Guide to starting compression therapy

Undertake the following before prescribing compression therapy:

• diagnose the aetiology of the ulcer (see Overview of leg ulcers)
• identify any precautions for use of compression therapy
• educate patient and carers (see Compression therapy—patient information sheet)
• discuss the cost
• refer to vascular specialist (see Venous leg ulcers).

Practice points for applying compression are shown in Practice points for applying compression.

Class III compression is recommended for venous leg ulcers. However, a lower class of compression (ie class II) may be needed initially if the ulcer is inflamed and painful and higher levels of compression are not tolerated. A practical approach to implementing compression therapy is to start with a three-layer elastic tubular system. This compression system is low cost, facilitates frequent dressing changes and is well tolerated; see Long-stretch bandages. When ulcer pain and inflammation have improved (ie with standard ulcer care) and the ulcer is suitable for a weekly dressing, switch to class III compression. Continue class III compression with weekly changes until the wound has healed, then switch to compression hosiery for maintenance compression therapy.