Compression (2) Bandaging

INTRODUCTION TO BANDAGING

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

• Bandaging can be safely worn both day and night.
  This is due to the low resting pressure exerted when the muscles are inactive and relaxed.
• Bandaging is effective during exercise because it provides additional resistance. This improves the efficiency of the muscle pumps.
• Bandaging is custom fitted each time the bandage is placed. This accommodates changes in the limb as the swelling decreases.
• Bandaging provides pressure to continue the reduction of
  the swollen limb.
  Manual Lymph Drainage (MLD) decreases the swelling of a limb and a well placed bandage provides resistance to aid in controlling additional swelling.
• Bandaging, with the placement of special pads within the bandage, helps to soften fibrotic (hardened) tissues.

BANDAGING IS, OR IS NOT, USED WHEN . . .

• The patient with stage O, or stage 1 lymphedema may NOT require bandaging; however these do patients require other forms of compression.
• Patients with stage 2, or stage 3 lymphedema, usually require bandaging during early treatment.
• During an intensive, which is also known as active treatment, bandages are worn 23 hours a day, 7 days a week throughout this treatment phase.
  At first the therapist places the bandages and the patient progressively learns how to perform self-bandaging for him or herself.
• After the intensive, many patients are able to replace bandages with other forms of specalized day and night garments. When full-time bandaging is discontinued, the bandages should be cleaned, rolled, and carefully stored in case they are needed in an emergency situation.
• Some patients with severe lymphedema need to continue bandaging throughout both the day and night. 
  Those patients who are unable to do their own wrapping need the assistance of a  caregiver who is able to assure that the bandages on the involves limbs are placed for patient comfort and to prevent increased swelling.

BANDAGING SHOULD NOT BE USED WHEN

• An infected area should not be bandaged! After the infection has healed, bandaging can be resumed with the doctor's permission.
• When an open wound is present! Instructions provided by the therapist, or physician, should include special bandaging precautions.
  It is essential that these instructions are followed carefully!
• Bandaging should not be placed without appropriate supervision or if other health conditions are present. Examples of these health conditions include heart problems, lipedema, or pregnancy. 
• The limb should not be wrapped too tightly in an effort to “squeeze out” excess fluid.  Although this sounds like a good idea for removing more fluid, it is NOT BENEFICIAL!
• Bandages that are too tight cause a tourniquet effect which blocks the flow of lymph and further damages the affected tissures and the compromised lymph vessels.

BANDAGING BASICS

• NEVER PLACE METAL CLIPS TO HOLD BANDAGES IN PLACE. These metal clips can be hazardous since they may increase the risk of infection by breaking the skin.
• There are several different bandaging techniques. It is best to follow the technique recommended by your therapist.
• Every detail is important, and therefore paying close attention is extremely important!
  Written instructions, provided by your therapist, are helpful.
• Sometimes it is a good idea to have a family member come with you as you are learning how to do this bandaging.
  This is helpful since, at first, you may need their help in applying the bandages properly.
• Another good idea to have your helper make a video, or take photos, as the therapist provides bandaging instructions.

SUPPLIES FOR MULTI-LAYER BANDAGING

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.

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

FIRST LAYER: STOCKINETTE

• The first layer consists of tubular gauze known as stockinette.
• Stockinette absorbs excess perspiration and protects the skin from rubbing against the other layers that will be placed over it.
• A fresh piece of stockinette is used each time you place a new bandage.

The stockinette is cut to the appropriate length of the limb to be covered.

• 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 as you need to bandage on the arm you bandaging.

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

SECOND LAYER: GAUZE FOR WRAPPING FINGERS AND TOES

• Gauze is used to wrap the fingers or toes.
• One inch wide gauze is commonly used for the fingers. 
• One and a half inch wide gauze is commonly used for the toes.
• As an alternative, your therapist may suggest special short-stretch finger or toe bandages.

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

THIRD LAYER: TYPES OF FOAM PROTECTIVE PADDING 

The third layer consists of a variety of foam-type wrappings. These protective foam pieces can also be used to cover prominences such as the outside of the elbow, the front of the knee, or the back of the ankle.

• This wrapping is a type of protective layer that is used when recommended by your therapist.
• Foam-type wrappings are applied to evenly distribute the pressure on the tissues. 
• It is also used to soften fibrotic (hardened) tissues, and to help shape the limb.
• The foam-type layer is wrapped around the limb as instructed by your therapist.
• This foam-type layer may be used to hold small, shaped foam pieces in place.
• This foam-type layer is used to protect indentations such as the inside of the elbow,
  front of the ankle, and back of the knee.
• It can also be used to cover prominences such as the outside of the elbow, the front of the knee, or the back of the ankle.

Rolled short-stretch bandage material. (Courtesy of BSN-Jobst Inc.)

FOURTH LAYER: SHORT-STRETCH BANDAGES 

• The fourth layer consists of short-stretch bandages.
• These come in different widths and are used depending on the area being wrapped.
• Short-stretch bandages ARE NOT PLACED on the fingers or toes. 
  Smaller width short-stretch bandage are used for fingers and toes.
• Short-stretch bandages are placed to provide the greatest compression at the far end of the limb and the least compression near the body.

Follow your therapist’s instructions as to the width of the bandages that should be used in different locations.

• Wider short-stretch bandages are needed to accommodate the increasing size of the limb as the bandaging moves upward toward the trunk.
• The short-stretch bandages are wrapped to provide greatest compression at the distal (far end) of the limb.
• The short-stretch bandages are wrapped to provide the least compression at the proximal (end closest to the body).

THE CARE OF SHORT-STRETCH BANDAGES

A bandage winder makes it easier to prepare fresh bandages.

• Used, or soiled, bandages lose their elasticity.
• They can cause skin irritation and increase the risk of infection.
• Short-stretch bandages should be unrolled and washed carefully by hand
  in warm water with a liquid detergent that does not contain bleach, perfume, or fabric softener.
• For example, Woolite® liquid soap is NOT recommended for this purpose.
• Washing allows the knit-bandages to resume their original shape and elasticity.
• 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 save time and ensure proper rolling of the clean and dried bandages.

REFERENCES

• Lymphedema Bandaging. Lohmann Rauscher.
• Lymphedema Management: The comprehensive Guide for Practitioners 2-E by J.E. Zuther. Thieme, 2009.
• Living Well with Lymphedema by A. Ehrlich, A. Harrewijn PT, CLT-LANA, & E. McMahon PhD. Lymph Notes. 2005, Chapter 11.
• Lymphedema Caregiver’s Guide by M. K. Kearse, PT, CLT-LANA, E. McMahon, PhD, and A. Ehrlich, MA. Lymph Notes, 2009. 

© LymphNotes.com 2015.This information does not replace the advice of a qualified health care professional.

Got a question or comment? Post in the 'How Lymphedema is Treated' forum.
Category: How Lymphedema is Treated Updated: 2015-01-10