Stopping of a external bleeding with a direct pressure on the wound (pressure bandage)

Authors: Rednenko VV, Poplavets E.V.

Editor: Rednenko V.V.

Equipment for the practical skill:

• gloves
• bandages
• cotton-cushion pad
• sterile gauze
• blanket

Clinical situation:      

• You see a person with a bleeding. Stop the bleeding

Order of the skill performance:

Preparatory stage:

• Put on protective gloves
• Perform a primary examination
• Identify a type of the external bleeding
  • verify the bleeding
  • visualize the wound
• Choose a way to stop the bleeding
• Obtain informed consent to the procedure
  • Give all the information to the person about what the procedure involves, including the benefits and risks, whether there are reasonable alternative, and what will happen without this procedure
  • Explain what you are going to do.
  • Ask the patient to consent to procedure.

Main stage:

• Take a comfortable position for this manipulation, If it’s possible, use the help of an assistant.
• Choose one of the following methods:
  • by finger pressure of the vessel on the proximal site from the wound (on limbs, the neck, and the head) - press the vessel at the set point for this segment of the body, using either a thumb or join together 2-5 fingers or a clenched fist, achieving a stop of bleeding. If possible, ask to perform this action (pressing the vessel) of the assistants or the patient. Make sure of the efficiency of your assistants actions.
    
  • by direct pressure on the wound - take the pressure element (roll bandage, cotton-cushion pad, multilayer cloth), Lay it on the wound and gently, gradually start pressing it with the palm (the base of the palm, thumb), gradually increasing the pressure, until the bleeding stops. It is forbidden to use this method in the presence inside the wound of foreign bodies, acute pieces of bones. If possible, ask to perform this action of the assistants or the patient. Make sure of the efficiency of your assistants actions.
    
• Prepare a pad (pressure element). 
  • For this, you can use cotton-gauze pads from special dressing, bandage rolls, multilayer dressing with cotton wool and gauze or clothing items.
  • When the pressure element is formed, the pad or napkin is twisted longitudinally until a dense bundle is formed, which then folds into a rounded element. Other actions are possible that will help to form a dense element corresponding to the size of the wound
  • If the pressure element is made of non-sterile materials or cotton wool, place a sterile cloth on the wound
• Cover the wound with a pad and apply direct pressure until the bleeding stops.It may take several minutes for the bleeding to stop.

• If blood soaks through the first gauze pad, put another one on top and apply additional direct pressure (press harder than you did before, if possible). 
• When the bleeding stops, check for circulation (feeling, warmth and color) beyond the injury.
• Apply a roller bandage. Wrap the bandage around the wound several times to hold the gauze pad(s) in place. Tie or tape the bandage to secure it.

• Check for circulation (feeling, warmth and color) beyond the injury. If there is a change in feeling, warmth or color (indicating that the bandage is too tight), gently loosen it.
• Remove your gloves and wash your hands.

Note: If the bleeding does not stop with the application of direct pressure, call 103 or the designated emergency number if you have not already, and give care for shock if necessary.

Final stage:

• In the cold season, protect the damaged limb from cold.