Precautions for use of compression therapy

Compression therapy is not appropriate for all patients. Compression should be used with caution in people with peripheral arterial disease (see Ankle brachial pressure index [ABPI]). Failure to diagnose arterial disease can result in unsafe use of compression therapy, potentially causing tissue damage. Only trained healthcare professionals should prescribe compression therapy.

Before applying compression therapy, complete a comprehensive wound assessment and select an appropriate wound dressing to use under compression.

Precautions of compression therapy include:

  • poor skin condition—delicate skin can be damaged by high pressure and shear forces during application of compression
  • abnormal limb shape—sub-bandage pressure is altered by limb shape
  • ulcer over bony prominences—these areas are at risk of pressure injury, so extra padding may be required
  • peripheral neuropathy—absent protective responses increase the risk of skin damage
  • heart failure—when compression bandaging is applied, large amounts of fluid may be returned quickly from the legs to the heart. Educate patients to report symptoms of worsening heart failure (eg shortness of breath when lying flat, or waking up gasping for breath)
  • spinal cord injury—if patients have reduced sensation and ability to report complications, ensure adequate monitoring
  • clinical infection (including cellulitis)—compression may be too painful, so consider reducing or delaying until the infection has resolved.
Provide patients with information about their condition, and ensure patients understand the risks and benefits of compression. Education can improve adherence to compression therapy. A patient information sheet on compression therapy is available (see Compression therapy—patient information sheet). Patients or their carers must be able to report problems, including:
  • numbness
  • pain
  • change in skin colour (blue, dusky) of their toes or foot
  • shortness of breath.
Note: Review the patient 24 to 48 hours after starting compression therapy to assess tolerance.

Review the patient to assess tolerance and complications 24 to 48 hours after starting compression therapy. Worsening pain following application of compression can indicate trauma or ischaemia. If this occurs, remove compression, review the limb and consider urgent referral if ischaemia is present.