DILATION AND CURETTAGE
D&C. The fractional D&C and the dilation and vacuum
(Page 359 on Manual)
OBJECTIVES
At the end of the video lecture the students will be able to:
1. Define Dilation and Curettage
2. Identify the indications of D and C
3. Identify the instruments and uses of D and C set
4. Apply the principles of sterile technique when assisting in
dilation and curettage procedure
5. Understand the importance of perioperative nursing
responsibilities during dilation and curettage.
DILATION AND CURETTAGE (D&C)
• Is a surgical procedure.
• Usually, doctors perform dilation and curettage to diagnose
and treat certain uterine conditions such as heavy bleeding
or the clear uterine lining after a miscarriage or abortion.
• If pregnancy is less than 13 weeks, D&C procedure may
be done.
• If to obtain samples like endo cervical and or endometrial
tissues, fractional D&C is performed
• D&C has a potential risk for uterine perforation from the
instrument used and carries an increase risk for uterine
infection.
• This is because of greater cervical dilation. So, a
prophylactic medication is given for the infection.
• If the pregnancy is 13 to 16 weeks dilation and vacuum
extraction is being performed.
• There are two types of procedures that can be done in
extraction.
• D&C is a surgical procedure in which the cervix is opened
(dilated), and a thin instrument is inserted into the uterus.
This instrument is used to remove tissue from the inside of
the uterus (curettage).
INDICATION OF THE PROCEDURE (Diagnostic
and Therapeutic Indications)
Diagnostic Indication
• Is performed by the doctor for diagnostic purposes.
• The Doctors usually collects tissues sample from the lining
of the uterus or the endometrium and sends the sample to a
lab for testing.
Indication of the Procedure Diagnostic Indications
1. Abnormal bleeding
2. Intermenstrual bleeding
3. Postmenopausal bleeding (rule out endometrial carcinoma)
4. Abdominal cytology (endocervical curettage, cone biopsy
for cervical carcinoma)
5. Ruling out disease of the endometrium (endometritis,
malignancy) at time of hysterectomy
6. Oligomenorrhea and amenorrhea
7. Infertility
Therapeutic Indication
• Dilation and pure touch are done to treat the following:
1. Suspected intrauterine pathology (polyps, incomplete
abortion, molar pregnancy)
2. Postpartum bleeding and retained secundines
3. Hematometra or hematocolpos (abnormal pooling of blood
inside the uterus)
4. Retrieve of "lost" intrauterine device.
5. Insertion of radioactive carrier for management of uterine
or cervical malignancy.
NURSING RESPOSIBILITIES DURING PRE-OPERATIVE
PREPARATIONS
Pre-Operative Preparations
• Remember that dilation and curettage can be done as day
surgery or may require an overnight stay in the hospital.
These are preparations, which are done prior to surgery to
improve the out come of surgery
1. NPO (nothing per orem)
o Take nothing by mouth
o It is recommended take nothing by mouth like food,
water and etc. for at-least six hours before the
schedule operation or after midnight if the operation
is planned in the morning
2. Antibiotics and painkillers
o Maybe prescribe by the doctor before the procedure
o So, these medications must be given to our patient
at the right time or as nurses we need to practice the
ten hours or the rights of our patient when giving
medications
3. Sedative
o Maybe useful to relieve the anxiety of surgery
o This medication can be given as per doctor’s order
4. The genital area must be shaved and prepared for the
surgery
5. Before the surgery or during the previous night, a bath is
advisable.
o Instruct patient to clean the genital area with soap
and water a few times to help in lowering the
bacterial that count and lessen the change of
infection from surgery
6. An enema maybe administered to the patient prior to
performing the surgery
7. Sometimes, a laxative maybe given to clear the bubbles
prior to the surgery as per doctor’s order
8. Instruct the client to void prior to the procedure
9. And lastly, explain the procedure to the client
Contents of Dilation and Curettage Set
1. Sims vaginal speculum
• Is an instrument which gynecologist used in order to
dilate a woman’s vagina so that the cervix and
vagina can be examined
• Is a gynecological instrument which comes with
only one blade
2. Cusco vaginal speculum ASSISTING DURING DILATION AND CURETTAGE
• Is a gynecological instrument which is used to view
a woman’s cervix properly. This instrument can be • Nurse’s role during dilation and curettage is to assist the
reused OB gynecologist when performing the procedure
3. Cervical dilators
• Used mainly to dilate the internal os of the cervix in • In assisting during the procedure, avoid touching unsterile
cases of abortion or in medical termination of surface to prevent contamination of the sterile field
pregnancy
• Are double ended or single ended metal dilators • Next is to prepare the necessary materials of D&C set
with a suitable curve for the uterocervical canal in following the principles of sterility
pregnant uterus
4. Uterine sound • Then the client is placed in a lithotomy position, after that
• A graduated sound used to measure the depth of the drape the client properly
uterine cavity
• Perineum should be washed and painted with cherry cotton
5. Tenaculum forceps balls with betadine
• Are used to hold, stabilize and seize tissues, blood
vessels, the uterus or cervix during various • As per doctor’s order, an anesthetic block is administered,
gynecological procedures o Either local, dental or general IV.
o If in general anesthesia, she maybe given an oxygen
6. Uterine curette 2-3 L per minute prior to administration of the drug.
• This instrument is used to spread the uterine lining
to diagnose or to treat an abnormal bleeding or to
remove products of conception
• The ends of the curette may be blunt and sharp or
both ends sharp or both blunt - loops are of various
sizes: small, medium and large
THE PROCEDURE
• Remember that the main responsibility of the nurse during
the procedure is to assist the ob-gynecologist while
maintaining the principle of sterile technique.
Dilation and Curettage (D&C of the Uterus)
• Your doctor has recommended that you undergo dilation
and curettage or D&C
Uterus
• Is a part of a woman reproductive system.
• Organ that contains the growing fetus.
Cervix
• Forms the neck of the uterus.
Vagina
• Canal for which conception and birth take place.
Endometrium
• Soft lining that protects the fetus during pregnancy.
REASONS FOR HAVING D&C VARY;
• Most D and C are performed because the patient is
complaining of unusually heavy menstrual bleeding.
• Other common problems include:
o Uterine infection
o Bleeding after sexual intercourse
o Incomplete miscarriage
o Presence of polyps (small pieces of extra tissue
growing on the inside of the uterine wall)
PROCEDURE:
• Then the surgeon will use a gloved hand to conduct the
vaginal examination and will check the size and
location of uterus by pressing the lower abdomen.
• A metal or plastic vaginal speculum is used to gently
expand the vagina and allow access to the cervix.
• Once the cervix is visible, a forceps is use to grasp the
front lip of the cervix causing the uterus to open a little.
• Using a blunt tip probe, the surgeon carefully used to
measure the length of the uterus and take a small
sample of tissue from the cervical canal.
• The surgeon will dilate or open the cervix using a series
of progressively larger metal rods called dilators.
• When the cervix is expanded sufficiently. The doctor
will used spoon shape instrument call the curette to
gently scrape off the lining of the uterus.
o In some cases, surgeon used a vacuum curette
that sucks tissue out through a narrow tube.
• When the entire lining of the uterus has been removed.
The instrument is withdrawn.
• The tissue removed will then be send to a laboratory for
analysis.
POST-OPERATIVE CARE
• The aim of post operative care is to provide the client with
a painless and safe recovery from surgery as possible.
• The immediate cause of operative period, the patient is
nurse in a recovery area using 1 to 1 nursing continuous
care.
• The role of the recovery nurse is to ensure the client is safe.

