lucy stopher a/cns vascular surgery - · pdf fileindications for compression bandaging venous...
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Lucy Stopher
A/CNS Vascular Surgery
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OBJECTIVES
Indications for compression bandaging
Precautions of compression therapy
Different types of bandages
Compression application
Levels of compression
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INDICATIONS FOR COMPRESSION BANDAGING
Venous insufficiency
To reduce oedema
To assist venous return
To apply local compression over an incompetent vessel
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INDICATIONS FOR COMPRESSION BANDAGING
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INDICATIONS FOR COMPRESSION BANDAGING
Lymphoedema
To reduce oedema
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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%
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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
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PRECAUTIONS Patient Education: promotes compliance with
treatment
Purpose of Bandaging
Care of bandages
Presence of pain
Borderline Cardiac function (CCF)
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Different bandages at SCGH Under padding:
Webril Kerlix
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Different bandages at SCGH Crepe: aids absorption
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Different bandages at SCGH Lastodur Lite: applies 14-17mmHg compression
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Different bandages at SCGH
Profore #4: applies 18-24mmHg compression
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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.
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Application: Kerlix Apply in spiral fashion from the base of the toes up to
2cm below the knee
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Application: Crepe Apply in spiral fashion toe to knee
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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.
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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.
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Application: Profore #4 Profore is applied in a spiral pattern from toe to knee
at natural stretch with 50% overlap
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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.
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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
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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
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Compression Stockings
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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.