By Laurie Swezey RN, BSN, CWOCN, CWS, FACCWS
Compression therapy is the “gold standard” for the treatment of venous ulcers. However, compression therapy is not a one-size-fits-all treatment and the clinician must decide on the right type of compression therapy for the individual client in order to prevent complications from occurring, such as ischemia and necrosis.
The Purpose of Compression
In individuals with chronic venous insufficiency, pressure in the veins during ambulation consistently exceeds 40mmHg, far higher than the 22mmHg pressure in the veins of people without venous insufficiency. The reason for this? Pressure decreases during ambulation due to foot and calf pump activity. Decreased range of motion in the ankle and calf pump dysfunction have been shown to be important factors in the development of venous ulcers.
Compression therapy serves several purposes in the treatment of venous insufficiency:
- Reduces the diameter of the vessels
- Returns blood to the central circulation
- Reduces edema
- May improve arterial circulation
- May reduce levels of inflammatory cytokines and proteases
A Variety of Compression Products
Compression therapy products are usually classified according to the level of compression they provide at the ankle. For patients who do not have arterial disease, aim for a pressure of approximately 40mmHg at the ankle.
Short Stretch Bandages
- Minimal stretch
- Can be laundered and reused
- Work by providing a firm support against which the calf muscles can push during ambulation (support the calf pump)
- Low resting pressure when the person is at rest (may be an advantage for patients with concomitant arterial disease)
- May not be the best choice for people with poor calf pump muscles
- May be used to reduce edema; however, the bandages may need frequent changing as the limb shrinks in size
- Studies show that short stretch bandages may not be as effective as others at healing venous ulcers
- Minimally absorptive (may not be appropriate for wounds that are heavily exudative)
- Unna boots- disposable inelastic bandages; calamine or zinc paste to decrease itching and discomfort; may be applied directly over a wound or over a primary dressing; gauze or cast padding can be added as a middle layer to absorb drainage from wounds
Long Stretch Bandages
- Able to stretch up to several times their length
- Better able to accommodate the shape of the leg
- High pressures sustained at all times (relaxation and ambulation)
- Generally used for immobile patients, patients with a fixed ankle or patients with inadequate calf pump
- NOT used for patients who also have arterial insufficiency
- Can be washed and reused
- Padding may be applied over bony prominences
- Usually three or four layers; “light” multi-layer bandages may have only two layers and may be used safely on patients who have mild to moderate arterial disease
- Layers are a combination of elastic or inelastic bandage, along with padding, crepe and cohesive layers
- Spiral or figure-eight wrapping permits the maintenance of the compression gradient for long periods of time at rest and when ambulating
- Require less frequent changing but unit costs are more expensive
- Research has shown improved healing with multi-layer bandages as compared to single layer bandages
- Can be bulky and may interfere with shoe wearing
- May alter gait and restrict ankle range of motion (increase risk of falls)
Compression stockings should be worn once the venous ulcer has healed to prevent reoccurrence. Compression stockings come in knee-high and thigh-high lengths. Accurate measurements of the legs must be obtained (calf/ankle circumference and length of the lower leg). Most stockings provide pressures of 30 to 40mmHg, but compression strength should be specified as there is no standardization among stocking classifications. Compression stockings should ideally be replaced every three to six months. They should be donned first thing in the morning before the client gets out of bed and are removed at bedtime. Compression stockings are sometimes used to treat small, superficial venous ulcers.
Compression therapy may be initially uncomfortable, and many patients may opt out of treatment due to this discomfort. It is important to educate the patient regarding the pathophysiology of their disease and the possible outcomes that may occur as a result of nonadherence to therapy. Work with the client to minimize discomfort and allow clients some choice in therapy whenever possible.
Sloan-Rivera, N. & Wu, S. (2012). A Guide to Compression Dressings for Venous Ulcers. Podiatry Today online, 25(2). http://www.podiatrytoday.com/print/2960
About The Author
Laurie Swezey RN, BSN, CWOCN, CWS, FACCWS is a Certified Wound Therapist and enterostomal therapist, founder and president of WoundEducators.com, and advocate of incorporating digital and computer technology into the field of wound care.
The views and opinions expressed in this blog are solely those of the author, and do not represent the views of WoundSource, Kestrel Health Information, Inc., its affiliates, or subsidiary companies.
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