Dressing an ear following surgical drainage of an aural haematoma

Key pointers

• Make sure that you are dressing the correct part of the anatomy.
• Make sure that you know your anatomical directions.
• Know your left from your right!
• Don't forget to talk to conscious patients; even if it is a cuddly toy in the exam!
• Adorn protective clothing if provided.
• Select the appropriate equipment before you begin and logically think over the procedure in your head before setting to work.
  Remember that in many situations where you are required to dress a wound, there may be more than 1 example of appropriate materials. In such circumstances, it is up to you to make a sensible choice, even though there may be no specific right or wrong answer. The selection of dressing materials is often dictated in practice not only by the type and severity of the wound, but also by cost and personal preference.

Practical examination example:
An English springer spaniel has had an aural haematoma drained under local anaesthetic. The veterinary surgeon has asked you to apply a dressing (the incision for drainage is on the ventral aspect of the right pinna. Demonstrate how you would do so (you are given a large cuddly toy upon which to work).

Suggested Equipment

• Apron and gloves
• Antiseptic solution for cleansing
• Swabs
• Straight Mayo scissors
• Cotton wool
• Rondopad
• 5cm Knitfirm
• 5cm Co-flex

Procedure

• Introduce yourself calmly and confidently to the patient.
• Ask an assistant to restrain the patient. He may be held in left lateral recumbency, but a conscious animal will probably tolerate sitting or standing rather better than being made to lie down.
• Adorn protective apron and gloves if provided.
• Assess the surgical wound. Although you are dealing with a toy dog, imagine it to be a real patient. Cleanse away any discharge gently with a suitable antiseptic solution such as dilute chlorhexidine (Hibiscrub) and cotton wool. Ensure that the area to be dressed is then carefully dried.
• Apply a pad of cotton wool to the top of the dog's head and fold the pinna of the right ear back onto it.
• Next select a suitable dressing. A non-adherent dry dressing (a cotton acrylic fibre pad with a perforated polyester film such as Rondopad) is ideal. These dressings come in various sizes, but can be cut to fit any shape or size of wound. Place the dressing gently over the incision remembering to place it shiny side down, in a sterile fashion.
• Place a pad of cotton wool on top to absorb excessive exudate. Extend the padding around the head to ensure comfort.
• Secure the padding with conforming bandage. 5cm Knitfirm is suitable. This should be applied in a figure-of-8 pattern passing under the chin, and anchoring upon either side of the free ear to prevent the dressing from slipping.
• Now select a suitable TERTIARY LAYER (the most exterior part of the dressing). Conforming, cohesive bandage such as Co-flex is ideal. 5 or 7.5cm are suitably sized. Cohesive dressings do not stick to the fur itself and therefore allow the dressing to be removed without pulling away large clumps of fur. It is essential that the dressing is not too tight. The dog should be able to open its mouth normally and respiration must not be obstructed.
• Check that the dressing is smooth and comfortable.
• Make sure that you can answer the following questions:
  i) How can patient interference be prevented? (see the Q & A section of this module).
  ii) What advice should the owner be given upon discharge of the dog? (see Key Notes 1 & 2 of this module).
  iii) What is the main disadvantage of the application of an ear dressing following the drainage of a haematoma? (Many aural haematomas are secondary to infections of the ear canal such as otitis. These generally require both topical and systemic antibiotic therapy - it is impossible to apply ear drops through an ear dressing of this nature without first removing it!).