Using compression therapy for venous insufficiency WOUND & SKIN CARE ； 2005 GALVAN, LINDA RN, APN, CWOCN, BSN 1/17

 Compression therapy reduces blood backflow in the veins and helps the calf muscles propel blood back toward the heart. 2/17

types of compression therapy  multilayered elastic compression wraps  elastic compression stockings  pneumatic compression devices  multilayer bandaging systems 3/17

 For ambulatory patients, a multilayered elastic compression wrap or multilayered bandage wrap is best.  Remember that compression therapy can't be used in patients who also have arterial insufficiency, and can be used only with caution in patients with mild arterial disease. 4/17

Two-layer wraps  provide 15 to 25 mm Hg of pressure when a cohesive bandage is applied.  hese may be best for a patient who needs compression therapy but can't tolerate higher pressures because of discomfort. 5/17

Four-layer elastic compression wrap  increases the pressure to about 40 mm Hg.  first layer :absorbent padding bandage.  second layer :light conforming bandage  third layer :compression wrap applied with the figure eight technique  fourth layer :compression wrap, is applied with a spiral technique. 6/17

 If your patient has a venous ulcer, you can apply a compression wrap over the wound dressing. This combination reduces ulcer pain and encourages autolytic debridement and wound healing. 7/17

Applying a compression wrap 1  choosing the compression method  measure the patient's ankle circumference  If it's less than 18 cm (7.2 inches), add additional cotton absorbent padding or gauze before applying the compression wrap. 8/17

Applying a compression wrap 2  For all patients, pad all bony prominences, such as the tibial spine and the malleolus.  Measure ankle circumference weekly — it should decrease as the edema decreases.  Have the patient dorsiflex her foot and apply the compression wrap according to the manufacturer's directions. 9/17

Helping your patient with therapy 1  Because most compression wraps are bulky, they can interfere with the patient's ability to wear shoes. Compression bandages also tend to roll up at the toes when she tries to put on shoes or slippers. 10/17

Helping your patient with therapy 2  A patient who's had a venous ulcer will need lifelong compression management  After the wound has healed and leg edema has decreased, measure and size the patient for compression stockings. 11/17

Helping your patient with therapy 3  These stockings are graded by the pressure they provide: 20 to 60 mm Hg at the ankle.  The stockings come in various lengths and styles. Some patients may need custom compression stockings — for example, if she has a wide calf and a much smaller ankle. 12/17

Helping your patient with therapy 4  Deciding on the pressure grade for stockings can be challenging.  two-layer compression bandages ： probably can tolerate 20 to 30 mm Hg compression stockings.  four-layer compression bandages ： should be able to tolerate 30 to 40 mm Hg compression stockings. 13/17

Helping your patient with therapy 5  If the patient's ulcer recurs, check that she's wearing the stocking correctly and replacing it every 6 months. If so, she may need a higher-pressure compression stocking. 14/17

Helping your patient with therapy 6  The patient may find her compression stockings difficult to put on  Suggest that she wear rubber gloves to help her get a grip on the stockings, but warn her not to pull aggressively, which could rip them. Lubricating silicone lotions applied to the leg before donning stockings may help to reduce friction. 15/17

Helping your patient with therapy 7  At the other end, compression stockings can slip down at the top. A roll-on adhesive designed for compression stockings and applied to the leg can help solve this problem.  Advise the patient to buy new compression stockings every 6 months and have two pairs on hand so she can wear one pair while the other is in the laundry. 16/17

Helping your patient with therapy 8  Encourage her to maintain a normal body weight, exercise daily (a walking program is especially good), and to elevate her legs periodically throughout the day. She shouldn't stand or sit for long periods, wear constricting clothing such as girdles, or cross her legs. Teach her to protect her legs and feet from injury and to inspect them daily. Remind her that vigilant self- care can help her avoid another venous ulcer. 17/17