Today's Wound Clinic - Winter 2008 - (Page 54) instruction Figure 10:The placement of stockinette over a compression wrap to prevent sticking to clothing and bed linens. Figure 9: Residual barrier ointment shown after wrap and dressing removed. plastic bag taped over the wrap, very pointed safety education must be provided to prevent falls. Having another person available for assistance or placing towels on the floor of the shower or tub to eliminate the slick surface can reduce the risk of falls. Cohesive wraps can be sticky. The cohesive layer outer wrap tends to be a bit “tacky” at times, causing pant legs to cling, dirt and lint to adhere, and bed linens to restrict movement during sleep. Applying a plain stockinette can alleviate this problem and make it easier to put on shoes without catching the wrap and causing it to bunch-up at the foot. (See Figure 10). Always have a contingency plan. Patient education is vital when compression therapy is used. A critical success factor is whether the patient will wear the wrap for the prescribed length-of-time and maximize the therapy.The patient who removes the wrap “since I was coming into the clinic anyway” can undermine several days’ worth of therapy. By the same token, the patient who does not remove the wrap 54 Winter 2008 Today’s Wound Clinic when pain or injuries are occurring also may have problems. The patient who removes the wrap can undermine several days’ worth of therapy. The patient who does not remove the wrap when pain or injuries occur also may have problems. CONCLUSION Mr. Swollen indeed may be a candidate for compression therapy. Only a comprehensive patient history and assessment will determine if he should receive compression and, if so, the type of compression treatment and the length-of-time for the treatment verses support. As previously discussed, the patient’s physical/medical needs, occupational and social situation, functional abilities, and financial means must be considered in the compression decision. If any one of these factors is omitted from the equation, the patient may be doomed to failure. The clinician needs to remember that compression therapy is rarely a short-term treatment. Most patients with chronic lower extremity edema will require long-term compression therapy followed by life-long compressive support to prevent the recurrence of limb threatening ulcerations. In wound healing clinics, there is a popular mantra: “Treat the whole patient, not the hole in the patient.” Clinicians always must remember that we are treating not just the wound or the edematous limb but also a disease process. ■ REFERENCES 1. Brown AC, Coutts P, Sibbald RG. Compression therapies. In: Krasner DL, Rodeheaver GT, Sibbald RG (eds). Chronic Wound Care:A Clinical Source Book for Healthcare Professionals, Third Edition. Wayne, Pa: HMP Communications; 2001:517–524. 2. Homa L, Macdonald, J, Seaman S. Compression Modalities in Chronic Wound Care: What to Use and When to Use It. Post Conference session presented at the Symposium on Advanced Wound Care and Wound Healing Society Meeting.Tampa, Fla. May 1, 2007. 3.Weir D. Pearls of compression. In Falabella AF, Kirsner RS (eds). Wound Healing. Boca Raton, Fla:Taylor & Francis Group 2005:423–437.
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