10)

Surgical Dressings
Surgical dressing is a term applied to a wide range of materials
used for the dressing of wounds. They are employed as coverings,
absorbents, protectives or supports for injured or diseased tissues.
They can be classified into following categories
1. Fibres plain and medicated;
2. Fabrics plain and medicated;
3. Bandages;
4. Self adhesive plaster;
1. FIBRES
TABLE 10.1
Classification of Fibres

Unmedicated Absorbent cotton

wool
Cotton
Medicated Capsicum cotton
wool
Fibres Lustrous (Regenerated
cellulose)
Rayon
Matt (Delustered
regenerated cellulose)
Wood cellulose
Wool
Cellulose wadding
Animal wool
for chiropody
190
 SURGICAL DRESSINGS
191

Ab_órbent Cotton Wool (Absorbent Cotton)

It consists of epidermal trichomes from the secds of
species of gossypium. It is available as rolls or sImall balls. Itcultivated
S and wound exudates rap1dly. absorbs
ldeally fibres of absorbent cotton
wool should be well carded, bleached to a good whíte, free from leaf,
ta onat. 'and must be free from optical
whiteness. They are used
for following purposes :
1, To absorb wound exudates
2. To clean and medicate the wounds using bactericidal solution
to the skin.
3. To give physical protection and warmth to the area.
Tests
1. Cotton on ignition burns with a flame and gives very liule
odour or fumes.
.2r Moisten with N/50 iodine and when nearly dry, add 80%
w/w/H2SO4, blue colour is prodúced.
3. In cold sulphuric acid 80% w/w, cotton dissolves.
4. In cold sulphuric acid 60% cotton remains insoluble.
3. In warm (40°C) Hydrochloric acid B.P. cotton is insoluble.
6. Cotton 'is insoluble in 5% potassium hydroxide solution.
1. Cotton gives no red stain with phloroglucinol and HCI.
8. Cotton is insoluble in 90% formic acid, phenol or acetone.
2. FABRICS

Surgical gauzes material

Ine function of surgical gauze is to provide an absorbent
0f sufficient tensile strength for surgical dressing.
In the process of making surgical gauze the raw cotton fibre is
intoa thread and thread
spun or twisted
mechanically
In turn WOvencleaned
into and
an then
open-mesh cloth. This cloth is gray in
white and rendered
appearance and non-absorbent. Itusedis inbleached
the preparation of surgical
absorbent by classified according to its mesh or number of threads
Cotton. Gauze
Same
is
processes as

per inch.

Absorbent gauze or Unmedicated gauze

It is a Soft cotton cloth of plain weave, open texture. It is usually
192 HOSPITAL AND CLINICAL
PHARMACY
Table 10.2
Classificantion of Fabrics
Unbleached
calco
Ordinary Absorbent
+ Gauzes
cotton gauze
X-ray Absorbent
Detectable ribbon gauze
Plain (cotton)
Gauze pad
Non impregnated

+ Muslin-Absorbent muslin

Plain with
raised

Nap (cotton)
Fabrics

Lints

Unmedicated ; Medicated

Absorbent lint Euflavine lint

Plain Water proofing oil and resins

(silk) Oiled silk and resins
impregnated

Leno Soft paraffin

(cotton, Paraffin gauze dressing
rayon or
both)
SURGICAL DRESSINGS 193

lengthwise and in various lengths. As cotton is in the form of

folded be applied directly to wounds for
spun threads hence gauze can
absorbs water readily and many layers are used to absorb
dressing. It
protection to a large wound.
the exudate or give adequate physical absorptive and protective
Hence it is usually covered with a more
dressing.
Gauze pad or gauze swab
The gauze may be
Absorbent gauze is folded into a square pad.
harmless dye. The number of layers (ply) and the
dyed with a to use but the common sizes
dimensions of the pad vary according
10 cm square available in 8, 12, 16 or 32 ply number
are 5, 7.5 and and shedding of fibres, no cut edges
minimise adhesion
of layers. To
WEFT

2 PICKS
INA
SHED

WARP

Fig. 10.1. Leno fabric (arrangement of threads).

