Compression Therapy…
Wendy McInnes Vascular Nurse Practitioner; Northern Adelaide Local Health Network;
[email protected] 051 036
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Compression Therapy
Graduated compression to the lower limb aids with • Venous return against gravity• Oedema management • Lymphatic reabsorption • Inflammation reduction (cellulitis) • Drainage of toxic substances in the tissue• Tissue repair – venous ulceration
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Compression TherapyGoverned by
StandardsEvidence Clinical GuidelinesBest Practice GuidelinesConsensus DocumentsLocal policy
RealityResources / costHealth practitioner knowledge, timePatients/families
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AWMA, NZWCS(2011) Australian & New Zealand Clinical Practice Guideline for Prevention & Management of Venous Leg Ulcers; Cambridge PublishingClinical Decision Making in Wound Management (2002) AWMA Standards for Wound ManagementWorld Union of Wound Healing Societies (2008) Principles of Best Practice: Compression in Venous Leg Ulcers A Consensus Document London, MEP LtdInternational consensus-.Optimising wellbeing in people living with a wound. An expert working group review. London: Wounds International, 2012.http://www.woundsinternational.com
Prior to CompressionPatient assessment - HEIDIEAge Heart failure / Other co-morbidities (neuropathy) PainMobility /gait – physical activity – falls riskLeg elevation Ability to tolerate – don/doff – dexterity Hygiene – good skin carePsychological preparation – commitment to treatmentNutrition & hydrationExerciseEducation Supports Quality of Life
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AWMA, NZWCS(2011) Australian & New Zealand Clinical Practice Guideline for Prevention & Management of Venous Leg Ulcers; Cambridge PublishingStandard 4 Best Practice In Wound Care (2002) AWMA Standards for Wound Management World Union of Wound Healing Societies (2008) Principles of Best Practice: Compression in Venous Leg Ulcers A Consensus Document London, MEP Ltd
Prior to CompressionLimb AssessmentArterial supply – PAD - palpable foot, poplitel , femoral pulses? IF NO THEN REFER ONFoot deformities
Size and shape of limb –
thin leg = higher sub-bandage pressure
Inverted champagne bottle leg shape – apply extra padding at ankle
Measure ankle circumference
Correct system/ combination of bandages
Skill & technique of bandager
Skin condition – venous eczma
Oedema +/- ulceration
Wound –
Infection vs colonisation
Wound Bed preparation
Wound products
Peri- wound skin protection
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AWMA, NZWCS(2011) Australian & New Zealand Clinical Practice Guideline for Prevention & Management of Venous Leg Ulcers; Cambridge PublishingStandard 4 Best Practice In Wound Care (2002) AWMA Standards for Wound Management World Union of Wound Healing Societies (2008) Principles of Best Practice: Compression in Venous Leg Ulcers A Consensus Document London, MEP Ltd
Compression Therapy• Multi-layered System (ie. Veno4; Profore)
• 2, 3 and 4 layered bandaging systems• Exerts pressure even when at rest• Sustained pressure for 1 week• Bulky and hot - Limits movement / shoes• Showering difficult• Applied by skilled practitioner• Can be modified for reduced ABPI• Injury if applied incorrectly
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AWMA, NZWCS(2011) Australian & New Zealand Clinical Practice Guideline for Prevention & Management of Venous Leg Ulcers; Cambridge PublishingWorld Union of Wound Healing Societies (2008) Principles of Best Practice: Compression in Venous Leg Ulcers A Consensus Document London, MEP Ltd
Compression Therapy• Inelastic Multi layered Compression (ie. Coban 2; Coban 2 lite) – Short
Stretch bandage
• Compresses superficial venous system; Decrease oedema• Good for people who are ambulatory and lymphoedema• Becomes loose easily when oedema decreases• Supports calf muscle pump when walking• Apply in spiral – easy to apply• Comes in different widths and sizes; plus toes
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AWMA, NZWCS(2011) Australian & New Zealand Clinical Practice Guideline for Prevention & Management of Venous Leg Ulcers; Cambridge PublishingWorld Union of Wound Healing Societies (2008) Principles of Best Practice: Compression in Venous Leg Ulcers A Consensus Document London, MEP LtdMoffatt C (2007) Compression Therapy in Practice, Wounds UK