POST-OPERATIVE CARE

• Monitor circulation and sensation in the legs and avoid

compression of the popliteal area.
o The lithotomy position requires the client legs
elevated in stair ups which can impair circulations.
• Instruct the client to use perineal pads and avoid tampons
for 2 weeks.
o This reduces the risk of infection and allows the
tissues to heal.
• Explain that the onset of the next menstrual period may be
delayed.
• Explain that intercourse should be avoided until after the
postoperative check up and after vaginal discharge has
ceased.
o This precaution reduces the risk of infection.
• Instruct the client to rest for several days after surgery.
• Avoid heavy lifting, and report any bleeding that is bright.
o Vigorous activity and lifting interferes the healing
and may cause hemorrhage.
PARENTERAL MEDICATION TYPES OF PARENTERAL MEDICATION
ADMINISTRATION (Page 301 -307)

Within 30 minutes of video lecture, the students will be able to:

● Define parental medication
● Identify different types of parenteral medication
● Identify the different parenteral medication sites
● Learn the different techniques in giving parenteral
medication

EXAMPLE OF MEDICATION TICKET

1. Intradermal (ID)
2. Subcutaneous (SC/SQ)
3. Intravenous (IV)
4. Intramuscular (IM)

RIGHTS OF MEDICATION ADMINISTRATION

1. Right patient
2. Right medication
3. Right dosage
WHAT IS PARENTERAL MEDICATION? 4. Right route
● Any medication administration that involves injecting a 5. Right time
drug directly into a vein (intravenous), muscle 6. Right documentation
(intramuscular), artery (intra-arterial), abdominal cavity 7. Right client education
(intra-peritoneal), heart (intracardiac), or into the fatty 8. Right to refuse
tissues beneath the skin (subcutaneous) 9. Right assessment
10. Write evaluation
WHAT DO YOU NEED TO KNOW ABOUT INJECTION ● Define as the administration of a drug into the dermal
SITES? layer of the skin just beneath the epidermis
● Purpose
○ To administer allergy and tuberculin test
○ To administer vaccination or immunization
(Example is the BCG)
● Not aspirated - Intradermal injection is not perform
with aspiration
● Small volume (0.1 ml) injected to form a small bubble-
like wheal or bleb just under the skin
● A tuberculin syringe is used with a 25-gauge, 3/8-to-
1/2-inch needle
1. You must know about the following information for
each injection sites
SITES FOR INTRADERMAL INJECTION
2. Name of the intramuscular sites
a. Inner Aspect of the Forearm
3. Name of landmarks
b. Upper Chest
4. Name of the muscle injected at IM sites
c. Upper Back
5. Name of major blood vessels and nerves to be avoided
6. Location of all subcutaneous and intradermal sites

1. INTRADERMAL (ID)
2. SUBCUTANEOUS INJECTION (SC or SQ)

● Define as the injection made into the loose connective 3. INTRAMUSCULAR INJECTION (IM)
tissue between the dermis and the muscle layer
● Drug absorption is slower than with IM injection
● Subcutaneous injection is given at 45-degree angle if
the patient is thin or at a 90-degree angle if the patient
has ample subcutaneous tissue
● Usual syringe size is 2 to 3 ml or tuberculin/ insulin
syringe with needle length of 3/8 to 5/8 inches and 25
gauge
● Use to administer insulin and heparin
● Intramuscular injection is defined as the injection of a
SITES FOR SUBCUTANEOUS INJECTION substance directly into a muscle
a. Abdomen ● Given at 90-degree angle
b. Lateral and Anterior Aspect of Upper Arm and Thigh ● Usual syringe size is 2 to 3 ml or 5 ml with needle
c. Scapular Area on Back length of 1 to 1/2 inches and 20 to 23 gauge
d. Upper Ventrodorsal Gluteal Area
Factors to Indicate the Size and Length of the Needle to be
Used
● The muscle
● The type of solution
● The amount of adipose tissue covering the muscle
● The age of the client

INTRAMUSCULAR INJECTION SITES

a. Ventrogluteal
b. Vastus Lateralis
c. Deltoid
d. Rectus Femoris

VENTROGLUTEAL

● Location: Lateral (ventral) side of the hip

● Landmarks: Iliac crest, anterior-superior iliac spine,
greater trochanter of femur
● Muscle mass: Gluteus Medius and Minimus
● Injection area: Opposing palm of hand over greater
trochanter, middle finger pointed to the iliac crest,
index finger toward anterior-superior iliac spine. inject
into the triangle created by these fingers. No major ● Position of the patient when you inject a ventrogluteal
vessels or nerves injection
VASTUS LATERALIS

● Location: Anterolateral aspect of the thigh

● Landmarks: Greater trochanter, lateral femoral condyle
● Muscle mass: Vastus lateralis muscle
● Injection area:
○ Between one hand breadth below the greater
trochanter and one hand breadth above the knee.
○ Width of area is from the midline on the anterior
surface of the thigh to midline on the lateral ● Form of V with your fingers by separating your first
side. fingers from the other 3 fingers.
○ Best to inject into the outer middle third of the ● Place the heel of your hand on the bone (femur) that
thigh. No major vessels or veins to avoid ends before the knee bends and aim the injection right
above the V in the center of the thigh.