 HOSPITAL AND CLINICAL
194

Table 10.3. Classification of Bandages

PHARMACY
+ Cotton (unbleached
calico) Triangular bandage
+Non elastic
+Cotton (heavy weft) Open wove bandage
W. Cotton Domette bandage
wt. wool

W. wool cotton, Crepe bandage

wf, cotton
-Twisting certain W. Cotton, wf. cot- Cotton crepe
Wrap threads ton, rayon or both bandage
Cotton Cotton stretch
bandage
Elastic
Rubber threads W. cotton, rubber Cotton rubber
wf. cotton elastic bandage
W. cotton, rubber Cotton and rubber
Bandages B-cotton elastic net band
Lace construction age
Crimping Crimped gauze Cotton confimng
bandage
-Leno Calcuim sulphate
and adhesives
Impregnated
Paste of zinc oxide Zinc paste bandage
Open Paste of zinc oxide
WOVe Zinc paste and
and coaltar coaltar bandage
Paste of ZNO and Zinc paste and
ichthammol ichthammol bandage

Warmed Elastic cloth-Mass Diachylon elas

for
+ Adhesive adhesion Diachylon tic adhesive
bandage and
ventilated type
Self
Elastic cloth-Zinc oxide Zinc oxide

Abbreviations Used
adhesive
w. Plaster elastic self ad
hesive ban
wt. -Warp
Weft dage and hal
spread
SURGICAL DRESSINGS 195

swabbing during
should be visible. Small gauze pads are used for
surgery. Variety of padsare used for wound dressing and for packing
wounds./
3. BANDAGES

Crepe Bandage
fabric of plain weave
It is an elastic bandage made by an elasticwool and weft threads
and
in which the warp threads are of cotton
threads is as shown in Fig.
are of cotton. The arrangement of warp
WEFT

WARP

W W C2 W
C

Fig. 10.2. Arrangement of threads (Crepe bandage)

altermate
10.2. It contains no rubber thread. Is opposite twists of the
use but
cotton threads gives best elasticity. Athough it is lost during
can be restored by washing in hot soapy water.
Uses :
Crepe bandage confirms well to body contours allowing limited
movement and stretching it swelling takes place. Hence they are very
 196 HOSPITAL AND CLINICAL PHARMACY

useful :
1. For giving light support to sprains and strains.
2. For convectional purposes.
3. As a compression bandage.
Plaster of Paris Bandage
This is a cotton cloth of leno weave, impregnated with dried
calcium sulphate consisting of a mixture of the amorphous and
crystalline forms and suitable adhesives such as methyl cellulose of
high methoxy content and hypromellose.
In use it is thoroughly moistened with water and applied to the
limb or body, where it sets in not more than 8 minutes to form a
splint. The setting time can be modified by suitable additives. The
water should be of high bacteriological purity.
Uses :
Plaster of paris bandage is used for immobilisation and correction
of fractures, and for the construction of body supports or for similar
purposes.
4. SELF ADHESIVE PLASTERS
These consists of a self adhesive mass spread on a supporting
material that may be a plain or elastic cloth or a plastic film. The
Support may be tinted in flesh colour.
Unlike adhesive bandage, they are often (but not always) used in
strips (rather than long length) to cover a restricted area.
Belladonna self-adhesive plaster (Belladonna plaster)
A belladonna plaster consists of a rectangular or
cotton, rayon or mixed cotton and rayon circular piece of
cloth spread
mass containing an extract of belladonna herb or root. evenly with a
be perforated and the mass is made The plaster may
porous
adhesive surface is covered with a protector. or permeable to air. The

Uses :
This plaster is used as a counter irritant in
and neuralgia. rheumatism, lumbago
Waterproof microporous self-adhesive plaster
This is similar to the previous dressing but both
are permeable to air and water vapour. The film s in film and mass
the forn of a
 SURGICAL DRESSINGS
197

microporous plastic filter that

but not liquid water. Hence allows passage of air and water vapour
plaster, this is intermediate in compared
propcrties.
with the other two plastic
Table 10.4.
Classification of Self-adhesive Plasters
Belladonna extract Belladonna self
adhesive plaster
+ Plain cloth
Salicylic acid
Salicylic acid self
adhesive plaster
Self-adhesive
Plasters
Zinc oxide
Zinc oxide self
adhesive plaster

