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COMPRESSION THERAPY
A system that provides less bulk,
allowing use of regular footwear is
also favourable and well-accepted
by patients (Stephen-Haynes and
Sykes 2013; Ashby et al, 2014).
Not only does this offer benefits
in terms of body image, but also
facilitates the wearer’s ability to
work and exercise while wearing
compression — exercise being an
essential component of venous
leg ulcer management. A recent
study highlighted the drawbacks
of wearing bulky bandages and
bandage shoes while exercising,
as several participants were afraid
of falling due to bandages and
found that bandage shoes restricted
exercise (O’Brien et al, 2014).
applying the evidence
to practice
To best meet the needs of the
individual, compression should
marry the latest evidence with
patient preference and the findings
of full holistic assessment (Moffatt,
2014). As previously said, in reality,
ritualistic practice in relation to
selection of compression therapy
may be preventing many individuals
with venous leg ulcers from
receiving optimal treatment.
To overcome inappropriate
choices, Jones (2014) suggests that
a four-step approach to assessment
(
Practice point
;
Figure 1
) will result in
successful selection of compression
for the management of venous leg
ulcers. This approach reinforces the
importance of assessing the shape
of the limb, which may be altered
due to the presence of oedema,
as part of holistic assessment to
underpin compression choice.
However, if clinicians are unaware
of the latest evidence-based care
options, they may be unable to
meet patients’ needs adequately.
With the emergence of new
compression products and recent
robust evidence to support the use
of leg ulcer hosiery kits (WUWHS,
2008; Ashby et al, 2014) in the
healing of venous leg ulcers, is
opting for the traditional choice
doing a disservice to some patients?
Every now and again, clinicians
should pause and ask themselves
patient that compression bandaging
is a relatively short-term treatment
that will be followed by the use of
hosiery can help patients to concord
with treatment (Gray, 2013).
‘With the emergence of new
compression products and
robust evidence to support
their use, is opting for the
traditional choice doing a
disservice to some patients?’
why they are doing an activity
and what evidence underpins it
(White, 2013).
Best practice in compression
therapy is not about the
ability to apply a bandage, but
W
e have found that leg
ulcer hosiery kits have
brought real benefits to
some of our patients. They are
great for delivering consistent
care to suitable patients in
settings where there may be a
high turnover of agency staff
delivering care.
For people with mental
health issues, they are accepted
more readily than compression
bandaging, which is frequently
tampered with due to its bulk.
The compression hosiery kit
seems to be more acceptable, due
to its similarity to socks.
For patients who wish to
shower daily, they are able
to remove and reapply their
compression therapy, enhancing
their independence and self-care.
For these patients, bandaging
is often removed, as the wish
to shower is greater than their
desire to concord with therapy.
For working patients the kits
are ideal, as they can be worn
with the relevant footwear.
In our rural location, we have
several farmers with venous leg
ulcers, who, before this option,
would simply remove their
bandaging and work without it;
their livelihoods depended on
them working and they could
not wear wellies with four-layer
bandaging.
There is no one size fits all for
patients with venous leg ulcers. As
nurses, it is our responsibility to
think about what we are doing
and work with the patient to find
a solution.
involves choosing a system that
considers the patient’s individual
requirements, goals of therapy and
stage of treatment (WUWHS, 2008).
Of course, some individuals will
still require bandaging (for example,
due to high volumes of exudate,
lymphorrhoea or limb distortion
due to oedema). Explaining to the
›
PRACTICE POINT
Carry out four-stage holistic
assessment to evaluate (Jones,
2014):
1. Patient health status,
comorbidities and possible
underlying conditions causing
ulceration and/or oedema
2. The presence of oedema
(to identify the correct
compression system)
3. The wound status (e.g. size,
exudate volume)
4. Patient lifestyle factors (e.g.
self-caring, mobility level).
Rosie Callaghan,Tissue Viability Nurse Specialist,
Worcester Health and Care Trust
Expert commentary