● Divide the area (anterior lateral aspect of thigh)

between the trochanter of femur and lateral femoral ● Image of a Vastus Lateralis Injection
condyle into thirds, select the middle third.
DELTOID ● Place where is finger over acromion process
● Location: Upper arm ● Site is 2-3 to 4 fingers breadth below acromion process
● Landmarks: Acromion process, axillary fold
● Muscle mass: Triangle apex of axillary line and base of GIVING OF IM INJECTION IN DELTOID SITE
triangle 2-3 finger breadth below acromion process
● Injection area: In the middle of the triangle/ into the
belly of the muscle mass. Avoid brachial artery and
radial nerve (BARN)

DELTOID SITE OF INJECTION

NERVES TO BE AVOIDED when GIVING IM through

DELTOID
1. Brachial artery
2. Radial nerve

RECTUS FEMORIS
● Location: Anterior aspect of the thigh
● Landmarks: Between one handbreadth below the
greater trochanter and one handbreadth above the knee
● Muscle mass: On top of the thigh
● Injection area: Center of the anterior middle aspect of
the thigh muscle
RECTUS FEMORIS SITE OF INJECTION ● Landmarks: Posterior superior iliac spine, greater
trochanter
● Muscle mass: Gluteus maximus muscle
● Injection area:
○ Draw an imaginary line between the anatomic
landmarks listed above.
○ Administer the injection lateral and slightly
superior (2 inches) to the midpoint of the line
● Avoid the sciatic nerve and superior gluteal artery

● Draw an imaginary line from superior iliac spine to

greater trochanter of femur.
● Site is lateral and superior iliac spine to greater
DORSOGLUTEAL trochanter of femur

● Note: The most dangerous site, trend is away from use

● Location: Upper lateral aspect of the buttocks
Locating the Right Dorsogluteal site and giving IM
injection in left Dorsogluteal Site

● Z-track: An intramuscular injection technique designed

to deposit medications deep into muscle tissue. Release
TECHNIQUES OF IM INJECTIONS the lateral slide of tissue ONLY after needle has been
1. Z Track method completely withdrawn
2. Pinching method

Z-TRACK METHOD
● Seal the medication in the muscle tissue.
● Minimizes subcutaneous tissue irritation from
tracking of the medication as the needle is
withdrawn
● Used more frequently now to decrease
discomfort and pain
● Used for irritating medications (Vistaril) and
tissue staining medications (Iron dextran -
Imferon) ● Pull or push the skin 2 to 3 cm away from the injection
● Use in Ventrogluteal or dorsogluteal sites site with the nondominant hand
(No explanation for the pinching method)

4. INTRAVENOUS INJECTION (IV)

● It is the infusion of liquid substances directly into a vein

● Intravenous (IV) means “within vein” ● Take a look at the different pictures on how the
● Purpose: different injection are being performed and kindly
○ To start an infusion of fluid or blood remember the degree of insertion
○ To withdraw a blood sample
○ To administer drugs DEGREE OF INSERTION
1. Intramuscular - 90-degree angle
INTRAVENOUS INJECTION SITES 2. Subcutaneous - 45-degree angle (especially if the client
is thin) and 90-degree angle if the client has too much
adipose tissue
3. Intravenous - 25-degree angle
4. Intradermal - 10-to-15-degree angle
NOTE: Look at the position of the needles SPECIAL CONSIDERATION

1. Observe aseptic technique to prevent infection during

an injection.
2. To prevent contamination of solution, draw medication
from ampule quickly. Don't allow it to stand open
3. To prevent needle contamination, avoid letting the
needle touch the outer surface of the needle cap, nurse’s
hand, countertop, table surface. (Outer edges of
ampule/vial)
4. To prevent syringe contamination, avoid touching the
length of the plunger or inner part of the barrel. Keep
tip of syringe covered with cap or needle
5. To prepare skin, wash skin soiled with dirt, drainage or
feces with soap and water and dry.
6. Use friction and circular motion, swab from center and
move outward in a 2-inch radius

EQUIPMENTS FOR PARENTERAL MEDICATION

1. Syringes
2. Needles
3. Vials
4. Ampules
PARTS OF A SYRINGE

PARTS OF A NEEDLE

1. Plunger
2. Barrel
3. Hub
4. Tip
5. Needle
6. Measure dose
● Remember that measuring dose is located at the
barrel

1. Hub
2. Shaft
3. Bevel
4. Lumen - the opening
 AVOIDING PUNCTURE INJURIES

1. Dispose uncapped needles and sharps in puncture

proof containers. ANY SHARP INSTRUMENTS
2. Never bend or break needles before disposal
3. Never recap used needles except under specified
circumstances
4. When recapping a needle use a safety mechanical
device
5. Use a one-handed “scoop” method (a video
DIFFERENT NEEDLE LENGTH AND GAUGE
PART OF THE AMPULES

1. Top
2. Neck
3. Bottom
PART OF THE AMPULES What is an AMPULE?
● It is a glass container usually designed to hold a single
dose of drug
● Vary in size from 1 to 10 ml or more
● Most have colored marks around them (prescored) for
easy opening
● If not prescored, the neck it filed and broken off at the
point

PREPARING MEDICATION FROM AMPULE

1. Scored point REQUISITES:

2. Conical Tip ● Medication Ticket
3. Neck ● Ampule
4. Body ● File if you don't have this you can use bandage scissor
(if ampule is not scored)
PARTS OF VIALS ● Small gauze square or plastic ampule opener
● Antiseptic swabs or cotton balls
● Syringe
● Needle for administering the medication
● Filter needle for withdrawing medication

