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What is the purpose of the Adominal Bind

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  • #16
    Research, Info, In-service

    As a first year DPT student, I am putting together an in-service on Abdominal Binder uses for Spinal Cord Injury Patients. I have been searching the web to find current info on the pros & cons of abdominal binders for Cervical SCI patients. Can anyone lead me in the right direction? The majority of the research articles I have been able to pull up on the web are prior to 2005. The remaining articles haven't offered much information to incorporate in my in-service. Searching abdominal binders alone has also proven virtually unsuccessful.
    Sincerely,
    The very green, DPT student
    DPT Student

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    • #17
      Have you checked any of the booklets published by the Paralyzed Veterans of America? I was thinking specifically of Early Acute Management in Adults with Spinal Cord Injury: A Clinical Practice Guideline for Health-Care Professionals

      You can download the pdf from their site.

      Since it is used for "Postural Hypotension" also known as "Orthostatic Hypotension" have you included that in your search terms?

      Out of curiosity, where are you going to school? My daughter just finished her freshman year in a DPT program.
      Last edited by sjean423; 07-02-2008, 11:38 PM.
      T7-8 since Feb 2005

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      • #18
        I have looked @ the table of contents & it is not lookinng promising. I will take a more indepth look. Thanks for the info.
        I am attending a university in Virginia.
        Last edited by DPT Student; 07-03-2008, 12:07 AM.
        DPT Student

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        • #19
          This is an old and non-controversial procedure for both prevention of orthostatic hypotension, help with breathing (abdominal stabilization), and the prevention of "quad belly". Because of that, I doubt you will find any more recent journal articles. You should find reference to it in the CPG listed above as well as in some of the more recent textbooks about SCI such as this

          http://www.amazon.com/Spinal-Cord-Me.../dp/1888799617

          rather than in journals. You will also find information about their use in AASCIN Core Curriculum and the ARN Core Curriculum as well as in this book:

          http://www.amazon.com/Rehabilitation...5055522&sr=1-1

          (KLD)
          The SCI-Nurses are advanced practice nurses specializing in SCI/D care. They are available to answer questions, provide education, and make suggestions which you should always discuss with your physician/primary health care provider before implementing. Medical diagnosis is not provided, nor do the SCI-Nurses provide nursing or medical care through their responses on the CareCure forums.

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          • #20
            Good luck in your studies.

            (I edited my post while you were posting, note my question on search terms).
            T7-8 since Feb 2005

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            • #21
              Hi KLD,

              I've recently been asking the nurses at the LT sub-acute (where my Dad is currently staying) to put the abdominal binder on my Dad.

              Can the binder go directly over the peg? One nurse put a towel around the peg and put the binder on top -- but, this seemed rather bulky and to diminish support.

              Another nurse put the binder over the the peg opening at the stomach and ran the tubing with the adapter feeding cap outside of the binder.

              Which is the correct method?

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              • #22
                The purpose of the abdominal binder is to compress the abdominal contents, giving some peripheral resistance to the large blood vessels in the abdominal which helps to keep his blood pressure up when in a seated position.

                Either method of PEG tube management is fine as long as it does not occlude the tube feeding flow, and does not leave marks from the tube on his skin. If needed, we will cut holes in the binder (and have the OT stitch up the edges to prevent fraying) for things like PEG tubes or ostomy appliances.

                The bottom of the abdominal binder should be right at his pubic bone, and it should not be over his ribs in front. Unless he is very tall, no more than a "3 panel" Velcro-type abdominal binder should be used. If it has metal stays, we usually remove these as it can cause skin problems. It should be applied tightly.

                (KLD)
                The SCI-Nurses are advanced practice nurses specializing in SCI/D care. They are available to answer questions, provide education, and make suggestions which you should always discuss with your physician/primary health care provider before implementing. Medical diagnosis is not provided, nor do the SCI-Nurses provide nursing or medical care through their responses on the CareCure forums.

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                • #23
                  Hi KLD,

                  Sorry - what do you mean that it should not be over his ribs in front?

                  In your Jun 19, 2006 post, you mentioned that the purpose of the abdominal binder was to "maintain" blood pressure -- thus, if my Dad's bp is a good reading, the abdominal binder can help to prevent his blood pressure from dropping when in a seated position.

                  A summary would be mucho appreciated.

                  My Dad is in a LT subacute and some of the nicer humbler nurses have asked 'what is the purpose' of the binder? One nurse claimed that his blood pressure was high at the last reading and thus, if we put on the binder, it'd be dangerous cuz it would raise his bp. However, my understanding is that if my Dad's reading is currently fine, we should put on the binder before sitting him up at 90 degrees (unfortunately, still in the bed).

                  Also, none of my Dad's nurses know how to put on the ace bandages -- so, they've ordered the hoses. Feedback is that it's easier and less time-consuming. My key worry is the skin breakdown.

                  In the ICU, the nurses only used the ace bandages... are the ace bandages better than the hoses?

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                  • #24
                    And, please let me apologize for the dumb questions

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                    • #25
                      If your dad has a high blood pressure now, it is much more likely to be autonomic dysreflexia, which should be treated immediately.

                      If he does not get faint when sitting up (very rare at his level of injury) you can skip the abdominal binder. You do not want it up above his waist or ribs. It should start at the pubic bone and fit tight around the lower abdomen. If it wraps around his rib cage, it is too large or applied to high on his trunk.

