Compression bandages

Overview

A variety of compression bandaging systems are available, in single- or multilayer products, made of long-stretch (elastic) or short-stretch (inelastic) components. Multicomponent systems combine both long- and short-stretch components. An overview of compression systems is provided in c_lwg2-c15-s5-1.html#lwg2-c15-s5-1__tlwg2-c15-tbl2. International consensus on types and grades of compression bandaging is lacking.

Ideally, the first application of compression bandages is undertaken in the morning when there is less oedema. Bandages are generally applied in a spiral or figure-of-eight pattern, according to the manufacturer’s instructions. Always apply a layer of padding underneath the compression bandage, unless the first layer is a padding layer.

Apply compression bandages from the base of the toe to the just below the knee. Once compression therapy is established, it is usually worn continuously (ie 24 hours a day) and changed weekly, depending on wound and patient characteristics. If exudate leaks through the bandage, adjust the primary and secondary dressings to be more absorbent and consider more frequent dressing changes (see Ulcer and wound dressings). When choosing a dressing or padding layer, remember that these can increase the total limb circumference. Increased limb circumference can change the effectiveness of the compression, and increase exudate. Choose a dressing or padding sufficient to absorb exudate with minimal bulk. Compression bandages should only be washed and reused according to the manufacturer’s instructions.

Short-stretch bandages

Short-stretch (inelastic) bandages remain rigid when the calf muscle expands on movement, creating a high working pressure. When the patient is resting, a marked decrease in compression occurs. The higher pressure exerted when the patient is mobile creates a massaging effect and helps the calf muscle pump with venous return. As limb oedema reduces, particularly in the first week of compression therapy, short-stretch bandages may become loose and require more frequent changes.

Long-stretch bandages

Long-stretch (elastic) bandages produce lower working pressures than short-stretch bandages.

Long-stretch bandages are useful in patients who are immobile because they provide compression while the patient is at rest.

Although tubular support bandages are not technically compression bandages, when combined in a three-layer system they provide adequate compression for ulcer healing. A three-layer elastic tubular system is useful as the patient’s first compression regimen due to low cost and comfort. The low cost and ease of application facilitates frequent wound review. A three-layer tubular system is created by applying three different lengths (long—toe to knee, medium—toe to calf, short—toe to malleolus) of bandage on top of each other to create a pressure gradient. The bandages should be of parallel design. Ideally, tubular bandages are for single use only.

Multicomponent compression bandage

A multicomponent compression bandage contains both long- and short-stretch components. Multiple layers increase the pressure applied by the bandage and its stiffness.

Check the patient’s ankle circumference before applying these bandage systems, because many are designed for an ankle circumference between 18 and 25 cm. Follow the manufacturer’s instructions.