PREPARING MEDICATION FROM AMPULE

● Check the medication order for accuracy and recency

● Clarify any discrepancy in the order to prevent errors in
giving medications and always remember the 10 rights
in administering medications
 ● Perform hand hygiene in order to prevent the spread of
microorganisms
● After reading the medication ticket take the appropriate
medicine from the shelfs and check for the expiration
date
THREE (3) CHECKS FOR ADMINISTERING
MEDICATION
Read the label on the medication:
● Before it is taken off from the shelf;
● Before withdrawing the medication; and
● After placing it back on the shelf or before disposing it
CONTINUATION OF PREPARING MEDICATION
FROM AMPULE
● Select the appropriate needle and syringe
● Open the sterile syringe and secure the needle without
removing its protective cap by grasping the needle hub
and turning the syringe clockwise to tighten it
● The needle size is selected according to the depth of
intrusion and viscosity of the drug. The small bore
allows non viscous medication for subcutaneous used to
pass easily
● Small gauge needles with larger bore are used for
withdrawing medications from ampules or vials and
this facilitates the flow of medication into the syringe
● Prepare medication ampules for drug withdrawal this
will bring medication down to the main portion of the
ampules
○ Remove any medication that is lodged in the
head or upper stem of the ampule by flicking
several times the upper stem of the ampule with
the use of fingernails
○ Open the ampule with an opener or by filing
across the marked line and then breaking off the
top. Place a piece of gauze or alcohol wipe
between your thumb and the ampule neck.
■ The sterile gauze protects the fingers
from the broken glass and any glass
fragments will spray away from the
nurse
○ Firmly grasp the neck and quickly snap the top
off away from the body by bending it towards
you.
○ Dispose the top of the ampule in the sharp’s
container
● Place the ampule on a flat surface
○ attach the filter needle or straw to the syringe if
they use of it is recommended
 ○ Filter needles are used for withdrawing premix
liquid medications from multi dose vials. This
also filter out fine glass particles/ slivers
produced when a top is broken
● Remove cough from the filter needle and insert the
needle into the center of the ampule without touching
the rim of the ampule. The ampule will need to be tilted
if the needle does not reach the base
● Dispose the ampule and use needles in the sharp’s
container
● Place drug and medication ticket on the medication tray
What is a VIAL?
● It is a small glass bottle with sealed rubber cap
● In different sizes from single to multi dose
● Reconstitution: The technique of adding a deal when to
a powder drug to prepare it for administration
PREPARING MEDICATION FROM VIALS
● Check the medication from the chart, check the label of
the vial against the chart and follow the 3 checks in
administering medications
○ Such as before it is taken off the shelf
○ Before withdrawing the medications
○ After placing it back on the shelf or before
disposing it
● Perform hand hygiene to prevent the spread of
microorganisms and prepare drug for withdrawal
● Mix the solution by rotating the vial between the palms
of the hand not by shaking it
○ Some vials contain aqueous suspension which
settles when they stand
○ Sometimes shaking is contraindicated because it
may cause the mixture to foam
● Remove the protective cap or clean the rubber cup of a
previously open vial with an antiseptics swab or cotton
ball with alcohol by rubbing in a circular motion
○ The antiseptic cleans the cap and reduces the
number of microorganisms
● Attach a filter needle to a syringe
○ Filter needle prevents any solid particles from
being drawn up through needle
● Ensure that the needle is firmly attached to the syringe
○ Because this facilitates withdrawal of desired
amount of solution from a vial
● Remove the needle cap and draw up an amount of air
into the syringe that is equal to the volume of the
medicine to be drawn
● For IM Inject the air into the upright vial through the
center of the rubber cap maintaining sterility of the
needle

● Keep the bevel of the needle above the surface of the

medication

● Withdraw the prescribed amount of medication by

keeping the bevel of the needle in the solution

● Hold a vial vertical at the eye level

● If necessary, tap the syringe barrel to dislodge air

bubbles. this air can be ejected into the vial

● When the correct volume of medication plus a little

more (0.25 ml) is obtained withdraw the needle from
the vial and replace the cap over the needle using a
scoop method

● Dispose the vial or return it to its storage place. Dispose

of the use needle in the sharp’s container

● Place the drug and medication ticket on the medication

tray.
 Care of Sterile Materials What is the difference between Medical Asepsis
and Surgical Asepsis?

 Not to confuse the two, in medical asepsis

Learning Objectives:
 Apply the principles and practice of
surgical Asepsis.
 Exhibit the skills on opening a sterile
wrapped package.
 Demonstrate the skills on the care of the
sterile transfer forceps.
 While in surgical asepsis, this eliminates
 Use the skills on the care of sterile covered
materials.
*****Return demonstration of the skills will be
scheduled later when situation permits.
Meanwhile, you will be provided with video clips
on demonstrating the skills. For the interest of
learning you can have this skills practice at home
with the available resources. *****
What is asepsis?
the most common intervention is hand
washing. This will help reduce the
number of pathogens. This is also
referred to as clean technique. This is
commonly used in administration of
medications, enemas, tube feedings, and
also giving daily hygiene to our patient.
all pathogens. This is referred to as sterile
technique. This is commonly used to
doing wound dressing, catheterization
and surgical procedures inside the
operating room applying the surgical
asepsis. The common intervention for
surgical asepsis is hand scrubbing,
gowning, and putting sterile gloves and
bonnet. Surgical Asepsis is defined as
the absence of all microorganisms within
any type of invasive procedure.

 One such basic but extremely important To achieve the goal of medical and surgical
task is maintaining asepsis. asepsis, one has to perform procedure
 It refers to the absence or free from any applying sterile technique.
infectious materials. These are the
disease causing contaminants like
bacteria, viruses and other pathogens.
What is Sterile Technique?

 It is a set of specific practices and

procedures performed to make
equipment and areas free from
microorganisms and to maintain
sterility.
 To prevent contamination of the sterile
fields, the nurse applies the sterile
technique guided by the principles
and practices of surgical asepsis.

