Download reflecting the individual needs of the patient with lymphoedema

Compression therapy:
reflecting the individual needs of the patient with lymphoedema
Authors: Hammond, C. E., Randles, J.M. & Wescombe, A. Nurse Maude, Christchurch, New Zealand.
Introduction
Low profile cohesive bandage system: 3M™ Coban™ 2 Layer Compression System
The physical and psychological affects of lymphoedema have major detrimental consequences on quality of life. Chronic pain, loss of mobility,
reduced function, recurrent infections, dependence and changes in body image can lead to isolation, depression and reduced self esteem. Effective
lymphoedema management encompassing compression therapy, exercise and massage enhances lymphatic and venous return, thus reducing
swelling. The compression system chosen should be comfortable, provide adequate graduated sustained compression and allow flexibility of the foot
and ankle. It should remain in place and allow the patient to wear their shoes. Providing effective compression can be a challenge for some patients
in the clinical setting. The aim of this poster presentation is to illustrate how some of these difficulties were overcome in a community wound clinic
using a low profile cohesive bandage system.
The 3M™ Coban™ 2 Compression System is a low profile cohesive bandage system with short stretch
properties and provides 40mmHg at resting pressure. The first layer is applied with the foam to the skin
to provide cushioning and protection. It also provides grip to the skin reducing slippage. The second
layer, a cohesive bandage is applied at full stretch, bonding with the first layer to create an inelastic
sleeve. For large or distorted shaped limbs the bandages can be cut and restarted allowing the bandage
to curve around difficult shapes. The flexibility of the bandage allows free movement of the ankle.
Discussion
Case 1
Day 1
Miss J a 58 year old
paraplegic woman
with dependant
oedema, complicated
by loss of sensation
• No sensation either leg due to spina-bifida
• Dependant oedema all her life
• Oedema gradually increasing over years
• Recurrent cellulitis/iv antibiotics
• Unable to lift legs independently
• Difficulty transferring independently
• Lives with mother (82)
• Mother having difficulty lifting Miss J’s legs
• Unable to wear shoes
• Embarrassed by appearance legs
Day 21
Day 21
Day 1
• Oedema resolving
• Able to lift her legs independently
• Able to transfer independently
• Mother able to support Miss J
• No further cellulitis
• Able to wear shoes
• Improved self esteem
• Measured for flat knit made to measure hosiery
• Treatment commenced
• Leg washed and oily emollient applied
• Lymphatic massage
• Self massage to thigh taught
• Compression bandaging and exercises
• Coban 2 applied
• Foam pads applied to ankles to prevent bandage damage
• ‘Cut and paste’ technique used
• Bandages changed x 2 per week
Case 2
Mr A an 82 year
old man with venolymphoedema
Day 4
Day 4
• Increasing lymphoedema over past four years
• Recurrent cellulitis
• Discomfort and aching
• Very low mood
• Difficulty in walking
• Unable to lift legs to elevate
• Sleeping in chair with legs dependant
• Unable to care for terminally ill wife
• Wishes to nurse wife at home
Day 16
• Treatment commenced
• Leg washed and oily emollient applied
• Lymphatic massage
• Compression bandaging and exercises
• Coban 2 applied
• Extra foam layer to ankle skin fold for protection
• Right calf reduced by 15cm
• Able to walk
• Comfortable
• Can get into/out of bed independently
• Measured and fitted with hosiery
• Able to care for wife at home
• Mood much improved
• No further cellulitis
Compression therapy is an essential component of
lymphoedema management reducing the risk of recurrent
cellulitis, enabling ulcers to heal, improving quality of life
and providing cost effective treatment. In the past short
stretch bandages have been the mainstay of lymphoedema
management, but they have their drawbacks. The reduced
ankle mobility from the restrictive bandages can lead to a
decrease in the effectiveness of the foot and calf muscle
pump. This can be further impeded through patients wearing
inappropriate footwear due to the bulkiness of the bandages.
Bandage slippage, particularly with large and distorted limb
shapes can lead to pressure damage and non-concordance.
The introduction of a low profile cohesive bandage system
provides choice for the clinician. As demonstrated in this poster
presentation, the use of the new bandage improved patient
outcomes providing effective, comfortable compression that
reflected individual patient needs.
Case 3
Mr R a 60 year old
man with venolymphoedema,
complicated by leg
ulcer, foot ulcer
with osteomyelitis,
diabetic neuropathy,
chronic charcot
foot. He also has
ischaemic changes
in left leg
• History of poorly controlled diabetes
• Extensive neuropathy
• Stable charcot foot
• Foot ulcer with osteomylelitis treated with iv antibiotics
• Recurrent cellulitis
• Venous ulcer
• Obesity
• Ulcer at ankle flexure from bandage
damage with 4 layer compression
• Works night shift as petrol attendant
• Multi-disciplinary approach with vascular surgeon, infectious disease team, diabetes team,
specialist podiatrist and wound care specialist
• Leg and foot washed and oily emollient applied
• Foot ulcer treated with npwt *
• Venous ulcer dressed with hydrofibre and low
profile absorbent pad
• Lymphatic massage
• Self lymphatic massage of thigh taught
• 12 weeks sick leave taken to allow leg elevation
• Short brisk walks three times per day
• Coban 2 applied
• Extra foam layer to ankle skin fold for protection
• Compression bandaging wrapped around NPWT tubing
• Layer one built up around ankle flexure to
prevent further damage
• Mr R able to wear his orthotic shoes
• At 12 weeks venous ulcer healed
• Neuropathic ulcer reduced by 50%
• Ankle flexure ulcer healed
*NPWT Negative Pressure Wound Therapy
Poster funded by 3M Health Care, New Zealand