Accidents, First aid and Treatments

It’s safe to shower 48 hours after surgery. After 48 hours, surgical wounds can get wet without increasing the risk of infection. After this time, you can get your stitches wet briefly with a light spray (such as in the shower), but they shouldn’t be soaked (for example, in the bath). Make sure you pat the area dry afterwards.

Dressings

If you have a dressing over your stitches, avoid getting it wet. Some dressings are waterproof, so you could wet your dressing lightly – for example, with the spray from a shower. However, you shouldn’t submerge your dressing under water. If you’re not sure whether your dressing is waterproof, avoid getting it wet. Do not remove the dressing unless you’re advised to do so by a healthcare professional.

Keeping stitches dry

If you have been advised to keep your stitches dry, you could:

• cover your stitches when you have a shower – for example, with a waterproof dressing, or you could use a rubber glove or plastic bag
• have a wash standing in a bath tub, using a cloth to clean yourself and avoiding your stitches

Dab your stitches dry with a clean towel after washing, even if the wound area didn’t get wet, to ensure the area is completely dry If your stitches get wet accidentally, simply dry the area immediately with a clean towel and make sure all the moisture around the stitches is soaked up.

A cut may need stitches (or other treatments) if:

• the bleeding does not stop after 10 minutes of applying pressure
• the cut is long or deep
• something is embedded within the cut
• the cut occurred as a result of an animal or human bite, or was punctured by any other object that may cause infection
• the cut is on the mouth, face, hand or genitals

If any of the above apply, then see your GP or visit an NHS walk-in centre as soon as possible. You should also see your GP if you think the cut is not healing properly, or may be showing signs of infection. Common signs of infection include:

• swelling
• redness
• pain
• pus coming from the wound

The cut may need to be cleaned or stitched, and you may be given antibiotics.

Treating minor cuts and grazes

Bleeding from small cuts and grazes can be controlled by applying pressure to the cut using a clean, non-fluffy pad (preferably a sterile dressing, if you have one). You should also raise the injured body part above the level of the heart so the bleeding slows down and stops. If it’s your hand or arm, raise it above your head; if it’s a lower limb, lie down and raise it. If you don’t have a sterile dressing, use a hand, tea towel or t-shirt to slow down the bleeding. Once you’re sure the cut is clean and the bleeding has stopped, wrap a dressing around it and make sure it’s secure. The cut should heal by itself within a few days.

The key points when applying a bandage are:

• Make sure the person is comfortable and tell them what you’re doing.
• Work from the side of the injury so you don’t have to lean across their body.
• Keep the injured part of the body supported in the position it’ll be in when the bandage is on.
• Use the right size bandage – different parts of the body need different widths of bandage.
• Avoid covering fingers or toes when bandaging a limb so you can easily check the circulation.
• Apply the bandage firmly, but not tightly, and secure the end by folding it over and tying a knot in the end. You can also use a safety pin, tape or a bandage clip.
• As soon as the bandage is on, ask if it feels too tight and check the circulation by pressing on a fingernail or a piece of skin until it turns pale. If the colour doesn’t return straight away, the bandage may be too tight, so you should loosen it. Limbs can swell up after an injury, so check the circulation every 10 minutes after you have put the bandage on.

Roller bandages

There are 3 types of roller bandage:

• bandages made of open-weave material allow ventilation, but don’t put pressure on wounds and don’t support joints
• elasticated bandages mould to a person’s body shape, and are used to secure dressings and support soft tissue injuries like sprains
• crepe bandages are used to give firm support to injured joints

To apply a roller bandage:

• keep the rolled part of the bandage above the injury and the unrolled part below the injury
• begin by wrapping twice around the injury to hold the end in place
• work up the limb, winding the bandage in spiralling turns, making sure that each new layer covers one-third to two-thirds of the previous one
• finish by wrapping the bandage around once more and securing the end

When applying bandages to elbows and knees to hold dressings in place or support sprains or strains, flex the joint slightly, apply the bandage in a figure of eight, and extend the bandage quite far on each side of the joint. When applying bandages on hands to hold dressings in place or support sprains and strains, work from the inside of the wrist using diagonal turns across the back of the hand to the end of the little finger, leaving the thumb free.

Tubular bandages

Tubular bandages are used to hold dressings on fingers or toes, or support injured joints. They’re made of seamless fabric tube. You can get elasticated ones to place over joints such as the ankle. Ones made of tubular gauze can be placed over fingers or toes, but don’t provide any pressure to stop bleeding. Before placing a tubular bandage over an injury, you may need to cut it to a smaller size.

Triangular bandages

Triangular bandages can be used as large dressings, as slings to support a limb, or to secure a dressing in place. If you’re using a triangular bandage as a sling on an arm, you use it opened out. You should:

• ask the person to hold their arm across their chest and support the arm while you work
• put the bandage under the arm and around the back of the neck
• put the other half of the bandage over the arm to meet at the shoulder and tie into a knot
• tuck the loose ends of the bandage in at the elbow, or use a pin

If you’re using a triangular bandage to support a lower limb or large dressing, fold it in half horizontally so the point of the triangle touches the middle of the long edge. Then fold it in half again in the same direction to make a broad strip.