Principles and Practices of Surgical Asepsis

When performing aseptic procedure, all personnel

involved in aseptic procedure are required to
follow principles and practices set forth by the
association of peri-op registered nurses all over 4. Sterile objects can become unsterile by
the world. Nurses are strictly applying these prolonged exposure to airborne
techniques in all hospitals inside the operating microorganisms. This means that we set-
room and any other area that requires surgical up sterile trays as close to the time of use
procedure. as possible.
 We stay organized and complete
1. All objects used in a sterile field must be
procedures as soon as possible.
sterile which means that all the contents
 We place large items on the sterile
that are found in a sterile area are all
field including the gloves and
sterile.
sterile transfer forceps.
 Add info, nurses who prepare the
5. Fluids flow in the direction of gravity.
sterile field and the articles inside
When pouring the sterile solution only the
the sterile field must check the
inner cap of the pouring container is
package for sterility, assessing the
considered sterile. The pouring container
intactness of the package, the
not touched in the part of sterile field to
dryness and the expiry date before
avoid splash.
using it.
6. Moisture that passes through a sterile
 Commercially packaged sterile object draws microorganism from
supplies are marked as sterile.
unsterile surfaces above or below to the
Other packing will be identified as sterile surface by capillary action. We
sterile according to the agency see to it that we maintain the dryness of
policy. the package or the sterile field to prevent
 Any torn, previously opened wet contamination.
packaging that has been dropped 7. The skin cannot be sterilized and is
on the floor is considered non unsterile.
sterile and may not be used in the 8. We must apply with our conscientious;
sterile field. alertness and with all honesty are
2. Sterile objects become unsterile when essential qualities in maintaining
touched by unsterile objects. It means surgical asepsis.
that sterile objects must only be touched
by sterile equipment or sterile gloves. Those are the principles and practices of surgical
 Whenever the sterility of an object asepsis.
is questionable, consider it as non-
sterile.
 Fluid that flows in the direction of
the gravity. Keep the tip of the
forceps down during the sterile
procedure to prevent fluid
travelling over entire forceps and
potentially contaminating the
sterile field.
3. Sterile objects that are out of sight or How to open a sterile wrapped package?
below the waist or table level are
considered unsterile. This means that the The principles of sterile technique are applied in
front of the sterile gown is sterile between opening a sterile wrapped package.
the shoulder and the waist and from to
sleeves to 2 inches below the elbow.
Purpose:
To maintain the sterility of supplies and
equipment
There are some considerations necessary to
apply when we open a wrapped package.
Considerations:
1. Confirm the sterility of the package. The
package should not be damaged. It should
be dry and intact.
2. Check the sterilization dates and look
for any indications that it has been
previously opened.
Procedure: (Divided into 3)
 To open a wrapped package while holding
it
 Opening of sterile wrapped package on flat
surface
 Opening of commercially packed material
How to open wrapped package while holding
it? (5 basic steps)
1. Loosen and remove the tape or other
fastening from the wrapper. A great
variety of items are prepared, wrapped and
sterilize in the Central Services
Department of the hospital. These are
prepared for more specific needs of the
client.
2. Hold the sterile package on your open
hand out in front of you and away from
your uniform. Wrappers are opened in a
special way to keep from contaminating
the contents.
3. Place the package so that the top flap of
the wrapper opens away from you.
Inside of the wrapper is indirect contact
with the sterile articles and the package.
4. With the other hand, turn back (away
from you) the top flap of the wrapper.
That should be turning it back, not forward
but backward.
5. Do not let your hand or arm touch the
inner surface of the wrapper. Touching
the inner portion of the wrapper or the
content of sterile pack by bare hands leads
to contamination.
6. Using your other hand, open the upper
flap to the side. Turn back other side
flap in the same way. The sterile article
are almost likely exposed. Make sure that
it does not touch anything. This is to
maintain sterility of the contents of the
package.
7. Grasp remaining flap, grasping only the
outer surface of the wrap. Always the
outside of the wrapper bringing it
towards you. Turn it back to open. Tuck
the corners under the hand holding the
package. Tucking the content make sure
that they do not flutter and contaminate
sterile objects.
8. Keep both arms under the wrapper and
hands under the package. The hands are
considered contaminated to it should
always be under the package.
9. Still holding the package, allow the
nurse or the physician to get the article
using gloved hands or sterile forceps.
Sterile objects should only be touched by
sterile instrument of gloved hand to
maintain sterility. Sterile objects should
 only be touched by sterile instrument,
gloved hand to maintain sterility.

How to open a sterile package in a flat surface?

1. Make sure that you place the package on

the center of your work area so that the
top of the flap of wrapper opens away
from you. The postion prevents the nurse
from subsequently reaching directly over
the exposed content which could
contaminate the item.
2. Reaching around the package not over it.
Pinch the first flap on the outside of the
wrapper remember be conscious all the
time, be alert and be smart we always hold
the outside part of the wrapper we never
touch the inside part of the wrapper which
is considered sterile using your thimb and
index finger with some folded packages, it
will be necessary to grasp the upper most
flap at its corner.

RLE NCM 107 – Parenteral
Injections – Intradermal Injection
Intradermal Injection (Found on Manual of
Nursing Procedures, Page 311)
Assessment:
• Appearance of injection site
• Specific drug action and expected
response
• Client’s knowledge of drug action and
response
Preparation for Skin Testing
1. Prepare all materials needed.
• Vial or ampule of correct medication
• Sterile water
• Sterile 1 ml syringe/ tuberculin syringe
• Needle gauge 25-27: ¼ - 5/8 inch long
• Filter needle / Aspirating needle
• Cotton balls (dry and with alcohol)
• 2x2 sterile gauze square
• Clean gloves (optional)
• Black ballpen
Procedure:
Perform hand hygiene – To prevent the
spread of microorganism.
Prepare the medication from a vial or
ampule
Explain the procedure to the client and
provide privacy. – Information can
facilitate acceptance and compliance
with the therapy.
Place the client in a comfortable sitting
position.
Select a site which are free of lesion,
bruises and discolorations (e.g., forearm
which is 3-4 finger widths below the
antecubital space). Apply gloves as
indicated by agency policy.
Clean the site with the inner aspect of
the forearm with a cotton ball with
alcohol/antiseptic swab starting at the
center and widening the circle outward.
Allow area to dry thoroughly.
Remove the needle cap and expel any air
bubbles from the syringe. Small air
bubbles that adhere to the plunger will
not harm the tissues.
Grasp syringe in dominant hand, close to
the hub, holding it between thumb and
forefinger. Hold needle almost parallel
to the skin surface, with bevel of the
needle up. – The possibility of the
medication entering the subcutaneous
tissue increases when using an angle
greater than 15 degrees.
Hold skin tautly on ventral forearm by
grasping the dorsal forearm of the client
with non-dominant hand. – Taut skin
allows easier entry of the needle and less
discomfort for the client.
Insert the tip of the needle far enough to
place the bevel through the epidermis
into the dermis. The bevel outline should
be visible under the skin surface. – This
verifies that medication entered the
dermis.
Stabilize the syringe and needle. Inject
the prepared skin testing solution
carefully and slowly so that it will
produce a small wheal on the skin.
Withdraw needle quickly; wipe excess
solution on the site with dry cotton ball
or with dry 2x2 sterile gauze pad. Do not
massage the area.
Encircle the wheal with a blue or black
ball pen. Indicate time due for reading or
interpretation of results. Interpretation
or reading of results should be done by
physician after 30 minutes or as
indicated by the agency protocol.
 Positive ID skin test shows: A raised, red,
itchy bump, and surrounding flare around
the wheal.

Common Mistakes on Marking the wheal:

• Don’t mark too far from the wheal.

• Never use a red pen.

Dispose of the syringe and needle into

the sharp’s container. – Do not recap to
prevent needlestick injuries.
Remove and discard gloves.
Record medication and site of injection,
reactions and other pertinent data after
the procedure.

(Additional):

Modification: Children should be gently

restrained during the procedure in order to
prevent injury from a sudden movement.