Elastic weft Zinc oxide Extension plaster.,

+ Elastic cloth

Elastic warp Zinc oxide Zinc oxide elastic

self-adhesive plaster
Permeable to

Water Air Water vapour

Perforated plastic
self-adhesive plaster

Plastic film Waterproof plastic

self-adhesive plaster
Water proof micro
+
porous self-ad
hesive plaster
Uses :
It is used to cover sites of infection when free passage of air and
water vapour is desired but exclusion of water is necessary.
STANDARDS FOR EVALUATION OF SURGICAL
DRESSING I.P.
The I.P. recommends following standards for absorbent Cotton
Wool (surgical dressing) :
198 HOSPITAL AND
SHIFA CC
CLINICAL
1. Identification
PHARMACY SURGICA
1. On treatment with iodinated zinc chloride solution, the
become violet. fibres the resid
the liquic
2. When examined under a microscope, each fibre is seen to the resid
be of single cell upto 4 cm long and upto 40 um wide,.
7. Ether
2. Acidity or alkalinity Not
In 15 gm add 150 ml of water, macerate for two hours in a with sol
closed vessel. Decant the liquid carefully and squeeze out the residual apparatu
to const
liquid, mix themn well. Reserve 10 ml for the test for surface active
substances and filter the remainder.
In 25 ml of filtered extract, add 0.1 ml of dil.
8. Sulp
phenolphthalein
solution. To another 25 ml, add 0.05 ml of methyl orange Not
Neither solution shows a pink colour. solution. for 10
gm of t
3. Surface active at first,
substances the resic
Intoa 25 ml graduated ground glass stoppered cylinder
rinsed with sulphuric acid followed by water, previously are nO

have di=
extract reserved in the previous test. Shake it add the portion of the currents
to stand for oneminute and shake again for 30 vigorously and allow acid ane
the height of the froth does not exceed 2 mmtimes. After 5 minutes, operatic
the liquid. above the surface of
0.5 mg
4. Fluorescence
9. Loss
Examine a layer about 5 mm in No
having a maximum output at 365 mm. Itthickness
shows
under a U.V. lamp at 105
violet fluorescence and a few yellow only a slight brownisn determi
isolated fibres show an intense blue particles, not more than Iew We
5. Colouring matter
fluorescence. dried fc
test. Pu
Slowly extract 10 gm in a narrow bottle a
50 ml of extract is percolator with alcohol unu
obtained. Pour the ligquid by gent
cylinder and examine a 20 cm layer against ainto acolourless glass the loaC
very faint yellow tinge may be white
tinge is apparent. observed but no bluishbackground.
or
A
greenish
the stop
time sE
prescrib
6. Water soluble substance
Aft
Not more than 0.5% as
with 500 ml of water for 30 determined by this method. Boil 5 gm bottle
min, stirring frequently
water lost by evaporation. Decant the and replace the applica
liquidinto a beaker, squeeze
CAL PHARMACY
SURGICAL DRESSINGS 199

ition, the fibres the residual liquid from the material carcfully with a glass rod, mix
the liquids and filter the extract while hot. Evaporate 400 ml and dry
ibre is scen to the residuc to constant wcight at 105°C.
Oum wide. 7. Ether soluble substances
Not more than 0.5% determined by this method. Extract 5 gm
wo hours in a
with solvent ether in continuous extraction apparatus such as soxhlet
apparatus for 4 hours. Evaporate the ether extract and dry the residue
it the residual to constant weight at 105°C.
surface active
8. Sulphated ash
enolphthalein Not more than 0.59% : Heat a silica or platinum crucible to redness
nge solution. for 10 minutes, allow to cool in a desicator and weigh. Put 1 to 2
gm of the substance, accurately weighed into the crucible ignite gently
at first, until the substance is thoroughly charred. Cool and moisten
the residue, with 1 ml of sulphuric acid, heat gently until white fumes
er previously are no longer evolved and ignite at 800 ± 25° until all black particles
ortion of the have disappeared. Conduct the ignition in a place protected from air
y and allow currents. Allow the crucible to cool, add a few drops of sulphuric
er 5 minutes, acid and heat. Ignite as before, allow to cool and weigh. Repeat the
e surface of operation until two successive weighings do not differ by more than
0.5 mg.
9. Loss on drying
U.V. lamp Not more than 8.0% determined on 5.0 gm by drying in an oven
ht brownish at 105°C. Loss on drying is the loss in weight in per cent w/w
e than few determined by the procedure given below :
Weigh a glass stoppered shallow weighing bottle that has been
dried for 30 minutes under the same condition as employed in the
test. Put the sample in the bottle, cover it and accurately weigh the
lcohol until bottle and the contents. Distribute the sample as evenly as practicable
urless glass by gently sidewise shaking to a depth not exceeding 10 mm. Place
kground. A the loaded bottle in the drying chamber (oven or desicator). Remove
or greenish the stopper and leave it also in the chamber. Dry the sample for the
time specified in the monograph or to constant weight at the
prescribed temperature:
Boil 5 gm After drying is completed, open the drying chamber, close the
replace the bottle promptly and allow it to come to room temperature (where
er, squeeze applicable) in a desicator before weighing.
 200 HOSPITAL AND CLINICAL
PHARMACY
10. Absorbency
1. Test for sinking time
Weigh the dry cylindrical copper wire basket to the ncares
centigram. Take fine portions each of approximately I gm from
different places in the sample, pack loosely in thc basket and weigh
the packed packet to the nearest centigram. Hold the basket in the
horizontal position and drop it from a height of about 10 mm into
water at 20°C contained in a beaker at lcast 12 cm in diamcter and
filled to a depth of 10cm. Measure with a stop watch the timc taken
by the basket to sink below the surface of the water. Repcat the
procedure on two further samples and calculate the average valuc.
Absorbent cotton wool requires not more than 10 seconds.
2. Test for water holding capacity
After the sinking time has been recorded, remove the basket from
the water, allow it to drain for 30 seconds in the horizontal position,
transfer it to a tared beaker and weigh to the nearest centigram.
Calculate the weight of water retained by the sample. Repeat the
procedure onto further samples and calculate the average value.
Absorbent cotton wool retains not less than 2. gm of water per g.
CATHETERS
Catheters are used to collect urine from the patients who are
unable to void naturally or where incontinence parts and urinals are
inadequate.
Flexible and non-flexible catheters are available. The flexible soft
rubber type of catheter is commonly preferred for both male
female patients. _and
Flexible soft rubber catheters
aclosed solid tip At one end is a consist of small rubber tubes with
attachment of the catheter to a glassfunncl shaped opening to facilitate
junction or another tube leading
to a collection unit.At the
inserted end is_a wide opening which
Jeads to the channel through which
(This type of cathcter is referred to asurine
a
flows to thc collection unil,
Straight Catheter in
to the retention catheter
which is designed to remain in the contrast
for long periods of time
as Balloon Retention catheters are commonly urethra
Catheters. The balloon catheters are designed in known
way that the Catheter tip remains
within the such
are two channelsone for the patient's
paSsing of urine and thebladder. There
other for the
 201
SURGICAL DRESSINGS

