Journal of Community Nursing - page 63

JCN
2013,Vol 27, No 4
63
WOUND CARE
to the World Health Organization
(WHO) is to offer symptom relief
and help the person to live as active
a life as possible until death (WHO,
2013). Palliative oedema at the end
of life can occur as a direct result
of a number of conditions, some of
which may be terminal, including
(International Lymphoedema
Network [ILF], 2010):
Advanced cancer
Chronic heart failure
Advanced neurological disease
Advanced liver disease
End-stage renal disease
End-stage chronic respiratory
disease
Human immunodeficiency virus
(HIV)/acquired immunodeficiency
syndrome (AIDS).
Oedema is a significant problem
at the end of life, with up to 67%
of patients with advanced cancer,
for example, experiencing oedema-
related pain (Badger et al, 1988).
Oedematous limbs can also cause
related pain, for example hip and
back pain (ILF, 2010).
Reduced or mild compression
can form part of a number of end-
of-life management strategies,
helping, for example, with reducing
oedema through manual lymph
drainage and the management
of skin conditions (ILF, 2010).
Compression can also improve
end-of-life patients’ quality of life
through cosmetic appearance and
improved freedom of movement,
both complications of palliative
oedema. Compression can form
part of exercise routines, where
light compression in particular can
help with muscle strength and tone
and, more generally, with increased
venous and lymphatic return
(ILF, 2010).
Crucially, responsibility for
compression in palliative care
should never be passed to the
patient (ILF, 2010). End-of-life
patients may find removal of
bandages and garments difficult and
attempts to apply these modalities
themselves could result in physical
harm such as dislocation, fracture
and skin tears (ILF, 2010), as well
as psychological distress. Constant
monitoring is vital, especially if
the end-of-life patient is unable to
communicate well.
Hosiery
The aim of compression hosiery
is to control oedema by applying
pressure evenly around the limb,
thereby increasing the rate of
venous return (Anderson, 2013).
Active leg ulcers are usually
controlled with the higher pressures
of compression bandaging, and
maintained once healed in RAL
grade hosiery to reduce recurrence
rates (Dowsett, 2011). However,
once ulcers have healed, patients
are often prescribed compression
hosiery, which provides lower levels
of compression, to maintain the
healed state.
According to a Cochrane review
of hosiery and patient concordance,
higher rates of compression are
more effective, but are rarely
maintained by patients (Nelson and
Bell-Syer, 2012). The researchers
also found that any compression is
better than none at all. Therefore,
it is recommended that patients
should wear the highest rate of
compression hosiery they can
tolerate, but the minimum should
be a UK (British Standard) Class 2
garment (Anderson, 2013).
In the past, cosmetic
considerations have played a
part in patient concordance with
compression hosiery, with many
products being bulky, cosmetically
unappealing and difficult to apply.
As a result, manufacturers have
developed different styles and
colours and hosiery is available
in a number of formats, including
(Anderson, 2013):
Below-the-knee garments
Full-leg garments
Socks.
Manufacturers have also
developed a number of hosiery
styles to make application easier,
including inner and outer layers,
and products that have zips. These
formats represent an understanding
by manufacturers and clinicians that
patients affected by mixed aetiology
ulceration, mild venous disease, or
palliative oedema at the end of life,
need compression hosiery that is
easy to apply.
duomed soft
®
duomed soft is a new range of
British Standard compression
hosiery that promotes patient
comfort through the use of soft,
sheer fabric. It has a silicone
top-band (
Figure 1
), which stops
slippage and does away with having
to wear prescribed suspenders. Its
soft fabric also gives it the look of a
non-medical stocking, making it far
more cosmetically acceptable to
the patient.
The range has a simple selection
method, so clinicians can easily
choose the right size and option for
their patients.
Table 1:
Compression classes and product codes
Style
Product code
Compression class 1 (ccl 1) = 14–17mmHg
Below knee, open toe
DT511/1-5 (S-XXL)
Below knee, closed toe
DT512/1-5 (S-XXL)
Thigh length with silicone top-band, open toe
DT611/1-5 (S-XXL)
Thigh length with silicone top-band, closed toe
DT612/1-5 (S-XXL)
Compression class 2 (ccl 2) = 18–24mmHg
Below knee, open toe
DT521/1-5 (S-XXL)
Below knee, closed toe
DT522/1-5 (S-XXL)
Thigh length with silicone top-band, open toe
DT621/1-5 (S-XXL)
Thigh length with silicone top-band, closed toe
DT622/1-5 (S-XXL)
Compression class 3 (ccl 3) = 25–35mmHg
Below knee, open toe
DT532/1-5 (S-XXL)
Thigh length with silicone top-band, open toe
DT632/1-5 (S-XXL)
1...,53,54,55,56,57,58,59,60,61,62 64,65,66,67,68,69,70,71,72,73,...116