Health teaching: Instruct and explain why the

injection site should not be washed, rubbed, or
scratched.

RLE NCM 107 – Parenteral
Injections – Intramuscular
Injection
Intramuscular Injection (Found on Manual of
Nursing Procedures, Page 314) – It is the
injection of a medicine into a muscle tissue.
Assessment:
• Client allergies to medication
• Specific drug action, side effects, and
adverse reactions.
• Client’s knowledge of and learning needs
about medication
• Tissue integrity of the selected site
• Client’s age and weight to determine site
and needle size
• Client’s ability or willingness to
cooperate
Requisites:
• Sterile Syringes with Needle (2-3 ml or
5ml)
• Extra sterile needle 20-23 gauge, 1- 1 ½
inches, long bevel
• Filter needle (if needed and available)
• Medication is an ampule or vial
• Cotton balls with alcohol/antiseptic wipe
• Medicine tray/ hypotray
• Sterile water or normal saline, if drug is
in powdered form
• Disposable gloves
Factors in the selection of needle size and
length:
1. Muscle
2. Type of solution
3. Amount of adipose tissue covering the
muscle
4. Age of the client
Special Consideration:
1. In the administration of IM injections,
select a safe site located away from large
blood vessels, nerves, and bone.
2. Do not administer in sites which has
injuries, nodules, lumps, abscess,
tenderness, or other pathology.
3. Literature and integrative review of
evidence indicate that the practice of
aspiration before vaccination injections
into deltoid has no basis in scientific
evidence (Crawford & Johnson, 2012).
Preparation:
1. Prepare all materials needed.
• Vial or ampule
• Syringe and needle of a size appropriate
for the amount and type of solution to
be administered
• Cotton balls (dry and with alcohol)
• Clean gloves
Procedure:
1. Prepare medication as described
previously, using appropriate syringe
and needle. – The needle must be long
enough to penetrate intramuscular
tissue. For more viscous medicine, uses
larger gauges.
2. Explain to the patient the procedure you
want to do. - Information can facilitate
acceptance of and compliance with
therapy.
3. Select the site of IM injection:
appropriate to client’s age and muscles
condition. Assess site for muscle
atrophy, tenderness, hardness, swelling,
inflammation, and skin lesions. – Use site
that has not been used frequently. A
properly selected site will prevent
complications.
4. Provide privacy if site necessitates
exposure of the client. – To prevent
 unnecessary exposure of client’s body
parts.
5. Perform hand hygiene and don gloves. –
To prevent transfer of microorganisms.
6. Place patient in an appropriate position:
- Appropriate positioning promotes
relaxation of target muscle.
• Deltoid – sitting
• Ventrogluteal- back lying with
knee and hip flexed
• Dorsogluteal- side-lying
• Vastus lateralis- sitting or back
lying
7. Locate exact injection site.
• Deltoid- Place 1st finger over
acromion process. Site is 4 finger
breadths below the acromion
process. No more than 1 ml of
solution is injected in this site.
• Ventrogluteal- the triangle
formed by index finger, third
finger and crest of ilium.
• Dorsogluteal- draw an imaginary
line from superior iliac spine to
greater trochanter of femur. Site
is lateral and superior iliac spine
to greater trochanter of femur.
• Vastus lateralis: Divide the area
(anterior lateral aspect of thigh)
between trochanter of femur
and lateral femoral condyle into
thirds, select the middle third.
8. Using a circular motion, cleanse the site
with antiseptic swab. Allow skin to dry.
Discard of swab appropriately. – The
mechanical action of swabbing removes
skin secretions, which contain
microorganisms.
Transfer and hold the swab between the
third and fourth finger of your non-
dominant hand ready for needle
withdrawal.
9. Remove the needle cap/ cover without
contaminating the needle.
10. Invert the syringe and expel excess air,
leaving only 0.2 ml of air (air-lock or air
bubble technique). This is helpful
especially when medication is irritating
to skin and subcutaneous tissue. – Some
clinicians suggest leaving a small air
bubble at the top so that all medicine
will be expelled. Also, it provides a seal
at the point of insertion and prevents
tracking of medication since air bubble is
inserted behind the medication into the
tissue.
11. Insert the needle by:
a. Stretching the skin (to about 2.5 cm/
1 inch) at the site of displacing it to
one side (z track technique) with the
non-dominant hand. – Pulling the
skin and subcutaneous tissue or
pinching the muscle makes it firmer
and facilitates needle insertion.
If emaciated or an infant, muscles may
be pinched.
b. Holding the syringe between the
thumb and forefinger (as if holding a
pen), pierce the skin quickly and
smoothly at 90-degree angle and
insert needle into the muscle. –
Using a quick motion lessens the
client’s discomfort.
12. Hold the barrel of the syringe steady
with your nondominant hand and
aspirate by pulling back on the plunger
with your dominant hand. Aspirate for 5
to 10 seconds. – If needle is in small
blood vessel, it takes time for the blood
to appear. If blood appears in the
syringe, withdraw the needle, discard
the syringe, and prepare a new injection.
This step determines whether the
needle has been inserted into a blood
vessel.
13. If blood does not appear, inject the
medication steadily and slowly
 (approximately 10 seconds per milliliter)
while holding the syringe steady. -
Injecting the medication slowly
promotes comfort and allows time for
tissue to expand and begin absorption of
the medication.
14. After injection, wait for 10 seconds if
using the ventrogluteal site and
withdraw the needle smoothly on the
same of insertion. – Waiting permits the
medication to disperse into the muscle
tissue, thus decreasing the client’s
discomfort.

-Apply gentle pressure at the site with a dry

sponge. – Use of alcohol swab may result in
irritation.

-It is not necessary to massage the area at

the site of injection. – Massaging the site
may cause leakage of medication from the
site and result in irritation.

- If bleeding occurs, apply pressure with a dry

sterile gauze until it stops.

15. Dispose syringe and needle

appropriately. Remove gloves and
perform hand hygiene.
16. Document all relevant information.