Compression Therapy• Inelastic Single layered Compression (ie. Comprilan) – Short Stretch
bandage
• Compresses superficial venous system; Decrease oedema• Different widths• Applied at full stretch to create a rigid cast - spiral• Protective orthopaedic wool or at least vulnerable areas• If applied correctly 50-60mmmHg in supine position
and 70-80 mmHg standing• Supports calf muscle pump when walking• Becomes loose easily when oedema decreases – daily application
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AWMA, NZWCS(2011) Australian & New Zealand Clinical Practice Guideline for Prevention & Management of Venous Leg Ulcers; Cambridge PublishingWorld Union of Wound Healing Societies (2008) Principles of Best Practice: Compression in Venous Leg Ulcers A Consensus Document London, MEP LtdMoffatt C (2007) Compression Therapy in Practice, Wounds UK
Compression Therapy• Elastic Bandages
• Supports calf muscle when walking• Exerts pressure when at rest• Good for people who have decreased mobility• Very high stretch may be removed at night• Easily applied as guides on the bandages• Orthopaedic wool as under-layer
• Minimal increase in bandage extension can result in significant rise in pressure• Dangerously high levels of compression in over –extension• Pressure damage
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AWMA, NZWCS(2011) Australian & New Zealand Clinical Practice Guideline for Prevention & Management of Venous Leg Ulcers; Cambridge PublishingWorld Union of Wound Healing Societies (2008) Principles of Best Practice: Compression in Venous Leg Ulcers A Consensus Document London, MEP LtdMoffatt C (2007) Compression Therapy in Practice, Wounds UK
Compression Therapy• Medical Grade Hosiery
• Can be difficult to apply and remove – patient dexterity - applicators• Different grades/classes – knits/weaves• Made to measure if unable to get off the shelf• Ulcer care kits• Single layer • Multi layer• Cost
• Education• Care instructions• Skin allergies - Dermasilk
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AWMA, NZWCS(2011) Australian & New Zealand Clinical Practice Guideline for Prevention & Management of Venous Leg Ulcers; Cambridge PublishingWorld Union of Wound Healing Societies (2008) Principles of Best Practice: Compression in Venous Leg Ulcers A Consensus Document London, MEP LtdMoffatt C (2007) Compression Therapy in Practice, Wounds UK
Compression Therapy• Compression Wraps (Farrow Wrap; CircAid Juxta Fit)
• Moderate to severe oedema• May find it easier to apply than compression stockings• Available in different classes of compression and pieces for different parts of the limb• Under sock for compression over the foot• Cost outlay $$• Protect from leaking wounds
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Compression TherapyTubular form Compression System (tubularform; tubigrip)• Graduated lengths of 3 layers• Exerts pressure when at rest• Easily applied and removed by patient, family, carers
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AWMA, NZWCS(2011) Australian & New Zealand Clinical Practice Guideline for Prevention & Management of Venous Leg Ulcers; Cambridge PublishingWorld Union of Wound Healing Societies (2008) Principles of Best Practice: Compression in Venous Leg Ulcers A Consensus Document London, MEP Ltd
Compression Therapy
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AWMA, NZWCS(2011) Australian & New Zealand Clinical Practice Guideline for Prevention & Management of Venous Leg Ulcers; Cambridge PublishingWorld Union of Wound Healing Societies (2008) Principles of Best Practice: Compression in Venous Leg Ulcers A Consensus Document London, MEP Ltd
Devices (Pneumatic Compression; Sequential Compression Devices)• Exert graduating pressure• Reduce oedema• Can be difficult to apply• Can only use when laying/sitting which can also be of benefit• Cost – purchase/hire - access
Wrap Up….Assess the patient holistically – risk vs benefit – DO NO HARMReduce Oedema/ Lymphoedema with Compression if able to…. Not just for ulcerationConsider tubular compression – single or layers – cost and accessGood Hygiene and Skin Care Education Vital – spend the timeIts all about “Quality of Life”
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