Today's Wound Clinic - Winter 2008 - (Page 49) instruction Figure 1: Example of double layered tubular bandage in place. Figure 2: Example of long stretch bandage and padding. therapy regimen may be quite different from the management of edema resulting from CVI. Wrap of choice. Multiple types of compression wraps are available for use in wound clinics. 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. For example, a construction or landscape worker likely would be challenged to wear a wrap for a full week due to perspiration and potential for external soiling. 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.What are the alternatives? 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. The ability to match the compression choice with the patient’s body, leg type and shape, occupation, shoe requirements, and the like is imperative. aging. A single layer provides approximately 8 mm Hg of compression. Because they are available in a variety of graduated sizes, each manufacturer provides a measuring tape to determine the appropriate choice based on the size of the patients calf, and the degree of stretch, low, medium or high.While not an ideal delivery system for adequate long-term compression, these bandages are an alternative when vascular status is being evaluated or when other options fail.Tubular bandages can be removed at night and may be washed and reused. Figure 3: Multilayered wrap applied in circle of eight pattern to exert sustained compression to extremity at all times. Wrap is being covered with a cohesive bandage wrapped in spiral fashion. compared to wraps; they are are washable, reusable, and easy to apply. 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. Examples: SurePress and SetoPress (Convatec, Skillman, NJ). (See Figure 2). Multilayer systems. Provided in prepackaged 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. This graduated compression usually equals 40 mm Hg at the ankle. Examples include: DYNA-FLEX (J&J, Somerville, NJ), Profore (Smith and Nephew, Largo, Fla), Proguide (Smith and Nephew, Largo, Fla). (See Figure 3). A newer option to a pre-packaged multilayer wrap provides seemingly sustained short-stretch equivalency. This system includes a foam layer that molds to the shape of the lower leg and provides a more rigid compressive layer and is followed by a prestretched cohesive bandage layer. The overall effect is less bulky; even at greater stretch on application, patients find it comfortable and non-constricting. These wraps can remain in place up to 1 week although some patients Today’s Wound Clinic Winter 2008 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. Examples: Tubigrip (Convatec, Skillman, NJ), Comperm LF (HartmannConco, Rock Hill, SC). (See Figure 1). Long-stretch bandages. Typically, these elastic bandages 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. These wraps often are inexpensive OPTIONS FOR COMPRESSION Tubular bandages. 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 pack- 49
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