Compression therapy options: A quick review
July 1, 1998 3 minutes read
Compression therapy options: A quick review
Presented here is a handy reference guide to the key features and important drawbacks of some of the top modalities in compression therapy.
Compression stockings (tubular compression)
· Can pull over leg like a sock, no special wrapping skills required
· Available in many sizes; ordered according to circumference of patient's leg at different anatomical points
· Patients with adequate manual dexterity and strength can apply and remove them without assistance, or home caregivers can assist them. No professional help is required.
· Washable, but shouldn't be placed in dryer
· Inexpensive
· Used as a preventive measure to reduce edema before a venous ulcer has developed or after it has healed
· Not for use when patient has an open venous ulcer
· Amount of compression not as high as with compression bandages
· May slip down the leg
· Patient compliance is essential
Other tubular compression:
Thera-Boot (manufactured by CircAid Medical Products, San Diego)
· Fastened with Velcro clasp
· Caregivers and patients with adequate manual dexterity can apply them
· Difficult for patients and caregivers to gauge amount of pressure being applied
· Reusable
· Adjustable as swelling decreases
· Expensive
Elastic bandages
· Inexpensive
· Should be applied by a health care professional
· Often reusable, and washable up to 15 times
· Should not be placed in a dryer
· Best results obtained by applying with 50% stretch and 50% overlap
· Some bandages have "stretch" markers woven into or printed on the fabric to guide those applying it to achieve 50% stretch
· Some bandages have a midline printed on them to help clinicians judge 50% overlap when spiraling up the leg
· Can be used as a preventive measure against swelling, or over an open, dressed venous ulcer
Multiple-layer bandage systems
· Prepackaged kits of three- and four-layer systems are commercially available
· Possible to construct your own multi-layered system based on existing models
· First layer usually some type of padding (e.g., cotton batting, cotton wool, or cast padding) applied in a continuous spiral
· Main purposes of first layer: absorb wound exudate, protect bony prominences at the ankles, normalize pressures achieved by overlying layers
· Second layer (in four-layer system) usually crepe, applied as a spiral
· Main purposes of second layer: smooth the inner layer and increase absorbency
· Third layer (second in three-layer systems) is elastic wrap applied in a spiral with 50% stretch and 50% overlap (purpose is to increase compression)
· Final layer is usually a self-adherent elastic layer applied in spiral with 50% stretch and 50% overlap
· Main purpose of last layer: Keeps other layers in place and increases compression to final goal
· Requires trained health care professional to apply
· Can leave in place for 7-10 days
· Disposable after dressing changes
· Should be applied when edema is at its lowest with leg in a horizontal position
· Potential drawback: Layers can slip down the leg, resulting in overly compressed areas that could create a tourniquet effect at the ankle
· Increase ankle circumference with padding for patients with very small ankles
Unna boots
· Time-proven modality, used successfully for a century
· Has become generic term for any gauze bandage impregnated with zinc oxide and used to achieve gradient compression in the legs.
· Application requires health care professional
· Several commercial preparations available
· Often becomes dirty and smelly
· Messy, not usually suitable for active people
· Usually remains in place for about a week
· Can be applied over wound dressings
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