Definition
Binders are special wide bandages used for supporting specific parts of body and large dressings.
Types
1.Abdominal binders
- Large rectangular piece of heavy cotton, muslin or flannel, which can be applied to fit the patient’s abdomen
- Synthetic or cotton binder with adhering straps.
- Scultetus binders or many tailed binders consist of a rectangular piece of strong cloth with many tails attached to the two longer sides. Used for support of abdominal musculature and to prevent wound dehiscence and evisceration following abdominal surgery.
2.T-binder
- Single-tailed T-binder
- Double-tailed T-binder
3.Breast binder
Breast binder – Large, rectangular
Abdominal Binders
Abdominal binders is a wide compression belt that encircles the abdomen and comes in different sizes.
Procedure
| Nursing action | Rationale | |
| 1 | Before procedure Identify patient with need for support of abdomen. Assess ability to breathe deeply and cough effectively. | Baseline assessment determines patient’s ability to breathe and cough |
| 2 | inspect skin for actual or potential alterations in integrity. Observe for irritation, abrasions or skin surfaces that rub against each other. | Actual impairments in skin integrity can be worsened with application of binder. Binder can cause pressure excoriation. |
| 3 | Review medical record if medical prescription for particular binder is required and reasons for application | Application of supportive binder may be based on nursing judgment in some situations, physician’s input is required. |
| 4 | Explain to the patient about procedure and the need for application of bander. | |
| 5 | Gather necessary data regarding size of patient and appropriate binder | Ensures proper fitting of binder. |
| 6 | Prepare necessary supplies. Abdominal binder of correct size (cloth or elastic) Safety pina | Binder must be large enough to surround abdomen and overlap to secure closure. |
| 7 | Close curtains or room door. | Promotes understanding and provides privacy. |
| 8 | During procedure Wash hands. | Maintain medical asepsis and prevents infection. |
| 9 | Apply abdominal binder: Position patient with head slightly elevated and knees slightly flexed. Fan-fold far side of binder toward midline of binder. Instruct and assist patient to roll away from you toward raised side rail while firmly supporting abdominal incision and dressing with hands. Place fan-folded ends of binder under patient. Instruct patient to rollover folded ends. Unfold and stretch ends out smoothly on far side of bed (binder should extend from just above symphysis pubis to just below costal margin). Instruct patient to roll back into supine position Adjust binder so that supine patient is centered over binder using symphysis pubis and costal margins as lower and upper landmarks. Pull distal end of binder over center of patient’s abdomen. While maintaining tension on that end of binder, pull opposite ends of binder over center and secure with Velcro closure tabs or safety pins. Assess patient’s ability to breathe deeply and cough effectively Ask patient about comfort level. Adjust binder as necessary. Record the procedure. | Minimizes muscular tension on abdominal wall. Reduce pain and discomfort. Permits placement and cantering of binder with minimal discomfort. Facilitates chest expansion and adequate wound support when binder is closed. Proper placement reduces chances of decreased lung expansion. Provides continuous wound support and comfort. Determines effective ventilation. |
T-binder
T- binder is used primarily to secure rectal or perineal dressings. Double T-binder is used for males and single T –binder is used for females.
Article
- T-binder
- Safety pins
Procedure
| Nursing Action | Rationale | |
| 1 | Before procedure Review medical record if medical prescription for particular binder is required and reasons for application. | Application of supportive binder may be based on nursing judgment. In some situations, physician’s input is required. |
| 2 | Explain to the patient about procedure and the need for application of binder. | |
| 3 | During procedure Assist patient to dorsal recumbent position. | |
| 4 | Have patient raise hips and place horizontal band around waist with vertical tails extending past buttocks. Overlap waistband in front and secure with safety pins. | Minimizes muscular tension on perineal organs and secures binder around patient. |
| 5 | Single-tailed binder Bring remaining vertical strip over perineal dressing and continue up and under to center of horizontal band Bing ends over waist band and secure vertical and horizontal band together with safety pin. Double-tailed binder: Bring remaining vertical strips over perineal or suprapubic dressing with each tail supporting one side of scrotum and proceeding upward on either side of penis. Continue drawing ends behind and then downward in front of horizontal band Secure all thickness with a safety pin. | |
| 6 | Assess comfort level with patient in lying, sitting, and standing positions. Readjust front pins as necessary. Increase padding if any area rubs against surrounding tissues. | Determine efficacy of binder to maintain dressing and support perineal structures |
| 7 | Instruct patient regarding removal of binder before defecating or urinating and need to replace binder afterward. | Cleanliness of binder reduces of infection |
| 8 | Record the procedure in nurse’s notes. | Gives information about patient’s response. |
Brest binder
A breast binder looks like a tight-fitting sleeveless vest when applied and is used to apply pressure to the breasts.
