for dress- ings that will be used in open wounds all raw edges must be carefully turned in. The counting of dressings that are to be used in the ab- dominal or other deep cavity is most important, and this couiU sliould always be verified by a second person. If ten dressings are supposed to be in a package and there are onl\- nine, the jjatient may be kept under ether with danger to the heart while the tenth and missing one is being sought for. 1 f eleven dressings are in the parcel, one may be left in the wound, the wound closed, and the mistake not discov- STANDARD SURGICAL DRESSINGS 1 3 ered until general disturbances in the patient's condition arouse suspicion. This mistake has occasionally made neces- sary a second operation. CHAPTER III How to Make Dressings that will be Used Sterile Sponges, Compresses, Pads, Drains, Gauze Rolls, Meter Gauze All dressings that come in direct contact with wounds must be sterilized before they are used. Sponge No. 1. Directions for Cutting Sponges may be cut from either the flat- fold or double- fold gauze. If the double-fold gauze is used, it is necessary to roll it on a board twelve inches wide. The board should be thin, as otherwise the size of the outer layers of gauze would be greater than of the inner layers. Begin to roll with the end of the gauze at the middle of the flat side of the board. After about twenty full turns have been made, make a cut down the middle of the flat side of the roll, from sel- vage to fold, on the same side on which you began to roll. This makes twenty pieces of gauze measuring i8 x 24 inches, double thickness. Cut these again through the mid- dle from selvage to fold, obtaining the desired size for sponges, 12x18 inches, double thickness. Sponges cut from double- fold gauze are more accurate in size and freer from loose threads than those cut from flat-fold gauze, but it takes longer to cut them. In cutting flat- fold gauze for sponges, arrange the entire piece of gauze on the table as straight as possible ; find center of selvage edges, lay yard- stick across and crease with scissors, cut through crease from selvage to selvage, and this will give two parts meas- uring 18x36 indies. Each of these pieces may be cut in 14 STANDARD SURGICAL DRESSINGS 15 thirds, making in all six pieces measuring 12 x 18 inches, double thickness. See diagram : Fold 36' Chart for Cutting Sponge No. 1 Cut Cut 12x18 12x18 12x18 36' 12x18 12x18 12x18 Fold 36" Directions for Folding Sponge No. 1 Spread one double thickness of gauze measuring 12x18 inches on table, remove all loose threads, turn in raw edges opposite fold i inch, turn in all corners, fold each remain- ing raw edge to center, fold again, edge to edge. Now fold from ends to center. Fold once more, making the complete sponge 3x4! inches. Sponge No. 2. Directions for Cutting Arrange entire piece of flat-fold gauze on table. Cut off entire strip of gauze along one selvage 4 inches wide. i6 STANDARD SURGICAL DRESSINGS This Strip will later be used to make drains. This cutting leaves a piece of gauze measuring 32 x 36 inches. Divide this lengthwise through middle, making two pieces meas- uring 16 X 36 inches. Each of these is divided into parts measuring 12 x 16 inches, single thickness, which is the required size for sponges. If the 36 inches were divided into three 12-inch pieces, the cutting of the fold on the outer ends would make these two pieces under size ; consequently the cutting represented in the chart is better. The two inside pieces measure 12 inches single, while the two outside pieces measure 6 inches double. See diagram : Chart for Cutting Sponge No. 2 36" fold 4" ^ 16" 1 12 X 16 CO 16" 12 X 16 c Q a> > 1, 12x16 12x16 |q 12 X 16 12x16 4> 3 § 12 X 16 ^ 16" 12 X 16 16" 36" fold STANDARD SURGICAL DRESSINGS I7 Directions for Folding Sponge No. 2 Place single thickness of gauze measuring- 12x16 inches on table, the shorter edge towards you. Fold the two shorter edges together, then fold again in the same direction, mak- ing strip 4x12 inches. Fold this again into thirds, making a square measuring 4 inches. This sponge is now turned in the following way in order to secure all loose threads and raw edges. Place thumbs inside the pocket (which is formed in the folding), with one thickness of gauze above "PLACK THUMBS INSIHE THE POCKET" and eleven thicknesses below. Hold sponge firmly and turn inside out, being sure to keep the corners square. This turn- ing forms another pocket, with two thicknesses of gauze above and ten thicknesses below. Place thumbs in this pocket, hold firmly in hands, and turn as before, keeping corners square. This completely covers all raw edges and makes the sponge safely and securely folded together. This sponge is also cut 6x8 inches, and is folded in the same way, to measure 2x2 inches when completed. i8 STANDARD SURGICAL DRESSINGS . '* t-'^i*.- «*. ^t iLi-'~-siGSl^3>>. THE COMPLETED TURN The primary use of a sponge is a wipe. Sponge No. 2 can be used only for a wipe, while sponge No. i may be used as a wipe or a drain, or may be shaken out for a dressing. Compresses These are made from a single thickness of gauze and of various sizes. They are not used in wounds, but as outside dressings. A compress cut 6x 12 inches will measure 3x3 inches when folded. One cut 18 x 36 inches will measure 9x9 inches when folded. The most practical size for gen- eral use is cut 10 x 20 inches and folded to measure 5 x 5 inches. The two diagrams following show methods of cutting compresses from entire piece of flat-fold gauze: STANDARD SURGICAL DRESSINGS Chart for Cutting Gauze Compresses 36" fold 19 18" 3 1 18 X 36 tH 18" 18 X 36 _1) 3 ^ 18 X 86 00 1—1 18" 18 X 36 18" 86" fold To Fold a Compress Place single thickness of gauze of the desired size on table with longer edge towards you. Fold long edges to middle, turn small corners, and fold ends to middle. Then fold once more, making a square of gauze having eight thicknesses. , Wicks or Drains These are used in septic wounds to keep them open that they may drain properly and heal from the bottom. Wicks may be made from i to 3 yards long and from ^ inch to 20 STANDARD SURGICAL DRESSINGS Chart for Cutting Gauze Compresses and Cut Gauze Folded edge 36" 3d Cut 4th Cut 14" double 14" double 5 Compress Z 14 X 28 Compress 14x28 ; CutGauze 7x8 : CutGauze 7x8 6" 6" en tn (U * 1— 1