Compression (2) Bandaging

Introduction

Learnng self-bandaging. © Lymph Notes

Bandaging, also known as wrapping, is an effective form of compression for some lymphedema patients because it:

• Can be safely worn day and night. This is due to the low resting pressure that is exerted when the muscle is inactive and relaxed.
• Is more effective during exercise. (This is due to more resistance during activity that improves the muscle pump efficiency.)
• Is custom fitted each time the bandage is donned. They can accommodate changes in the limb as the swelling decreases.
• Provides pressure to continue the reduction of the swollen limb. (MLD decreases the swelling of a limb. One goal of bandage placement is to maintain this decreased swelling.)
• Provides resistance to aid in controlling additional swelling.
• Aids in the softening of fibrotic (hardened) tissues through the placement of special pads within the bandages aid

When Bandaging Should be Used

• Lymphedema patients in stage 0, or stage 1, may not require bandaging. However these patients will require other forms of compression.
• Patients in stage 2, or stage 3, usually require bandaging during early treatment.
• During an intensive, also known as active treatment, bandages are worn 23 hours a day for 7 days a week throughout this phase of treatment. During this stage the therapist places the bandages and teaches the patient how to perform self-bandaging.
• After the intensive, many patients are able to replace bandages with other forms of day and night compression garments. When regular bandaging is discontinued, the bandages should be cleaned and stored in case they are needed in an emergency situation.
• Some patients with severe lymphedema need to continue bandaging through both night and day. If these patients are unable to do their own wrapping, they should arrange for the help of a caregiver so that the limbs can be bandaged for patient comfort and to prevent increased swelling.

When Bandaging Should Not be Used

• If the area to be bandaged is infected do not wrap it until the infection has been brought under control.
• If an open wound is present, ask your therapist about the special bandaging precautions that should be taken.
• If you have other health conditions such as a heart condition, lipedema, or pregnancy do not bandage until you have learned about the special precautions that are required.
• Do not wrap bandages tightly to “squeeze” the limb in an effort to remove more fluid.
• Bandages that are too tight cause a tourniquet effect. This can further damage the already compromised lymph vessels.
• Metal clips are never be used to hold bandages in place. These clips can break the skin and risk infections.

Bandaging Basics

Learn to follow the bandaging technique recommended by your therapist. Every detail is important, so pay very close attention. If you have questions, ask for written instructions.

It is often desirable to have a family member also learn how to do the bandaging. You may need their help in applying the bandages properly. It also is a good idea to have your helper made a video, or take photos as the therapist provides bandaging instructions.

Multi-Layer Bandaging Supplies

Bandages are created from multiple layers of materials. Those listed here are the types of supplies most commonly used. There can be variations and you should use the types of supplies recommended by your therapist.

First Layer: Stockinette

Stockinette used in bandaging. Courtesy of BSN-Jobst Inc.

The first layer is a tubular gauze bandage, known as stockinette. This material absorbs excess perspiration and protects the skin from being rubbed by the other layers that are placed on top of it.

For the leg, the stockinette extends from the base of the toes upward as high as you need to bandage, For the arm, the stockinette extends from the base of the fingers upward as high on the arm as you need to bandage.

The stockinette is in direct contact with the skin and a fresh piece should be used each time you bandage.

Gauze for wrapping fingers. Courtesy of BSN-Jobst Inc.

Second Layer: Gauze

Gauze is used to wrap the fingers or toes.

• For fingers, one inch gauze is commonly used.
• For toes, one-half inch gauze is commonly used.

As an alternative to gauze, your therapist may suggest short-stretch finger or toe bandages.

Third Layer: Protective Padding

Padding for self-bandaging. Courtesy of BSN-Jobst Inc.

The third layer consists of a felt, or foam-type, of wrapping. This is applied to evenly distribute the pressure, to soften fibrotic (hardened) tissues, and to help shape the limb.

• Use the type of protective layer recommended by your therapist.
• Wrap this layer around the limb as instructed by your therapist.
• This layer may be used to hold small, shaped foam pieces in place to protect indentations such as the inside of the elbow, front of the ankle, and back of the knee.
• Protective foam pieces can also be used to cover prominences such as the outside of the elbow, front of the knee, or back of the ankle.

Fourth Layer: Short-Stretch Bandages

Roll of short-stretch bandage material. Courtesy of BSN-Jobst Inc.

The fourth layer consists of short-stretch bandages. These are used in different widths depending upon the area being wrapped.

• Follow your therapist’s instructions as to which wide of these bandages should be used in different locations.
• Short-stretch bandages are not placed on the fingers or toes.
• Usually a smaller width short-stretch bandage is used for the hand or foot.
• Wider short-stretch bandages are needed in order to accommodate increasing size of the limb toward the trunk.
• The short-stretch bandages are wrapped to provide greatest compression at the distal (far end) of the limb and the least compression at the proximal (near end closest to the body).

Care of Short-Stretch Bandages

Plastic bandage winder.

Used bandages tend to lose their elasticity. They also can cause skin irritation and increase the risk of infection.

• Short-stretch bandages should be unrolled and washed carefully in warm water with a liquid detergent that does not contain bleach, perfume, or fabric softener. As an example, Woolite® liquid soap is not recommended for this purpose
• Washing allows the knit-bandages to resume their original shape and elasticity.
• The bandages should be air-dried flat or placed in a medium setting in a laundry bag in the drier.
• The use of a bandage winder, as shown above, can time and ensure proper rolling of the clean and dried bandages.

References

[1] Lymphedema Bandaging. Lohmann Rauscher.

[2] Lymphedema Management: The comprehensive Guide for Practitioners 2-E by J.E. Zuther. Thieme, 2009.

[3] Living Well with Lymphedema by A. Ehrlich, A. Vinjé-Harrewijn PT, CLT-LANA, and E. McMahon PhD. Lymph Notes. 2005, Chapter 11.

[4] Lymphedema Caregiver’s Guide by M. K. Kearse, PT, CLT-LANA, E. McMahon, PhD, and A. Ehrlich, MA. Lymph Notes, 2009.

© LymphNotes.com 2009.This information does not replace the advice of a qualified health care professional.

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Category: How Lymphedema is Treated Updated: 2009-12-10