                      We use compression hose 24/7 (removing twice daily for skin checks only) with ace wraps on top for any times when out of bed. Shame on nurses who don't know how to apply a figure 8 ace wrap!!! You should talk to the nursing supervisor or nurse educator there about this. Here is a link:

                      Applying a figure 8 ace wrap to the leg

                      (KLD)
                      The SCI-Nurses are advanced practice nurses specializing in SCI/D care. They are available to answer questions, provide education, and make suggestions which you should always discuss with your physician/primary health care provider before implementing. Medical diagnosis is not provided, nor do the SCI-Nurses provide nursing or medical care through their responses on the CareCure forums.

                      Comment


                      • #26
                        Originally posted by SCI-Nurse View Post
                        If your dad has a high blood pressure now, it is much more likely to be autonomic dysreflexia, which should be treated immediately.

                        If he does not get faint when sitting up (very rare at his level of injury) you can skip the abdominal binder. You do not want it up above his waist or ribs. It should start at the pubic bone and fit tight around the lower abdomen. If it wraps around his rib cage, it is too large or applied to high on his trunk.

                        We use compression hose 24/7 (removing twice daily for skin checks only) with ace wraps on top for any times when out of bed. Shame on nurses who don't know how to apply a figure 8 ace wrap!!! You should talk to the nursing supervisor or nurse educator there about this. Here is a link:

                        Applying a figure 8 ace wrap to the leg

                        (KLD)
                        Does your hospital use a typical drugstore variety ACE bandage for compression wrapping? I thought compression wrappings were a different type of wrap (and safer) than a high stretch elastic ACE bandage that is used for athletic injuries. I was under the impression that compression wraps were a low stretch material designed specifically for treating edema and venous insufficiency, with a special technique for overlap and wrapping.

                        All the best,
                        GJ

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                        • #27
                          Originally posted by gjnl View Post
                          Does your hospital use a typical drugstore variety ACE bandage for compression wrapping? I thought compression wrappings were a different type of wrap (and safer) than a high stretch elastic ACE bandage that is used for athletic injuries. I was under the impression that compression wraps were a low stretch material designed specifically for treating edema and venous insufficiency, with a special technique for overlap and wrapping.

                          All the best,
                          GJ
                          Yes, we use 4" and 6" ace wraps (4" on the foot and ankle, 6" for the rest of the leg). I think you are confusing ace wraps with Unna boots used for the treatment of venous ulcers in the leg. Not the same thing at all. The latter is a wound care product.

                          (KLD)
                          The SCI-Nurses are advanced practice nurses specializing in SCI/D care. They are available to answer questions, provide education, and make suggestions which you should always discuss with your physician/primary health care provider before implementing. Medical diagnosis is not provided, nor do the SCI-Nurses provide nursing or medical care through their responses on the CareCure forums.

                          Comment


                          • #28
                            My Dad's bp was high prior to his injury, but had been manageable with meds.

                            So, with the injury, his blood pressure has dropped. Result: a fluctuation

                            In the ICU, he could sit up at 90 degrees for over 5 hours without a problem. But now, he's been left in bed for over a month and transferred to a chair only 3X (without an abdominal binder or wraps) -- and he has felt faint. Now, even in bed, if we raise him to 90 degrees, he feels faint.

                            I've pushed to have an "order" written to have the binder (as a minimum) put on him because I have heard that sitting up will help with his breathing and recently, I learned that it will help to prevent pneumonia -- I'm so sad cuz I found out too late. After a month in the LT subacute, he now has pneumonia.

                            The OT says that the tet hose is less time-consuming and the doctor says that the ace bandages don't give consistent pressure whereas the hoses do. However, when I asked the nurses who are nice enough to help me, they tell me that they don't know how to put on the bandages (because I have some from the previous facility and I want my Dad to sit up asap) -- and the hoses are easier. They've ordered the hoses, but they haven't arrived.

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                            • #29
                              Originally posted by stormie427 View Post
                              kld...

                              could u please steer me in the right direction as to purchasing a binder. the va has been very slow in getting one to jim. i tried buying one here in town and none of the pharmacys carry anything like what u've described. we want to keep jim's quad belly from getting any bigger. thanks!

                              stormie
                              Here is a link to a PDF catalog for various types medical support garments:
                              http://trulife.com/LiteratureRetrieve.aspx?ID=36779

                              As I understand, Medicare guidelines, which drive what many insurance companies will pay for, do not cover the all elastic and velcro type supports, like picture #1. They only cover supports like picture #2 which only have a small elastic gusset on each side at the bottom and straps. Guidelines may have changed, but this was the difficulty I ran into a few years ago, when I bought the support in picture #2.

                              An orthotist is a good resource for a fitting of what you really need. You can spend a lot of money and make a lot of mistakes on supports until you find the right one. An orthotist can be a big help.

                              All the best,
                              GJ

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                              • #30
                                Recently, I've insisted that the abdominal binder be put on my Dad before he sits up in a chair. The nurses have not put on the TED hoses or the ace bandages -- I've noticed that my Dad's calves got very "hard."

                                So, today, I put on the ace bandages on my Dad prior to his sitting up -- his calves were much better, ie, not as "hard" but I was worried because some areas were a bit hard. I was guessing based on KLD's link (thank you!) and tried to follow the instructions.

                                What are the reasons for why my Dad's calves becoming hard?

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