Compression Bandage Systems Research Articles

Measuring sub-bandage pressure: comparing the use of pressure monitors and pulse oximeters

To test the use of low-cost sub-bandage pressure monitors and pulse oximeters as part of a quality-control measure for graduated compression bandaging in leg ulcer clinics. Twenty-five healthy volunteers (mean age 40 years) providing 50 limbs were bandaged with a four-layer compression bandaging system. The ankle systolic pressure (ASP) was measured using a pulse oximeter (Nellcor NBP-40) before applying the graduated compression bandages. Interface pressure was measured by placing pressure sensors on the skin at three points (2cm above the medial malleolus; the widest part of the calf; and a point midway between them) in the supine and standing positions. The ASP was measured again with the pulse oximeter after the bandage had been applied, and the effect of the bandage on the ASP was recorded. The actual pressure created by the bandage was compared with the required pressure profile. Interface pressures varied with change of position and movement. With the operator blinded to the pressure monitors while applying the bandages, the target pressure of 35-40mmHg at the ankle was achieved in only 36% of limbs ([mean +/- 95% confidence interval]; 32.3 +/- 1.6mmHg [supine]; 38.4 +/- 2.4mmHg [standing position]). With the help of the pressure monitors, the target pressure was achieved in 78% of the limbs. There was no correlation between the pressure monitors and pulse oximeter pressures, demonstrating that the pulse oximeter is not a useful tool for measuring sub-bandage pressures. The results suggest a tool (interface pressure monitors) that is easy to operate should be available as part of quality assurance for treatment, training of care providers and education.

Is compression bandaging accurate? The routine use of interface pressure measurements in compression bandaging of venous leg ulcers

Objective: To test the use of a low-cost, portable, battery-powered sub-bandage pressure monitor as a part of a quality control measure for graduated compression bandaging in the leg ulcer clinics. Methods: A total of 25 healthy volunteers (mean age 40 years) providing 50 limbs were bandaged with a 4-layer compression bandaging system. Interface pressure was measured by placing pressure sensors on the skin at three points (2 cm above the medial malleolus, on the widest part of the calf and on a point midway between them) in supine and standing positions. A further 16 patients (mean age 62 years) providing 22 limb measurements also participated in this study. Bandages were reapplied in patients with the help of the pressure monitors when the target pressure was not achieved in the first attempt. Results: The interface pressures varied with change of position and movement. With the operator blinded, the target pressure of 35–40 mmHg at the ankle was achieved in only 36% of healthy volunteers (mean±95% confidence interval, 32.3±1.6 mmHg [supine]; 38.4±2.4 mmHg [standing position]). With the help of the pressure monitors, the target pressure was achieved in 78% of the patients. Conclusion: This result suggests that it is important to have a tool that is easy to operate, and available as a part of the quality assurance in connection with treatment and also training of care providers, nurses, etc in how to apply a compression bandage.

Managing and promoting change: implementing the Leg Club model

Patient knowledge of their disease may increase concordance to compression therapy. The Lindsay Leg Club® model (Lindsay, 2004) empowers the community nursing team to truly get to know their communities and deliver local, high-quality, evidence-based care for patients with leg ulcers and leg related problems. The author’s experience of opening a Leg Club has lead to changes in clinical practice: re-evaluation of the use of long stretch bandages in favour of short stretch; replacing conventional compression bandage systems with two piece graduated compression hosiery; increased patient concordance post healing with increased use of compression hosiery; the introduction of toe bandaging and appropriate long-term management for those patients with lymphoedema; and developing the role of the nursing auxiliary in leg ulcer care. This article won First Prize in the Compression Therapy Award at the British Journal of Nursing Clinical Practice Awards 2005.

Actico: a short-stretch bandage in venous leg ulcer management.

Actico compression bandage system (Activa Healthcare) completes the prevention and treatment regime of venous leg ulcer management. Actico gives the patient comfort by being a simple two-layer compression bandage system that is also effective and which stays in place because of its cohesive nature. This product focus looks at the impact of venous leg ulcers, the use of compression and focuses on short-stretch bandages and the Actico bandage system.

The Profore (TM) multilayer compression bandaging system

Multilayered bandaging has been shown to be extremely effective in the treatment of venous ulcers. The Profore™ multilayered compression bandaging system was developed so that all bandages required in the multilayer system could be provided in one kit, thereby reducing workload for district nurses. Clinical governance will ensure that treatment for venous ulceration is highlighted and compression therapy will be the gold standard required for monitoring healing rates. The Profore™ multilayered compression bandaging system supports the ideal of clinical governance as it has been shown to be a clinically-effective treatment with excellent healing rates.

Tubular Compression in the Treatment of Venous Ulcers of the Leg: A New Graduated Tubular Device

Background: Compression treatment remains an effective method of healing of venous ulceration. Traditional bandaging techniques require considerable nursing time to apply. Elastic stockings are comfortable but patients find these difficult to put on over dressings. Aim: To develop a tubular compression bandage system that can be easily applied to patients with venous leg ulceration. Methods: A tubular bandage has been designed (Tubulcus) which applies 30-40 mmHg compression at the ankle with graduated compression above this. An applicator system has been designed (Tricolore) which allows the compression bandage to be applied over ulcer dressings. The device has been evaluated on a cylindrical former and an anatomical model of a leg, in order to assess its suitability for clinical trials. It has been compared with three types of compression bandage. Results: The tubular bandaging system provides sustained compression to be applied to leg ulcers whilst facilitating dressing changes. The graduated compression profile achieved with this system is more easily obtained than when using any of the three types of bandage. Conclusion: A system of application of elastic compression has been designed specifically for use in patients with venous ulceration. Clinical trials are now required to demonstrate the efficacy of this system.