Fig. 10.3. Catheters

and Balloon catheters.

Fig 10.4. Rubber catheters
inflate the balloon.
injection of sterile water which procedure and is handled
of catheters is a dangerous
The insertion Serious infections of the bladder
and
or trained nurses.
by physicians
the urethral and bladder tissues may result from improper
damage to
insertion.

I.V. SETS
intravenously are sterile.
Administration sets used to deliver fluids
free and disposable.) They_have certain basic components.
pyrogen
plastic spike to pierce the rubber closure or plastic
These include a chamber to trap air and to permit
IV.container, a drip
seal on the to 180 inch) of polyvinyl
adjustiment of flow rate, and a length (60injection port. At the tip of
chloride tubing terminating in a rubber adapter is used. An adjustable
the port is rigid needle or catheter
roller type) on the tubing pinches the tubing to
clamp (screw or rubber port is self sealing, additional
regulate flow. Since the gum
(Fig. 10.5.) at these ports
medication can be added to the V system
of entry.
procedure is adopted for administration of IV fluid :
Following
administration set is inserted into
1, The spike adapter of the
stopper or seal of the IV container.
202 HOSPITAL AND CLINICAL PHARMACy

SPIKE NEEDLE
ADAPTER

AIR
VENT

DRIP
CHAMBER INJECTION
SITE

+CLAMP TUBING

Fig. 10.5. Parts of administration sets.

2. The IV fluid is hung on a stand at bedside and air is purged
from the administration set by opening clamp until fluid
comes out of needle.) The tubing is then clamped off.
3. The venipuncture is made by members of Physician/ Nurses.
4. The infusion rate is adjusted by slowly
clamp until the desired rate of drop opening and closing
viewed in the drip
chamber is obtained. The usual running time is 4 to 8 hours.
Piggyback Method
The piggyback method refers to the
of asecond solution, through the intermittent intravenous drip
venipuncture
primary V system (Fig. 10.6.). With this set thesite of an established
of as entering the vein on "Top' of drug can be thought
the primary IV fluid, hence the
designation piggyback"'. The
piggyback technique (Fig. 10.7.) not
only eliminates the need for 'another
venipuncture,
iltion and peak blood levels within a but also achieves
relatively short time
span, usually 30to 60 minutes. Drug dilution helps to reduce iritation.
SURGICAL DRESSINGS 203

SPIKE
ADAPTER

AIR INLET AND

BALL VALVE

AIR FILLER

DRIP
CHAMBER

Fig. 10.6. Setting up prinary IV fuid for administration.

