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Policies,Clinical,UWHC Clinical,Department Specific,Nursing Patient Care,Musculoskeletal

Lower Extremity Compression Therapy (Adult) (5.12-A)

Lower Extremity Compression Therapy (Adult) (5.12-A) - Policies, Clinical, UWHC Clinical, Department Specific, Nursing Patient Care, Musculoskeletal

5.12-A

NURSING PATIENT CARE POLICY & PROCEDURE





Effective Date:
September 30, 2016

Administrative Manual
Nursing Manual (Red)
Other _______________

Policy #: 5.12A

Original
Revision

Page
1
of 8

Title: Lower Extremity Compression
Therapy (Adult)

I. PURPOSE

To provide guidelines for application of various lower extremity compression
modalities used in the treatment of venous stasis disease and/or ulcers, and for edema
management among adult patients.

II. DEFINITION

Compression therapy is the application of external pressure or static support to the
lower leg for improvement of lymphatic drainage, reduction of superficial venous
pressure, improvement of venous stasis ulcers, and reduction of edema. Several types
of compression therapy modalities are available. Compression is contraindicated if
the ankle-brachial index is at or below 0.7 and in some situations of uncompensated
heart failure.

III. POLICY

Therapeutic compression may be applied on adult patients by trained registered
nurses upon written provider order specifying the type of compression therapy to be
applied and the site of application.

IV. COMPRESSION THERAPY PROCEDURES

A. Inelastic Paste Bandage (Central Services [CS] Item Number 2100013)
1. Equipment
a. Prescribed medicated bandage
b. Wound dressing, if ordered
c. Ace wrap
d. Protective bandage covering: Elastoplast, Coban
TM
, or high
compression wrap
e. Scissors
f. Wound washing supplies as ordered (soap and water, wound
cleanser, sterile saline, etc.)
g. Gauze or wash cloths
h. Non-sterile examination gloves
2. Application
a. Obtain a provider order for application of inelastic paste bandage
specifying the location for application.
b. Perform hand hygiene according to UWHC Hospital

Page 2 of 8

Administrative Policy 13.08, Hand Hygiene, and don non-sterile
exam gloves.
c. Cleanse and rinse the lower extremity as ordered according to
managing service. Cleanse existing wounds as ordered according
to managing service. Pat the skin dry. Make sure to wash away any
loose scabs, drainage, or necrotic tissue. (CAUTION: Vigorous
rubbing can be injurious to fragile surrounding skin.)
d. Palpate pedal pulse. Assess color and temperature of the foot and
leg, any ulcer size and depth, wound bed color, and leg edema each
time a new bandage is applied. If unable to palpate pedal pulse,
please consult ordering provider prior to applying compression
therapy.
e. Apply the medicated gauze layer bandage.
i. With the foot positioned at a right angle to the leg, begin
wrapping the medicated bandage in a spiral fashion around
the foot starting at the base of the toes behind the first
metatarsal. Wrap twice around the toes without any tension.
ii. Continue wrapping the bandage around the foot, heel, and
ankle using a spiral technique, with each strip overlapping
the previous strip approximately 50 to 75 percent.
iii. Smooth the medicated paste bandage while applying.
Eliminate any creases or folds in the bandage by cutting the
folds or creases with each turn. Mold the bandage to the
contour of the leg while wrapping.
iv. Continue to apply the bandage in a “pressure gradient
manner”.
• Pressure is neutral over the dorsum of the foot.
• The greatest pressure should be applied at the ankle
and the lower third of the calf with progressively
diminishing pressure over the upper two-thirds of
the calf.
v. End the wrap approximately one (1) inch below the tibial
tubercle of the knee. Apply a second layer of the medicated
gauze in the same manner.
vi. Apply the outer wrap of elastic bandage from the base of
the toes to just below the knee making sure to enclose the
heel. Apply the elastic bandage in a figure eight technique
with each layer overlapping the previous lay by 50 percent
and the wrap applied at 50 percent extension.
vii. Apply the self-adherent compression wrap using a spiral
technique.
viii. Remove gloves and perform hand hygiene.
f. Patient education occurs at the time of the first application, and is
reinforced with every subsequent application. The patient is
instructed to keep the inelastic paste bandage dry and is instructed
to report any adverse signs and symptoms, i.e., numbness/tingling
sensation, pain, dusky color changes of the toes or decreased
temperature of the toes. The patient is to report excessive drainage
soaking through the dressing as indicated in Health Facts For You

