Compression treatment: some considerations
Before you read the chapter on what tools you have for compression, you need to know what you have to consider before you choose a compression device.
Figure 1 Unfortunately, this is something we see often. A compression bandage has been applied and no one has checked up on the patient to see whether the bandage is still sitting nicely. We see that it has rolled up at the lower end and the visible part of the foot has subsequently become even more swollen. If this patient has no one to check up on him daily, then a compression bandage may not be the right device for this patient. Maybe a class one stocking which he can wear day and night may be a safer option although it may be less effective.
What do we need to know before we start with compression treatment?
Compression treatment is the key factor in treating venous ulcers. It is also of importance in many other aspects of wound care. Compression treatment is a challenge because our choices depend on many factors:
Is the patient willing to use compression devices? Some patients are very clear about this and simply deny using any compression.
Can the patient afford compression devices?
Will the patient be able to put on the compression device on their own? Or will they have to depend on others to help them?
If the patient needs help putting on the compression device - is it the relatives or a home-care nurse helping with this?
How much edema is there?
What is the patient's ankle-brachial index?
What type of device does the patient want to use?
Does the patient experience pain when using the device?
How much exudate is coming from the ulcer? (if an ulcer has much exudate, it is wise to use a cheap compression bandage as this will need to be changed often, especially during the first couple of weeks)
Should I use a compression bandage, medical compression stockings, or velcro compression devices?
When the patient has a leg ulcer, it is usually most practical to use a compression bandage. If the patient can afford it, velcro compression devices are a good alternative. These can also be easily adjusted to a compression level that the patient is comfortable with.
Because many caregivers are not trained in applying a good compression bandage, some countries also advocate using compression stockings when the patient has an active ulcer. The argument is that it is better and safer to use the stocking rather than risking discomfort and poor compression from an ill-fitted bandage.
When the patient has a large leg ulcer with much exudate, medical compression stockings are not a suitable choice. Firstly, compression stockings will often not fit over a bulky absorbent dressing. Secondly, the stockings will easily be soiled by leaking exudate and will have to be washed frequently.
Once the wound has healed, it is usual to go from compression bandages to medical compression stockings. Stockings are more practical for everyday use as they are less voluminous- it is easier to wear them beneath trousers and easier to fit into shoes. However, stockings can be very challenging to put on. There are aids to help put on stockings, but many elderly patients find them hard to use. If the patient can afford them, velcro compression devices are an excellent alternative also for long-term use. Some of our patients actually prefer to use compression bandages also after the wound has healed. The most important aspect is finding a solution that the patient accepts and is happy to use indefinitely.