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Unna Boot (102.128)

Unna Boot (102.128) - Policies, Clinical, UWMF Clinical, UWMF-wide, Clinical Policies and Procedures, Surgical

102.128

1
UNIVERSITY OF WISCONSIN MEDICAL FOUNDATION
CLINICAL POLICY AND PROCEDURE

TITLE: UNNA BOOT

Effective Date: August, 2004 Approval: See Authorization
Supersedes Protocol: None Contact: Clinical Staff Education

Reviewed April, 2005 November 2007 June 2009 December 2010 October 2011


PURPOSE: To provide guidelines for UNNA Boot application and management at UWMF Clinics.

DEFINITION: The purpose of an UNNA Boot is to provide continuous compression to the affected area, to
aid in healing and reduce swelling. Compliance is necessary for this to happen and does not occur unless
therapy is continued for some time. An Unna boot can be used to treat uninfected, non necrotic leg and foot
ulcers that result from such conditions as venous insufficiency and stasis dermatitis
BACKGROUND: The application of Unna dome paste, zinc gelatin bandage, or "colloid" dressings to an
extremity is used for the treatment of dermatological and other conditions. These dressings are often covered by
an elastic bandage to give added support, hold the dressing in place and provide a protective cover.

POLICY: The clinical staff will utilize the following guidelines to properly assist with UNNA Boot
applications.

SUPPLIES:
UNNA Boot dressing (one or two Packages),
Bandage scissors
4x4 sterile sponges
Non-sterile gloves
Elastic bandage or elastic adhesive bandage- such as coban
Ointment (per provider),
Provider’s order
Patient’s record

PROCEDURE:

1. Check provider’s order and clarify any inconsistencies.

2. Review history with provider for contraindications to the procedure.
3. Wash hands and gather equipment.

4. Introduce yourself and identify the patient. Include date of birth.

5. Explain procedure to the patient and answer questions. Verify allergies, especially to zinc or colloid
dressings.

6. Provide good light and provide privacy by closing curtains or door.

7. Position patient on exam table to remove old boot (if needed).

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8. Cut old boot with bandage scissors.
NOTE: Identify location of wound, cut along a line that is a safe distance from wound.

9. Wash affected area with soap and water (or other prescribed cleaner)

10. Gently dry area, making a note of skin appearance, color and patient’s pain level.

11. Expose and position leg according to provider’s order.
NOTE: Leg is either dangled or held with knee slightly flexed.

12. Apply prescribed ointment –if ordered

13. Wrap UNNA boot dressing using firm equal pressure.
Over inner ankle to one inch below the knee.
At the base of the toes to one inch below the knee.

NOTE: Continue wrapping in overlapping turns using:
A figure-eight or spiral method/pattern.
Mold the cast with free hand until smooth.
NOTE: If a turn does not fit snugly, cut bandage and start a new turn.

14. Pad ulcer area with sterile 4 X 4 sponges if moderate to large amount of drainage is noted.

15. Cover cast with elastic adhesive bandage i.e. coban

16. Provide patient with support during the procedure.

17. After procedure, remove gloves and wash hands.

18. Assist patient in dressing and scheduling follow-up appointment, (as needed).

19. Discharge Instructions
 Activity (per physician order)
Resume normal activity unless advised by the provider.
Do not get the UNNA boot wet, cover when in the shower.
Elevate the leg 2 or 3 times a day, or more often if boot feels tight.
If boot continues to remain tight, loosen outer wrap.
Elevate the foot of the bed 3-6 inches.
Check the foot for swelling, color, temperature and flexibility.
Walk daily or as prescribed by the provider.
Avoid sitting at a ninety-degree angle for too long.
 Warning signs (patient or family to call for the following)
Increase in pain or pressure in the extremity
Drainage or odor from dressing
Excessive swelling in affected area
An open sore or broken-down skin
A change in skin color or temperature in affected area
Tingling or numbness in affected area
Decreased movement or loss of feeling in affected area

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20. Return equipment to proper place, and dispose of waste items.

21. Documentation (in Progress Notes section of patient record in HealthLink)
Patient education provided
Skin assessment
Procedure done, with date and time
Medications administered by clinical staff (using SmartPhrase .medinclinic)
Patient discharge instructions and follow-up care
How the patient tolerated the procedure

REVISED BY: Carol Decker, RN, MSN, Clinical Staff Educator

REVIEWED BY: Shelly Key, RN, Team Leader, Odana Atrium
Kelly Meyer, R.N., General Surgery

WRITTEN BY: Kelly Patterson, R.N., Clinical Staff Educator

REFERENCES:
Kowalak, J. P. (Ed.). (2009). Lippincott’s nursing procedures (5th ed.). Ambler, PA: Lippincott Williams & Wilkins.

Perry, A.G. & Potter, P.A. (2002). Clinical nursing skills & techniques. (5th ed.). St. Louis, MO: Mosby.

Perry, A.G. & Potter, P.A. (2009). Fundamentals of nursing. (7th ed.). Hall, A. & Stockert, P.A. (Eds.). St. Louis, MO: Mosby
Elsevier.


AUTHORIZATION:


Medical Director Date