Lucy Stopher

A/CNS Vascular Surgery

OBJECTIVES

Indications for compression bandaging

Precautions of compression therapy

Different types of bandages

Compression application

Levels of compression

INDICATIONS FOR COMPRESSION BANDAGING

Venous insufficiency

To reduce oedema

To assist venous return

To apply local compression over an incompetent vessel

INDICATIONS FOR COMPRESSION BANDAGING

INDICATIONS FOR COMPRESSION BANDAGING

Lymphoedema

To reduce oedema

FACTORS TO CONSIDER BEFORE APPLYING COMPRESSION

Skin condition

Shape of limb

Presence of neuropathy

Presence of cardiac failure

A shift in blood volume can increase preload and effect cardiac output by 5%

PRECAUTIONS

Ankle Brachial Index (ABI) prior to application to ensure adequate blood supply

0.7-0.8: Reduced/light compression

0.8-1.2: full compression

Sufficient padding to prevent trauma from bandages

PRECAUTIONS Patient Education: promotes compliance with

treatment

Purpose of Bandaging

Care of bandages

Presence of pain

Borderline Cardiac function (CCF)

Different bandages at SCGH Under padding:

Webril Kerlix

Different bandages at SCGH Crepe: aids absorption

Different bandages at SCGH Lastodur Lite: applies 14-17mmHg compression

Different bandages at SCGH

Profore #4: applies 18-24mmHg compression

Different bandages at SCGH

When all four layers are combined the patient should achieve 32-41mmHg.

This is called 4 layer compression and is the gold standard of venous ulcer treatment.

Application: Kerlix Apply in spiral fashion from the base of the toes up to

2cm below the knee

Application: Crepe Apply in spiral fashion toe to knee

Application: Lastodur Lite

Lastodur Lite is applied in a figure of 8 pattern from toe to knee.

The Lastodur Lite must be stretched to 50% tension and overlap 50% on itself.

Application: Lastodur Lite

The yellow line can be used as a guide to assess the 50% overlap.

Ensure the ankle is dorsiflexed at 90 ̊ to prevent creasing of bandages over the dorsum of the foot and ankle which can become uncomfortable.

Application: Profore #4 Profore is applied in a spiral pattern from toe to knee

at natural stretch with 50% overlap

Levels of compression 3 layer:

Layer of under padding (webril/kerlix)

Layer of Lastodur Lite

Tubigrip (size ‘F’ for medium sized legs)

This would give ~20mmHg of compression, graduated from the ankle to the calf.

This is useful in patients whose ABI’s are 0.7-0.8 or for patients who cannot tolerate 4 layer compression.

Levels of compression 4 layer

Layer of under padding (webril/kerlix)

Layer of crepe bandage

Layer of Lastodur Lite

Layer of Profore #4

Provides 30-40mmHg of compression which is the most effective treatment to heal venous leg ulcers and should be used when ABI 0.8-1.2

After the ulcer has healed?

Graduated compression hosiery

Worn for life if veins cannot be treated with surgery

Applied when getting up in the morning and taken off before bed

Replace 6 monthly

ABI’s checked yearly

Compression Stockings

Summary

To treat venous leg ulcers it is necessary to decrease and prevent the build up of fluid in the lower leg.

This is achieved through compression bandaging, from toe to knee.