compression therapy… - aogp · hygiene –good skin care psychological preparation –commitment...

Compression Therapy…

Wendy McInnes Vascular Nurse Practitioner; Northern Adelaide Local Health Network;

[email protected] 051 036

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mailto:[email protected]

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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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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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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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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Compression Therapy

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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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