Developing skills in leg ulcer nursing: the lessons learned.

The high treatment costs of inappropriate leg ulcer management are well referenced. Wide variations in practice have also been reported. A training programme for community nurses has been in place in Leicestershire and Rutland NHS Trust for five years. Its objective is to promote evidence-based leg ulcer management. The aim of this prospective audit was to assess and compare the effectiveness of the compression bandage systems used in the trust: the original Charing Cross system (August 1996 to September 1997) and Robinson's Ultra Four kit (October 1997 to December 1998). All patients with leg ulceration were assessed using the Leicestershire leg ulcer assessment form. This was submitted along with an audit tool to the tissue viability service in exchange for a 12-week supply of compression bandages. The audit form was resubmitted after each subsequent 12-week period until the patient either had healed or was withdrawn from the audit. Differences between the two groups in mobility, previous deep vein thrombosis, fixed ankle deformity, the male to female ratio, duration of ulcer and ulcer surface area were noted. Patients using the Ultra Four kit had faster healing times than those given the Charing Cross system, but this was not statistically significant. Cost comparisons between the previous dressing regimen and compression bandaging showed a significance difference (p < 0.001). There was also a significant reduction in nurse time (p < 0.001). The audit results showed that compression bandaging therapy was an effective method of achieving healing in patients with venous leg ulcers and that significant cost savings were made in terms of dressing cost and nurse time. Furthermore, there were potential benefits in continuing compression therapy for the group of non-healers.

Successful methods of treating leg ulcers

PREVIEWSome therapies for chronic leg ulcers, such as surgical debridement and split-thickness skin grafting, have been used for many years and still have a role in management. However, several new methods are also available. Among these are multilayer compression-bandage systems, topical recombinant human platelet-derived growth factor, and human skin equivalent for use in grafting, all of which aid in healing and wound closure. In this article, Dr Phillips discusses the role of established as well as novel therapies for chronic ulcer and summarizes other issues in the current standard of care.

Patients’ tolerance of leg ulcer treatments

Little has been published about patients’ tolerance of their venous leg ulcer treatments. That which has, fails to clearly distinguish between ‘tolerance of’ and ‘compliance with’ treatment. As part of a pragmatic randomised trial, treatment tolerance was monitored in a sample of patients with venous leg ulcers receiving either four-layer compression bandage system in a clinic setting (Clinic Group n 120) or receiving their ‘usual’ leg ulcer treatment at home from the district nursing service (Home Group n113). Data were collected weekly for twelve weeks using a structured questionnaire. Log-linear modelling was used for statistical analysis where appropriate. There was a trend for Clinic Group patients overall to be slightly more tolerant of their leg ulcer treatment, although the results were not statistically significant. Overall, Home Group patients had more frequent ulcer dressings; suffered more ulcer infections; suffered more ‘strike through’; dressings allergy, dressings pain and dressings discomfort. Nurses also reported overall worse health status, more illness and a greater number of referrals for the Home Group patients, although again, the results were not statistically significant. The costs associated with these problems have an impact on the cost effectiveness of leg ulcer treatments for patients. Patient’s tolerance of, and compliance with, venous leg ulcer treatments should be monitored. Further investigation is required into patients’ tolerance of compression therapy.

Venous ulcer healing: effect of socioeconomic factors in London.

To determine which social and clinical factors are associated with healing in patients with venous ulceration. Patients were questioned about social factors at their first visit to a community ulcer clinic. They were treated by high compression bandage system and were interviewed again after 12 weeks. Community leg ulcer clinics held in health centres throughout Riverside Health Authority in London. All patients referred to five community leg ulcer clinics with venous ulceration over a six month period. These were factors significantly associated with healing within 12 weeks of beginning treatment, measured by odds ratio (OR) given by logistic regression analysis. Of 168 patients with venous ulceration, 87 (52%) healed after 12 weeks of treatment. Univariate analysis showed that low social class (OR = 3.44, 95% CI 1.17, 10.14), lack of central heating (OR = 2.22, 95% CI 1.18, 4.18), and being single (OR = 2.77, 95% CI 1.15, 6.69) were all significantly associated with delayed healing. After adjustment for the known risk factors of ulcer size, ulcer duration, and general mobility only lack of central heating was still significant (OR = 2.27, 95% CI 1.11, 4.55). The remaining factors failing to achieve statistical significance because of their inter-relationship with the known risk factors. Clinical features of the ulcer seem to determine the progress of healing in patients with leg ulceration. Although there were associations between socio-economic factors and poor healing, adjustment for clinical risk factors generally led to lower non-significant associations. Only lack of central heating retained its association and may play a part in prolonging healing of venous ulceration.