Page 3 of 8

5808, Caring for Your 4-Layer Compression Boot.
g. The bandage is changed twice weekly or weekly as indicated by
drainage, hygiene, or anticipated decrease in edema as ordered by
the provider. If the patient is an inpatient, the provider follows the
patient daily and orders a new bandage as indicated.
h. Document the following in the patient’s clinical record:
i. Bandage change
ii. Location
iii. Patient’s response to the application
iv. Continuing progress as appropriate
v. Patient education
NOTE: Include wound measurement and wound
description.
3. Removal of Inelastic Paste Bandage
a. Perform hand hygiene according to UWHC Hospital
Administrative Policy 13.08, Hand Hygiene, and don non-sterile
exam gloves.
b. Unwrap the outer dressing. Saturate the inelastic paste bandage
with warm water and gently unwrap the medicated gauze layer if it
has hardened. Take care to prevent injury to the ulcer and
surrounding skin.
c. Carefully cleanse the skin as directed in A.2.c above.
d. Remove gloves and perform hand hygiene according to UWHC
Hospital Administrative Policy 13.08, Hand Hygiene.
4. Documentation
a. Assessment of pedal pulse, color and temperature of foot
b. Lower extremity edema
c. Ulcer to lower extremity – measurements and description
d. Application of inelastic paste bandage
B. Elastic Compression Bandage with Multiple Layers (Profore
TM
) (CS Item
Number 4001233
1. Equipment
a. Profore
TM
multilayer compression wrap kit
b. Wound dressing as ordered
c. Scissors
d. Wound cleansing supplies as ordered (soap and water, wound
cleanser, sterile saline, etc.)
e. Gauze or wash cloths
f. Tape
g. Non-sterile exam gloves
2. Application
a. Obtain a provider order for application of the Profore
TM

compression bandage specifying the location for application.
b. Perform hand hygiene according to UWHC Hospital
Administrative Policy 13.08, Hand Hygiene, and don non-sterile
exam gloves.
c. Cleanse and rinse the lower extremity as ordered according to
managing service. Cleanse existing wounds as ordered according
to managing service. Pat the skin dry. Make sure to wash away any

Page 4 of 8

loose scabs, drainage, or necrotic tissue. (CAUTION: Vigorous
rubbing can be injurious to fragile surrounding skin.)
d. Palpate pedal pulse. Assess color and temperature of the foot and
leg, any ulcer size and depth, wound bed color, and leg edema each
time a new bandage is applied. If unable to palpate pedal pulse,
please consult ordering provider prior to applying compression
therapy.
e. Apply prescribed dressing over the wound. If no dressing is
prescribed, apply the sterile wound contact dressing from the kit
directly to the wound.
f. Apply each layer of multilayer bandage
i. Profore
TM
Layer 1 (absorbent padding)
• Ensuring that the foot is flexed, apply as smoothly
and evenly as possible without stretching. Start at
the base of the toes and give the bandage
anchorage around the foot with two (2) turns,
ensure the foot is entirely covered.
• Apply the packing in a spiral technique ensuring a
50 percent overlap. Work up the leg and finish
below the knee at the tibial tuberosity. Cut any
excess padding.
• Use any remaining padding to protect any bony
prominences or to improve absorption if the
wound is heavily exudating.
ii. Profore
TM
Layer 2 (light conforming bandage)
• Start at the base of the toes and give the bandage
anchorage with two (2) turns around the foot.
• Bring the bandage under the arch of the foot and
the bottom of the heel to ensure this is tight.
• Using a spiral technique and ensuring a 50 percent
overlap, wrap Layer #2 bandage to the tibial
tuberosity. Cut off excess bandage. Use adhesive
tape to secure.
iii. Profore
TM
Layer 3 (Ace bandage; light compression
bandage)
• With the foot flexed, anchor the bandage with two
(2) turns around the foot, then pass behind the
heel. Using a figure eight wrapping technique,
wrap the bandage across the front of the foot at a
45 degree angle with 50 percent extension.
• Continue wrapping with a figure eight technique
using the central yellow line for 50 percent
overlap. Wrap to the tibial tuberosity ending just
below the knee crease.
• Cut any excess bandage and use tape to secure the
cut edge.
iv. Profore
TM
Layer 4 (Cohesive Compression Bandage;
Coban
TM
)

