36 Tips on Compression for Your Clinic

  Compression therapy is considered a standard of care for chronic venous insufficiency (CVI) patients. The following are tips on compression for use in the clinic setting.

  1. Knowing when to apply compression, what compression or support to utilize, and how to safely compress are critical in the care of patients.

  2. The bedrock of the treatment plan must be a comprehensive patient assessment.

  3. Through appropriate clinical testing, the root cause of the edema must be determined.

  4. Ask the questions: Does the patient have lymphedema, CVI, or a combination of the two? Is the patient experiencing an acute flare or episode related to another diagnosis such as deep vein thrombosis or congestive heart failure (CHF) exacerbation?

  5. A thorough history and exam should rule out disease processes (eg, arterial occlusive disease) that would put the limb at greater risk with the addition of a compression therapy.

  6. If arterial patency is in question, comprehensive arterial studies should be done before compression therapy is applied.

  7. Special consideration and precaution should be given to diabetic patients who may have a deceptively elevated ankle/brachial index (ABI) secondary to disease related atherosclerotic changes and calcification of vessels.

  8. If it has been established that the patient’s lower extremity arterial system is adequate and compression would be of benefit, the source of the swelling (ie, edema or lymphedema) must be determined.

  9. Patients with lymphedema ideally should have been seen and treated by a clinician trained in manual lymphatic drainage (MLD) and complete decongestive therapy (CDT), or a certified CLT-LANA therapist.

  10. Although edema and lymphedema patients both are treated with compression therapy, the lymphedema therapy regimen may be quite different from the management of edema resulting from CVI.

  11. Multiple types of compression wraps are available for use in wound clinics.

  12. Selection of the wrap or bandage type requires not only a comprehensive assessment of the patient and the wound, but also a thorough understanding of the patient’s lifestyle including occupational and social needs, shoe wear, and functional status.

  13. Know Your Patient. A construction worker likely would be challenged to wear a wrap for a full week due to perspiration and potential for external soiling.

  14. Additionally, that same construction worker may be required to wear high boots that would not fit over a multilayered wrap. Missing work is not an option for this patient.

  15. Access to multiple types of wraps and compression systems is not a supply redundancy. Rather, it is almost imperative for the wound center treating large numbers of patients with edema to have multiple options available to meet the needs of this large patient group.

  16. The ability to match the compression choice with the patient’s body, leg type and shape, occupation, shoe requirements, and the like is imperative.

  17. Tubular bandages are fabric tubes with horizontal rings of elastic. Used as single or double layer, available with latex or latex-free, they are supplied primarily in rolls, but also in single patient “unit dose” type of packaging.

  18. While not an ideal delivery system for adequate long-term compression, tubular bandages are an alternative when vascular status is being evaluated or when other options fail.

  19. Tubular bandages can be removed at night and may be washed and reused.

  20. Typically long-stretch bandages are elastic bandages that offer sustained pressure over a longer period of time. They exert pressure from the outside of the leg, expanding and recoiling as the calf muscles contract and relax.

  21. These wraps often are inexpensive compared to most wraps; they are washable, reusable, and easy to apply.

  22. Most brands are available premarked with guides to indicate the appropriate amount of stretch. Cotton padding can be applied as a first layer to make the wrap more comfortable.

  23. Provided in pre-packaged kits, multilayer wraps include a soft cotton padding as a skin-side layer that helps absorb skin moisture, provide padding to bony prominences, and add bulk and padding to the ankle, around the heel, and at the post-tibial area, helping to equalize the pressures exerted by the elastic layers.

  24. Paste bandages, historically referred to as the Unna Boot, consist of roll gauze impregnated with zinc oxide, gelatin, and in some cases calamine.

  25. Like the bandages previously mentioned, the short-stretch variety are applied from the base of the toes to the knees or above.

  26. Another long-term alternative for compression are orthotic devices consisting of inelastic straps that overlap and are secured with Velcro®. These devices are easier to apply, are durable, and therefore may be more cost effective than stockings.

  27. Changes in edema levels and the potential for high ulcer exudate (especially early in the treatment) require frequent assessment of the patient, leg, and ulcer.

  28. With each visit, the leg should be thoroughly washed and moisturized. This step is essential not only for the skin health, but also the patient’s sense of well-being.

  29. Many wraps may prohibit patients from wearing not only the shoes worn into the clinic on the day of the initial wrap, but possibly all of their shoes.

  30. Multilayer wraps tend to be thicker and heavier and as a result can tend to slide as one unit, especially in the case of very irregularly shaped legs.

  31. Compression wraps may cause rubbing, discomfort, and possibly blistering, resulting in iatrogenic injury and further ulceration.

  32. Wound exudate can cause maceration at the very least and skin breakdown at worst.

  33. The wrap applied for a week or even several days at a time makes personal hygiene a challenge because the wrap needs to be kept dry.

  34. The cohesive layer outer wrap tends to be a bit “tacky” at times, causing pant legs to cling, dirt and lint to adhere, and bed linens to restrict movement during sleep.

  35. Always have a contingency plan. Patient education is vital when compression therapy is used.

  36. Clinicians must always remember that they are treating not just the wound or the edematous limb but also a disease process.