RLE NCM 107 – Parenteral
Injections – Subcutaneous
Injection
Subcutaneous Injection (Found on Manual of
Nursing Procedures, Page 308) – It is the
injection of a drug into the subcutaneous (below
the skin) tissue of the body.
The drugs administered in Subcutaneous /SQ
includes: Vaccines, Insulin, and Heparin
Requisites Includes:
• Sterile Syringes with Needle
• Extra needle of proper gauge and length
in accord with site
• Filter needle (if needed and available)
• Vial or ampule of medicine
• Cotton balls with alcohol/antiseptic wipe
• Medicine tray/ hypotray
• Sterile gauze
• Sterile water or normal saline, if drug is
in powdered form
• Disposable gloves
Procedure:
1. Identify the client and explain the
procedure according to the level of
client’s understanding. – This ensures
that the right client receives the right
medication.
2. Select the site of administration. Select
one which is free of tenderness,
hardness, swelling, scarring, itching,
burning or localized inflammation.
Select one which has not been used
frequently. – Correct administration site
minimizes trauma., facilitates
absorption and lessens possible adverse
effects such as infection at the site.
3. Provide privacy if the site necessitates
exposure of the client. – It prevents the
client from being embarrassed.
Assist the client to a position in which
arm, leg, abdomen can be relaxed,
depending on site to be used. – A relaxed
position of site minimized discomfort.
4. Wash hands and don gloves.
5. Cleanse the site with a cotton ball with
70% alcohol using a circular motion,
starting at the center going outwards to
about 5 cm (2 inches) diameter. Discard
the swab appropriately. Allow the area
to dry thoroughly. – Antiseptic
minimizes/lessens the number of
microorganisms in the skin.
6. Place and hold swab between third and
fourth fingers of nondominant hand, or
position swab on the client’s skin above
intended site. – This technique keeps the
swab readily accessible when the needle
is withdrawn.
7. Remove needle from its cover. Pull the
cap straight off. – This avoids
contaminating the needle by the outside
edge of the cap.
8. Expel any air bubbles from the syringe by
inverting the syringe and gently pushing
the plunger until a drop of solution can
be seen in the needle bevel. -Expelling
air ensures that the correct amount of
solution is being administered. Prevents
injection of air into the subcutaneous
tissue.
9. Insert needle by:
a. Holding syringe between the thumb
and forefingers (as if holding a pen)
of the dominant hand (90 degrees
insertion) or hold the syringe with
the palm facing to the side or
upward (45 degrees insertion).
b. Pinching or spreading the skin at the
site with non-dominant hand. –
Pinching the skin elevates the
 subcutaneous tissue and
desensitizes the area somewhat and
thus lessen, the sensation of needle
insertion. Spreading the skin can
make it more firm and facilitates
needle insertion. Spreading the skin
taut is used for those with
substantial subcutaneous tissue.
c. Piercing the skin quickly with bevel
upward at 45-degree angle or at 90-
degree angle (for obese client).
10. Inject the medication by holding the
syringe steadily and slowly pushing in
the plunger. – Holding the syringe steady
minimizes discomfort for the client.
11. Remove the needle quickly, pulling with
the line of insertion while depressing the
skin with your non-dominant hand. –
Depressing the skin places counter-
action on it and minimizes discomfort
while needle is withdrawn.
12. Lightly massage the site with a sterile
cotton ball with alcohol. -This is to
dispense the medication into the tissues
and thus facilitates its absorption/
Massaging is omitted with heparin and
insulin injections.
13. If bleeding occurs, apply pressure to the
site until it stops, and apply an adhesive
bandage if needed. – Bleeding rarely
occurs with subcutaneous injection.
14. Dispose of used supplies according to
agency procedure. Do not recap needle;
discard it in sharps container. – To
prevent yourself and others from injury
and contamination.
15. Assist the client to a comfortable
position.
16. Remove gloves and wash hands.
17. Record the medication given, dosage,
time, route, any complaints of the client
and the signature of the nurse.
 BASIC FIRST AID AND BANDAGING
ROLE OF FIRST AIDER
1. Bridge the gap between the time of the accident and
the arrival of the physician.
2. ends with medical assistance begins.
3. doesn’t intend to compete with or take place the role
of the physician.
OBJECTIVE OF FIRST AID
1. To prolong life
2. To alleviate suffering
3. To prevent further or added injury.
CHARACTERISTICS OF GOOD FIRST AIDER
• Observant – notice all signs
• Resourceful – make best use of all things
• Gentle – shouldn’t cause pain
• Tactful – shouldn’t be alarming
• Sympathetic – should be comforting
➢ Pinch the lower part of the nostrils just below
the bony part of the nose for 10 minutes while
breathing through the mouth.
➢ Release nostrils slowly, repeat procedure if
bleeding continue.
➢ Do not touch or blow the nose for about 24
hours. Do not pact the affected nostrils with
cotton.
➢ Bring patient to hospital if necessary
WOUNDS
- Break in the continuity of a tissue either external
and internal.
Classification:
• Closed (Internal) – has damage that occurs
without exposing underlying tissue
• Open (external) – have exposed body tissues at
the base of the wound
• Explosion – complex type of physical trauma
resulting from direct or indirect exposure to a
blast

Signs and Symptoms

- Pain
- Swelling
- Discoloration
- Hematoma
- Uncontrolled restlessness
- Thirst
- Shock
- Vomiting

CLOSED WOUND
CONDITIONS REQUIRING FIRST AID The types of closed wounds are:

FAINTING 1. Contusions
- Cause by sudden fall in the supply of blood to - more commonly known as bruises, caused by a
their brain that results in the temporary loss of blunt force trauma that damages the tissue under
consciousness. the skin.

Signs and symptoms 2. Strained muscles

- swing - Over-stretching of muscles that have not been
sufficiently warmed-up (could be called “cold”
- Dizziness
muscles).
- Nausea
- Weakness
3. Sprained Ligament
- Paleness
- Sudden force causing joint to move beyond its
- Ringing in the ears
natural range of movement e.g to break one’s
- Blurred vision
fall at speed during an activity such as ice-
First aid
skating.
➢ Lay the person flat on the ground. Elevate the
legs to coax or draw more blood into the brain.
First aid:
➢ If person is on chair, push his head down
➢ Rest the affected area
between his knees.
➢ Ice application or cold compress
➢ Loosen tight clothing
➢ Compression over the affected area
➢ Avoid crowding the patient.
➢ Elevate the affected area above the heart
➢ Call doctor if necessary
OPEN WOUND
NOSE BLEED
- Occurs when a small blood vessel in the lining
1. Abrasions (grazes)
of the nose bursts. It is very common in children
- Superficial wounds in which the topmost layer
and often result from harmless activities such a
of the skin (the epidermis) is scraped off.
your child picking their nose, blowing it too hard
or too often or from getting knocked on the nose
2. Lacerations
during play.
- Are jagged, irregular, or blunt breaks or tears in
First aid:
the soft tissues. We usually get this with
➢ Sit down and lean forward slightly.
accidents from knives, tools, and machinery. In
 the case of deep lacerations, bleeding can be
rapid and extensive.