Page 5 of 8

• With foot flexed, anchor the bandage around the
foot with two (2) turns. Using a spiral technique,
wrap around the back of the foot making sure to
cover the heel and continue up the leg to the tibial
tuberocity and just below the knee crease.
v. Remove gloves and perform hand hygiene.
g. Patient education occurs at the time of the first application, and is
reinforced with every subsequent application. The patient is
instructed to keep the Profore
TM
bandage dry and is instructed to
report any adverse signs and symptoms, i.e., numbness/tingling
sensation, pain, dusky color changes of the toes or decreased
temperature of the toes. The patient is to report excessive drainage
soaking through the dressing as indicated in Health Facts For You
5808, Caring for Your 4-Layer Compression Boot.
h. The bandage is changed twice weekly or weekly as indicated by
drainage, hygiene, or anticipated decrease in edema as ordered by
the provider. If the patient is an inpatient, the provider follows the
patient daily and orders a new bandage as indicated.
i. Document the following in the patient’s clinical record:
i. Assessment of pedal pulse, color and temperature of foot
ii. Lower extremity edema
iii. Ulcer to lower extremity – measurements and description
iv. Patient’s response to the bandage application
v. Continuing progress as appropriate
vi. Patient education
3. Removal of the Profore
TM
Bandage
i. Perform hand hygiene according to UWHC Hospital
Administrative Policy 13.08, Hand Hygiene, and don non-
sterile exam gloves.
ii. Unwrap the outer Coban
TM
bandage or carefully cut the
Coban
TM
for removal.
iii. Unwrap each of the remaining layers.
iv. Carefully cleanse the leg, wound and surrounding skin as
directed in B.2.c above.
v. Remove gloves and perform hand hygiene according to
UWHC Hospital Administrative Policy 13.08, Hand
Hygiene.
4. Documentation
a. Assessment of pedal pulse, color and temperature of foot
b. Lower extremity edema
c. Ulcer to lower extremity – measurements and description
d. Application of the Profore
TM
bandage
C. Elastic Compression Multiple Layers (Badger Compression Boot)
1. Equipment
a. Profore
TM
bandage layers 1, 3, and 4
b. Inelastic paste bandage (CS Item Number 2100013)
c. Wound dressing, if ordered
d. Scissors
e. Wound cleansing supplies as ordered (soap and water, wound

Page 6 of 8

cleanser, sterile saline, etc.)
f. Gauze or wash cloths
g. Non-sterile exam gloves
h. Tape
2. Application
a. Obtain a provider order for application of the Badger Compression
Boot specifying the location for application.
b. Perform hand hygiene according to UWHC Hospital
Administrative Policy 13.08, Hand Hygiene, and don non-sterile
exam gloves.
c. Cleanse and rinse the lower extremity as ordered according to
managing service. Cleanse existing wounds as ordered according
to managing service. Pat the skin dry. Make sure to wash away any
loose scabs, drainage, or necrotic tissue. (CAUTION: Vigorous
rubbing can be injurious to fragile surrounding skin.)
d. Palpate pedal pulse. Assess color and temperature of the foot and
leg, any ulcer for size and depth, wound bed color, and leg edema
each time a new bandage is applied. If unable to palpate pedal
pulse, please consult ordering provider prior to applying
compression therapy.
e. Apply any prescribed dressings directly over the wound(s) surface.
f. Apply each layer of the Badger Compression Boot.
i. Profore
TM
Layer 1 (absorbent padding)
• Ensuring that the foot is flexed, apply as smoothly
and evenly as possible without stretching. Start at
the base of the toes and give the bandage
anchorage around the foot with two (2) turns,
ensure the foot is entirely covered.
• Apply the padding in a spiral technique ensuring a
50 percent overlap. Work up the leg and finish
below the knee at the tibial tuberosity. Cut any
excess padding.
Layer 2 (inelastic paste bandage with calamine). Use any
remaining padding to protect any bony prominences or to
improve absorption if the wound is heavily exudating.
• Begin bandaging with the inelastic paste bandage
wrap at the base of the toes, without pressure,
keeping the foot at a right angle to the leg.
• Continue bandaging beyond the ankle,
overlapping half the bandage to ensure molding to
the contours of the leg.
• Complete bandaging to just below the knee. The
three (3) inches of inelastic paste bandage, which
continues above Layer 1, helps keep the Badger
compression boot from slipping.
ii. Layer 3 (Profore
TM
Layer 3 [Ace bandage; light
compression bandage])
• With the foot flexed, anchor the bandage with two