Butterfly stitches are narrow adhesive strips that help to close the edges of a small wound and encourage the skin to heal. They are sold in pharmacies as skin-closure strips or “Steri-Strips”. They should not be used on areas where the skin moves a lot, such as joints, or on oily, moist or hairy areas. You can use the strips if the wound is shallow, clean and uninfected, and you’re sure nothing is embedded in it. Do not use them if the wound is on the face, or was the result of an animal or human bite. These types of wound should be checked by a GP or the staff at your local walk-in centre. Make sure the skin around the wound is also clean and dry. It’s not always necessary to use the full length of the strips – you can cut them to a more appropriate length. Leave about 3mm between each strip.

How to apply them

To apply skin-closure strips:

• carefully line up the edges of the wound
• push them together and, starting at the middle of the wound, apply the strips to hold the edges together
• place half of the strip on one side of the wound, gently bring the other side of the wound towards it, and then pass the strip over
• place strips alternately above and below the first strip – this helps to match up the edges and keeps the skin tension equal
• to anchor the rows of strips in place, put two strips vertically across the rows – one on each side of the wound

A protective dressing is not usually necessary. The strips are waterproof, so you should be able to take a shower 24 hours after applying them, but try to keep the wound and strips as dry as possible. If the wound does not stop bleeding once the strips have been applied, this is a sign that butterfly stitches are not suitable. You should go to a minor injuries unit because another method of treating the wound may be required. If you do not have ready access to a minor injuries unit, walk-in centre or similar out-of-hours service, visit your nearest A&E department. Instructions to remove the strips vary by type and location of the wound. Check the patient information leaflet that comes in the packet. If the wound becomes swollen, red or more painful then it may have become infected. Seek advice from your GP surgery, or from staff at your local walk-in centre or minor injuries unit.

Wash and dry your hands before applying any dressing, and wear disposable surgical gloves if you have them. Also:

• sit or lie down, or get the person who’s bleeding to do this
• if you’re helping someone else, tell them what you’re doing as you apply the dressing
• stop any bleeding by applying pressure and raising the affected leg or arm higher than the heart
• use a dressing that’s slightly bigger than the wound you want it to cover
• hold the dressing at the edges, keeping your fingers away from the part that’s going to cover the wound

Sterile dressing pads attached to bandages

Sterile (hygienic) dressing pads come in a protective wrapping. Once out of the wrapping, they’re no longer sterile. When applying one:

• clean and dry the wound and surrounding skin
• hold the bandage on either side of the pad
• lay the pad directly on the wound
• wind the short end once around the limb and the pad
• wind the other end around the limb to cover the whole pad
• tie the ends together over the pad to secure it, and put slight pressure on the wound

Dressings should be replaced on a regular basis

If the wound is severe, you may need to go to a minor injuries unit after applying the dressing. If you can’t stop the bleeding, go to your nearest accident and emergency (A&E) department as soon as possible.

Plasters (adhesive dressings)

Plasters are made from a piece of gauze and have a sticky (adhesive) backing. They’re usually wrapped in single sterile packs. They sometimes come in different shapes and sizes, or you can cut them to size. Some plasters are waterproof. When applying one:

• clean and dry the wound and surrounding skin
• unwrap the plaster and hold it by the protective strips with the pad side facing down
• peel back the strips, but don’t remove them
• place the pad on the wound, pull away the strips, and press the edges of the plaster down

Plasters should be replaced every time they get dirty or wet, or if the blood soaks through. A small number of people are allergic to the adhesive strips – ask them if this is the case before applying a plaster.

It’s important to clean a wound before applying a plaster or dressing. This will reduce the risk of infection and encourage the healing process. A plaster or larger dressing is usually all that is needed to stop a wound bleeding. However, you might need to apply pressure to the area, and if an arm or leg is affected, you should raise it above heart level if possible. Follow these steps:

• wash and dry your hands thoroughly
• wear disposable gloves if available
• if treating someone else, tell them what you’re doing and make sure they’re sitting or lying down
• don’t try to remove anything embedded in the wound – seek medical advice (see below)
• rinse the wound under running tap water for 5 to 10 minutes
• soak a gauze pad or cloth in saline solution or tap water, or use an alcohol-free wipe, and gently dab or wipe the skin with it – don’t use antiseptic as this may damage the skin
• gently pat the area dry using a clean towel or pad of tissues, but nothing fluffy such as a cotton wool ball – strands of material can get stuck to the wound
• apply a sterile dressing, such as non-adhesive pad with a bandage, or a plaster – use a waterproof dressing if available
• if blood soaks through the dressing, leave it in place and add another dressing, and continue to apply pressure on the wound

When to seek medical advice

Visit your nearest minor injuries unit or walk-in centre, or call NHS 111 if the wound:

• does not stop bleeding
• is very large or very deep
• has something embedded in it
• is too painful for you to successfully clean
• is near to a major blood vessel or joint
• becomes red and swollen or has pus coming out – it may be infected
• was caused by a bite – all animal and human bites need medical atten

The time it takes for dissolvable or absorbable stitches to disappear can vary. Most types should start to dissolve or fall out within a week or two, although it may be a few weeks before they disappear completely. Some may last for several months. Ask your doctor about the type of stitches you have been given and how long they should take to dissolve. If your wound has healed and your stitches are bothering you, you might want to consider making an appointment with a GP or practice nurse, who may be able to remove them, rather than waiting for them to dissolve completely.