3. Avulsion
- Is forcible separation or tearing tissue from the
victim’s body. It usually occurs during violent
accidents such as body crushing accidents,
explosions, or gunshots. They bleed heavily and
rapidly.

4. Incised
• An incision is cut through the skin that is made
during surgery. It is also called a surgical
wound. Some incisions are small, others are
long. The size of the incision depends on the
kind of surgery you had. Sometimes the incision
breaks open. This may happen along the entire
cut or a part of it.

5. Puncture
- Wounds that caused by a sharp object that
penetrates the skin. The wound may not bleed
much but these wounds can be deep enough to
damage the internal organs. If you have a small
puncture wound, you need to visit your doctor or
go to Barangay Health Centers for tetanus shot
and prevent infection.

First aid:
The major principles of open-wound treatment to care
to:
➢ Control Bleeding
- Direct pressure
- Elevation
➢ Prevent further contamination of the wound
(wound dressing & bandaging)
➢ Immobilize the injured part
➢ Stabilize any impaled object (impaled items –
objects that have punctured the body’s soft
tissue and are still embedded)
BASIC FIRST AID (Contiuation…)
Fracture
- A medical condition in which there is a
break in the continuity of the bone.
- This can be the result of a high-forced
impact or stress or an injury that results
from certain medical conditions that
weaken the bones.
TYPES OF FRACTURE
1. Greenstick fracture
- an incomplete fracture in which
the bone is bent.
2. Transverse fracture
- a fracture at a right angle to the
bone’s axis
3. Spiral fracture
- a fracture in which the break has
a curved or sloped pattern.
- With this fracture, this is a
complete fracture of long bones
that results from a rotational force
applied to the bone.
- Usually, a spiral fracture is the
result of high energy trauma and
are likely to be associated with
displacement.
- It often occurs when the body is
in motion while one extremity is
planted. Usually, one can have
spiral fracture due to falling hard
on the playground. Another one is
taking a hit in contact sports like
basketball and football. Another
cause would be being in a motor
vehicle accident and child abuse.
4. Comminuted fracture
– a fracture in which the bone
fragments into several pieces.
Usually, this is a breakage of the
bone into more than two fragments.
It takes a considerable force such
as automobile accident, usually
external fixation like cast, splints
are not sufficient to treat this kind
of fracture. The usually require
surgery to restructure the bone. A
person with this kind of fracture
can return to normal life after
receiving proper treatment,
recovery and rehabilitation.
5. Compound fracture
- meaning the bone ends are no
longer touching. This is a fracture
where the bone protrudes to the
skin resulting in an external
wound. This may result in
shocking pain along with swelling
and bruising in the affected region.
In worst cases usually it results in
deformation which can further lead
to impairment in the movement in
the affected area. Complications
can also occur and worsen the
condition when there is presence of
infection or wound healing process
is quite slow.
Example of a compounded fracture wherein the
bone is outside the skin
Signs and Symptoms
- Pain and swelling at the fracture site.
- Tenderness close to the fracture.
- Paleness and deformity (sometimes are
seen on patients).
- Loss of pulse below the fracture, usually in
an extremity (this is considered as an emergency).
- Numbness, tingling or paralysis below the
fracture (rare; once it is seen this is an
emergency).
- Bleeding or bruising at the site.
- Weakness and inability to bear weight.
Usually when a large bone is affected such as the
pelvis or femur, the victim may look pale and
clammy. There is also dizziness or feeling or
fainting. There is also feeling of sickness and
nausea. If possible, do not move a person with
broken bone until emergency response personnel
is present and can assess the situation and if
required apply a splint. If the patient is in the
dangerous place such as in the middle of the busy
road, one sometimes has to act before the
emergency services has arrive.
First Aid:
Initial treatment for fractures of the arms,
legs, hands and feet in the field include splinting
the extremity in the position it is found, elevation
and ice. Immobilization will be very helpful with
initial pain control.
BANDAGING
Three key uses:
1. Apply pressure to bleeding wounds.
2. Covering wounds and burns.
3. Providing support and immobilization
for broken bones, sprains, and strains.
These include gauze, triangular, elastic and
tubular bandage.
SQUARE KNOT
 hold the two ends of the base side
 across the right hand and over the left hand
and then loop it
 loop on what it is in your left hand over
the right and pull it both ends to seal
The purpose of doing the square knot among other
knots is that, besides being easy to tie, it is also
easy to be removed.
CRAVAT
 Hold the apex on your right then fold the
base perpendicular to it
 Next, fold the bandage towards you, so
that it forms of this some sort of triangular
shape
 Insert your right hand inside this triangular
shape then grab the bandage and pull it
inside out
 You can do it again twice or more so as to
get just the right size and thickness for
most bandaging techniques
FIVE BANDAGING TECHINQUES
HEAD INJURY
 Do a narrow cravat
 Wrap around the head (make sure it
applies enough pressure to the injury)
 Use square knot to tie the ends in front of
the forehead
 Hide lose ends
SCALP INJURY
 Fold the base twice so that it leaves a large
area that is unfolded
 Wrap around the head (make sure it covers
the injury area)
  Use square knot to tie the ends at the back ANKLE INJURY
of the head
 start at the sole of the foot
 Hide the lose ends by kinking the apex
 crisscross towards the back and crisscross
inside the loop
the back to the sole of the foot
SHOULDER INJURY  then towards front, make a square knot
 tuck excess bandage
 Do a narrow cravat
 Do an “X” above the shoulder by looping
the bandage beneath the armpit (make sure
the x applies enough pressure to the injury)
 Use square knot to tie the ends beneath the
other armpit

ARM INJURY (Two bandaging techniques)

ARM SLING

 Make the patient pin the bandage using

his/her injured arm (such that the base is
opposite to the injured arm)
 Loop the ends around and behind the nape
 Use square knot to tie the ends behind the
nape
 Kink the apex if it extends

UNDERAM SLING

 Make the patient pin the bandage using

his/her injured arm (such that the base is
opposite to the injured arm)
 Loop the ends around and behind the nape
 Make sure the other ends is beneath the
armpit
 Use square knot to tie the ends behind the
nape
 Kink the apex if it extends.

Video

ARM INJURY

 From the bottom crisscross the bandage

going towards the palm then crisscross at
the bottom until the entire hand is covered
 Make a square knot and tuck the excess
bandage.