Fig. 10.7. Piggyback administration set up.

 204
HOSPITAL AND CLINICAL PHARMACY

SYRINGES
Syringes are instruments meant for injection of parenteral
preparations into the body or its cavities. They are classified according
to the differences in principle of action into various categories :
A. Plunger syringes -(hypodermic syringes.)
2. Bulb syringes.
Hypodermic syringes
These syringes are used to administer medication
or intradermally, intravenous or subcutaneously
of the hypodermic syringes is to intramuscularly.) The basic principle
use a combination of a glass barrel
through which a carefully fitted glass plunger passes and a needle
attachment which pierces the skin.
A. Non-disposable syringes (Fig. 10.8.)
1. All glass
2. Half record
3. Record
4. Nylon
B. Disposable syringes (Fig. 10.9.).
Disposable syringes are meant for use on one occasion only and
are most often made from transparent polystyrene.The
a white opaque variety of same material, At the end ofplunger
is of
the plunger
is rubber grummet that may have been treated with a silicone.>
Luer syringes
Luer syringes are comparatively expensive and more accurate in
measuring medication for administration. The latest type of luer
syringe has an unground glass barrel with a fitted ground glass
plunger.
Hypodermic syringes are always of the plunger type, characterised
by the type of piston and difference in size or capacity. The tuberculin
syringe is a small syringe not exCeeding 1 ml in capacity. The
hypodermic syringe is usually 2 ml to 50 ml capacity.
Bulb Syringes
Bulb syringes are frequently prepared for use where sterility is not
necessary. Bulb syringes are of particular value in the nose and ear :
1. Nasal syringes are soft rubber bulbs of about 1 ounce
 205
SURGICAL DRESSINGS

Fig. 10.8. Non-disposable syringe.

Record
Half record
All glass
Glass barrel with metal
Similar to glass but
Easy to having metal needle mounts top and bottom and
clean
mount aor plunger that is compietely
Transparent/ partly metal. More
Disadvantage : Difficult to durable but difficult to clean.
clean.

A - Transparent polystyrene
B Opaque polystyrene plunger
C- Rubber grummet

Fig. 10.9. Disposable syring.

206 HOSPITAL AND CLINICAL PHARMACY

O.1
0,2
O.3
-0,4
H0.5+|
0,61
to,7
0.8+
09
-I,0
CC

Fig. 10.10. Luer syringe.

capacity.
2. Ear syringes are one piece moulded bulbs of soft flexible
rubber with long, narrow nozzle and are employed in treating
eye, ear and nose.
RYLE'S TUBE
It is about a metre long, red rubber or synthetic transparent tubing.
The tip of the tube is blunt with a lead shot inside., The lead shot at
the tip facilitates the passing down of the tube into oesophagus.
Secondly the lead shot makes the tip of tube visible on X-ray. This
helps in knowing the exact position of tube, once it has been passed
in. There are a number of side holes present near the end of the tube.
The body of the tube has got a minimum of three black circular
markings over it. The first mark nearest from the tip (40cm), when
present at the tip of nose, indicates that the lower end of the tube. is
lying at gastro-oesophagal junction in an adult patient.The second
circular mark, lying at 50 cm from the lower end, marked by two
circular grooves. When the tube has been introduced till this mark,
at that time the tip of the tube is in the body of the
third circular mark is present at about 60 cm from thestomach.
The
lower end.
When the tube has been passed till this mark, at that time the tip of
tube is lying at the pylorus. Some tubes have a fourth mark, about
65 cm from the tip.
SURGICAL DRESSINGS
207

First mark at 40 crn.

Ilird mark at 60 cm

Ilnd mark at 50 cm
Fig. 10.l1. Ryle's Tube.
Uses :
1/ Feeding is done with these tubes.
2./ To remove poison from stomach.
3. To do gastric lavage (washing) with KMn04 etc.
4. To suck out gastric juices in different surgical cases.
REVISION EXERCISE
Short Answer Questions :
1. Write short note on pharmacopoeial tests for surgical
dressings. (1996)
2. Write short note on official standards for evaluation of
surgical dressings. (1996)
3. Write short note on surgical dressings.
(2000)
Long Answer Questions :
1. Discuss Pharmacopoeial tests for
surgical dressing and
disposables. (1995, 1997)
2. What are various types of surgical
dressings used in hospital?
Enlist the I.P. standards of absorbent cotton?
(1996)
3. Mention four categories of surgical
adhesives in details. dressings. Give any two