If you have stitches, take care to:

• keep them clean and dry
• watch out for any increase in redness, swelling or pain

This will reduce your risk of developing an infection. Your doctor or nurse should tell you how to care for your wound. If you are unsure what to do, ask your healthcare team for advice.

Protect your stitches

It’s important not to scratch your stitches; even though they’re strong, scratching may damage them. You should avoid contact sports, such as football or hockey, to give your wound the best possible chance to heal. You should not go swimming until your wound has healed and your stitches have been removed. If your child has stitches, don’t let them play with water, mud, sand and paint. Playing with things like these could cause the wound area to get dirty or sore, or cause an infection. Children may also be advised to avoid PE at school until their wound has healed.

Signs of infection

Watch out for any signs of infection near the stitches, such as:

• swelling
• increased redness around the wound
• pus or bleeding from the wound
• the wound feeling warm
• an unpleasant smell from the wound
• increasing pain
• a fever of 38C (100.4F) or above
• swollen glands

If you have any of the above symptoms, speak to your GP or call NHS 111 for advice. You could also visit an NHS walk-in centre or minor injuries unit.

Removing stitches

You will be told if you need to return to your GP or a nurse to have your stitches removed. These are the usual time periods:

• stitches on your head – you’ll need to return after 3 to 5 days
• stitches over joints, such as your knees or elbows – you’ll need to return after 10 to 14 days
• stitches on other parts of your body – you’ll need to return after 7 to 10 days

Some stitches are designed to dissolve gradually and will disappear on their own.

Bruises are bluish or purple-coloured patches that appear on the skin when tiny blood vessels called capillaries break or burst underneath. The blood from the capillaries leaks into the soft tissue under your skin, causing the discolouration. Over time, this fades through shades of yellow or green – usually after around two weeks. Bruises often feel tender or swollen at first.

What about dark skin and bruising?

You can still bruise if you’ve got dark skin, but they may show up more on fair skin.

What causes bruising?

Bruising is caused by internal bleeding under the skin, and occurs when a person has injured themselves. Some people are naturally more likely to bruise than others – for example, elderly people may bruise more easily because their skin is thinner and the tissue underneath is more fragile.

How can I reduce bruising?

Treat bruises on your skin by limiting the bleeding. You can do this by cooling the area with a cold compress (a flannel or cloth soaked in cold water) or an ice pack wrapped in a towel. To make an ice pack, place ice cubes or a packet of frozen vegetables in a plastic bag and wrap them in a towel. Hold this over the area for at least 10 minutes. Do not put the ice pack straight on to your skin as this will be too cold and could hurt. Over-the-counter painkillers such as paracetamol or ibuprofen may help relieve the pain associated with bruising.

When to see your GP

Most bruises will disappear after around two weeks. If the bruise is still there after two weeks, see your GP. You should also see your GP if you suddenly get lots of bruises or start to bruise for no obvious reason. Unusual bruising is sometimes a symptom of an underlying illness, such as a problem with the way your blood clots.

Internal bruising

Bruises don’t just happen under the skin – they can also happen deeper in your tissues, organs and bones. While the bleeding isn’t visible, the bruises can cause swelling and pain.

It’s important to have a well-stocked first aid kit in your home so you can deal with minor accidents and injuries. Your first aid kit should be locked and kept in a cool, dry place out of the reach of children. Many people also keep a small first aid kit in their car for emergencies.

Your basic first aid kit

A basic first aid kit may contain:

• plasters in a variety of different sizes and shapes
• small, medium and large sterile gauze dressings
• at least 2 sterile eye dressings
• triangular bandages
• crêpe rolled bandages
• safety pins
• disposable sterile gloves
• tweezers
• scissors
• alcohol-free cleansing wipes
• sticky tape
• thermometer (preferably digital)
• skin rash cream, such as hydrocortisone or calendula
• cream or spray to relieve insect bites and stings
• antiseptic cream
• painkillers such as paracetamol (or infant paracetamol for children), aspirin (not to be given to children under 16), or ibuprofen
• cough medicine
• antihistamine cream or tablets
• distilled water for cleaning wounds
• eye wash and eye bath

It may also be useful to keep a basic first aid manual or instruction booklet with your first aid kit. Medicines should be checked regularly to make sure they’re within their use-by dates.