Leg ulcer management accounts for a large proportion of the work for district nurses (Moffat, 1991; Williams, 2001). Therefore, it is vital that treatment of these often-recalcitrant wounds is firmly based on evidenced based care. There is some evidence (Brown & Marshall, 2001) that many health care professionals still remain unaware of the evidence-base for best practice in leg ulcer management. Selection of compression therapy is not necessarily a simple choice, understanding how the different systems perform united with a holistic assessment of the patient and their individual needs, will lead to appropriate bandage choice. In order to demonstrate the understanding and application of theory to practice in the management of leg ulcers, this literature review will: * Review the background to compression therapy. * Compare and contrast different types of bandages. * Consider the appropriate therapy for patients with various underlying factors. * Investigate different bandaging techniques. * Identify a protocol for compression hosiery. Rational for compression bandaging (Thomas, 1990b) suggests "compression implies the deliberate application of pressure in order to produce the desired clinical effect" The aim of compression bandaging is to correct venous incompetence and facilitate the movement of fluid and waste products out of tissue and back into the circulating volume. Thus these physiological effects following compression bandaging lead to improved healing by reduction and control of limb oedema. However Kerstein and Gahtan (1996) argue that clinical studies to document these effects are limited. All forms of compression bandaging rely on variation in limb diameter to achieve effectiveness. Laplace's law, adapted to compression (Thomas 1996), states that: Compression = [Tension x Number of layers]/[Circumference x Width of bandage] Altering any of these variables alters the pressure applied to the limb. In a normal lower leg there is a gradual increase in circumference as you move upwards from the ankle to the calf muscle. If a bandage of fixed width, tension and equal number of layers is applied to such a limb, graduated compression is achieved by the increasing circumference of the limb decreasing the pressure applied. The therapeutic target is to achieve 40mmHg pressure at the ankle and 20mmHg at the calf (Stemmer, 1969) to reverse chronic venous hypertension. Factors to consider before applying compression: * Skin condition: Delicate friable skin may be damaged by compression. * Presence of neuropathy: Loss of protective sensation increases the risk of pressure damage. * Presence of cardiac failure: Rapid fluid shifts can increase cardiac pre-load. * Shape of limb, ankle circumference: Sub-bandage pressure and the pressure gradient will be altered by limb shape. Skin over bony prominences may be damaged. Bandages The ideal bandage has been described in the literature in terms of pressure profile and performance. There are a range of bandages capable of exerting therapeutic pressures that have been evaluated in clinical trials. Nevertheless, there is little evidence to recommend one high-compression bandage regime over another, although multi-layer systems appear to be more effective than single layer systems (Boutle et al., 1997). The actions of different types of bandage vary according to the elasticity within the...
Share on Pinterest A pressure bandage (also called a pressure dressing) is a bandage that’s designed to apply pressure to a particular area of the body. Typically, a pressure bandage has no adhesive and is applied over a wound that’s been covered with an absorbent layer. The absorbent layer may or may not be held in place with an adhesive. Pressure bandages are used to control bleeding and encourage blood clotting without constricting normal blood circulation. They help:
Keep reading to learn when and how to apply a pressure bandage as well as precautions. Doctors often use pressure bandages following surgical procedures. They’re also used by emergency medical responders. Initial wound treatmentIf you or someone you’re with has a deep wound that’s profusely bleeding, you may need to apply a pressure bandage. But first, here are the initial steps you should follow:
At this point, the wound should be more stable. However, if you see blood soaking through the bandage or dripping out from underneath it, you need to apply a more effective pressure bandage to prevent excessive blood loss. Excessive blood loss can result in:
If elevation, gauze, and manual pressure haven’t adequately stopped the bleeding, here are your next steps:
You can also use a pressure bandage to treat venomous snake bites. According to Queensland Children’s Hospital, applying firm pressure over the blood vessels at the site of the poisonous snake bite can slow the venom from progressing into the bloodstream. If the pressure bandage is tied too tightly around an extremity, the pressure bandage becomes a tourniquet. A tourniquet cuts off the blood supply from the arteries. Once that blood supply has been cut off, the tissues separated from oxygen-rich blood flow — such as the nerves, blood vessels, and muscles — can be permanently damaged and result in loss of the limb. If you’ve applied a pressure bandage, continually check around it to make sure you haven’t tied it too tightly or swelling hasn’t made it too tight, but try to maintain a proper amount of pressure. For some wounds, a pressure bandage may be used to help control bleeding and better allow the blood to clot over a wound. It’s important, however, for a pressure bandage not to be too tight, as you don’t want it to halt blood flow from the arteries. You can also use pressure bandages in the treatment of venomous snake bites to help stop the venom from getting into the bloodstream. Last medically reviewed on February 28, 2020 |