Purposes
- To provide support after surgery
- To support breasts for comfort in case of engorgement.
- To secure dressing.
- To compress breasts to help in suppression of lactation following fetal loss or neonatal death.
Articles
- Brest binder
- Dressing pads or breast pads if padding is required.
Procedure
| Steps of Procedure | Rationale | |
| 1 | Before procedure Review medical record if medical prescription for particular binder is required and reasons for application. | Application of supportive binder may be based on nursing judgement. In some situations, physicians’ input is required. |
| 2 | Explain to the patient about procedure and the need for application of binder. | |
| 3 | Assist patient to supine position in bed | Maintains normal anatomical alignment of breasts and facilitates healing skin contact with under surface |
| 4 | During procure Pad area under breasts, if necessary. | Prevent skin contact with under surface |
| 5 | Place binder under torso with the center of binder at midline. | |
| 6 | Bring the further end over patient’s breasts, take the near end and place over the first one. | |
| 7 | Using Velcro closure tabs, secure binder at nipple line until entire binder is closed | Reduces risk of uneven pressure or localized irritation. |
| 8 | Bring the shoulder strap over on either side to the front and fix to the upper border of binder. | |
| 9 | Make appropriate adjustments including individualizing the fit of shoulder staps. | Maintain support to patient breasts. |
| 10 | Instruct and observe skill development in self-care related to applying breast binder. | Self-care is an integral aspect of discharge planning |
| 11 | After procedure wash hand. | Prevent cross infection |
| 12 | Observe underlying skin for integrity circulation and characteristics of the wound (if present) and comfort level of patient. | Determines that binder has not resulted in irritation of skin or underlying organs Binders shoulder not impede breathing or increases discomfort. |
| 13 | Record application of binder, condition of skin and circulation, integrity of dressing and comfort level. | Documents procedures. baseline date ensures continuity of care. |
Key points in the use of Binders
- Binders are applied so that firm, even pressure is exerted.
- Binders should not impair neuromuscular or pulmonary functions
- Since binders are not attached to the skin, they slip out of place easily and may require periodic reapplication.
- Wrinkled binders are uncomfortable and may cause tissue damage.
- Binders are secured so that there is no movement and friction against underlying skin surfaces.
- Pins or knots are placed away from wound edges or tender areas.
- Binders are applied with the body part in anatomical alignment and with joints in position of function.
- Soiled or moist binders may promote infection if applied over skin surfaces that are not intact.
- The skin surfaces underneath a binder should be inspected at frequent intervals.
- Neurovascular integrity of areas distal to the binder should be assessed at frequent intervals.
- Binders that cause discomfort should be removed and reapplied.
- Talcum powder may be applied to skin surface.
REFERENCES
- Annamma Jacob, Rekha, Jhadav Sonali Tarachand: Clinical Nursing Procedures: The Art of Nursing Practice, 5th Edition, March 2023, Jaypee Publishers, ISBN-13: 978-9356961845 ISBN-10: 9356961840
- Omayalachi CON, Manual of Nursing Procedures and Practice, Vol 1, 3 Edition 2023, Published by Wolters Kluwer’s, ISBN: 978-9393553294
- Sandra Nettina, Lippincott Manual of Nursing Practice, 11th Edition, January 2019, Published by Wolters Kluwers, ISBN-13:978-9388313285
- Adrianne Dill Linton, Medical-Surgical Nursing, 8th Edition, 2023, Elsevier Publications, ISBN: 978-0323826716
- Donna Ignatavicius, Medical-Surgical Nursing: Concepts for Clinical Judgment and Collaborative Care, 11th Edition ,2024, Elsevier Publications, ISBN: 978-0323878265
- Lewis’s Medical-Surgical Nursing, 12th Edition,2024, Elsevier Publications, ISBN: 978-0323789615
- AACN Essentials of Critical Care Nursing, 5th Ed. Sarah. Delgado, 2023, Published by American Association of Critical-Care Nurses ISBN: 978-1264269884
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