Page 7 of 8

(2) turns around the foot, then pass behind the
heel. Using a figure eight wrapping technique,
wrap the bandage across the front of the foot at a
45 degree angle with 50 percent extension.
• Continue wrapping with a figure eight technique
using the central yellow line for 50 percent
overlap. Wrap to the tibial tuberosity ending just
below the knee crease.
iii. Layer 4 (Profore
TM
Layer 4 [Cohesive Compression
Bandage; Coban
TM
])
• With foot flexed, anchor the bandage around the
foot with two (2) turns. Using a spiral technique,
wrap around the back of the foot making sure to
cover the heel and continue up the leg to the tibial
tuberocity and just below the knee crease.
iv. Remove gloves and perform hand hygiene.
g. Patient education occurs at the time of the first application, and is
reinforced with every subsequent application. The patient is
instructed to keep the Badger Compression Boot dry and is
instructed to report any adverse signs and symptoms, i.e.,
numbness/tingling sensation, pain, dusky color changes of the toes
or decreased temperature of the toes. The patient is to report
excessive drainage soaking through the dressing as indicated in
Health Facts For You 5808, Caring for Your 4-Layer Compression
Boot.
h. The bandage is changed twice weekly or weekly as indicated by
drainage, hygiene, or anticipated decrease in edema as ordered by
the provider. If the patient is an inpatient, the provider follows the
patient daily and orders a new bandage as indicated.
i. Document the following in the patient’s clinical record:
i. Bandage change
ii. Location
iii. Patient’s response to the bandage application
iv. Continuing progress as appropriate
v. Patient education
NOTE: Include wound measurements and wound
description with each bandage change.
3. Removal of Badger Compression Boot
i. Perform hand hygiene according to UWHC Hospital
Administrative Policy 13.08, Hand Hygiene, and don non-
sterile exam gloves.
ii. Unwrap the outer Coban
TM
bandage or carefully cut the
Coban
TM
for removal.
iii. Unwrap each of the remaining layers.
iv. Carefully cleanse the leg, wound and surrounding skin as
directed in C.2.c above.
v. Remove gloves and perform hand hygiene according to
UWHC Hospital Administrative Policy 13.08, Hand
Hygiene.

Page 8 of 8

4. Documentation
a. Assessment of pedal pulse, color and temperature of foot
b. Lower extremity edema
c. Ulcer to lower extremity – measurements and description
d. Application of the Badger Compression Boot

V. UWHC CROSS REFERENCES

A. Health Facts For You 5808, Caring for your 4-Layer Compression Boot
B. Hospital Administrative Policy 13.08, Hand Hygiene

VI. REFERENCES

A. Carmel, J. (2012). Venous Ulcers. In R. A. Bryant, D. P. Nix (Eds.). Acute and
Chronic Wounds: Current Management Concepts (194-213). St. Louis, MO:
Mosby.
B. Compression Therapy: Multi-layer and two-layer compression bandage systems.
Retrievable at Smith & Nephew website at: http://global.smith-
nephew.com/master/Compression_29403.htm

VII. REVIEWED BY

Clinical Nurse Specialist, Burn Intensive Care Unit
Nursing Patient Care Policy and Procedure Committee, September 2016

SIGNED BY

Beth Houlahan, DNP, RN, CENP
Senior Vice President Patient Care Services, Chief Nursing Officer