Edema in wound management

what is edema?

The abnormal accumulation of interstitial

tissue fluid

where is peripheral edema common?

legs and feet

what are the different types of edema? (7)

venous

cardiac

lymphedema

inflammatory

idiopathic

hypoproteinemic

renal

what is pitting vs non pitting edema?

early edema (pitting) vs progressed with fibrosis (non-pitting)

how do we treat edema?

-Medical team managing medical conditions

i.e. heart failure, kidney disease

-Compression

-Exercise

-Elevation and moving often during day

-Skin care

-Manual lymph drainage if indicated

what are the benefits of compression?

-Reduces diameter of veins, causing endothelial cells to become tighter therefore reducing fluid leakage from the veins

-Produces increase in blood flow toward heart and reduces venous reflux

-Facilitates lymphatic fluid movement

what is the degree of compression determined by? (5)

-Elasticity of bandage

-Number of bandage layers

-Shape and size of limb

-Skill and technique of bandager

-Nature of physical activity undertaken by

patient

what is Laplace's Law/

Sub Bandage Pressure (mmhg) = (Tension) x (Number of Layers) x (4630) \ (Limb Circumference) x (Bandage Width)

what does laplace's law show?

sub bandage pressure is directly proportional to bandage tension and number of layers but inversely proportional to the limb circumference to which it is applied and the bandage width.

When compression bandages are applied evenly, there will be a greater pressure at a (larger/smaller) radius leg due to distribution of the same tension over the greater or lesser area

smaller

Increased bandage tension = (increased/decreased) sub bandage pressure

Increased

Increased # of bandage layers = (increased/decreased) sub bandage pressure

increased

Increased leg circumference = (increased/decreased) sub bandage pressure

decreased

Increased bandage width = (increased/decreased) sub bandage pressure

decreased

what are the 2 main bandage types (stretch), and what are they used for?

long stretch: ace wrap used for more aggressive compression

short stretch: unna boot is safer than long stretch due to less extensibility and therefore less tension to limb

what is the difference between resting pressure and working pressure?

Pressure bandage exerts on the tissues at rest

Pressure bandage exerts against working

musculature

Long Stretch Bandages:

(high/low) resting pressure

(high/low) working pressure

(high/low) risk of damage

(140%/60%) extensibility

(polyurethane/cotton) material

high

low

high

140%

polyurethane

Short Stretch Bandages:

(high/low) resting pressure

(high/low) working pressure

(high/low) risk of damage

(140%/60%) extensibility

(polyurethane/cotton) material

low

high

low

60%

cotton

what are the precautions for compression? (7)

-DM

-Peripheral arterial disease

-Acute cellulitis/infection

-Neuropathy

-Acute heart failure

-Low ejection fraction

-Fragile skin

what are the contraindications for compression?

-ABI less than 0.5

-High compression (30-40 mmHg) with ABI

<0.8

what is the progression for compression from open wounds to closed wounds?

1) open wounds: compression wraps (may consider velcro compression garment but not ideal)

2) closed wounds: compression stockings or compression garments

→wraps to stockings!

what are compression stockings indicated for?

indicated for legs with hx of ulcers; edema or risk for edema; varicosities or spider veins; history of DVTs; or history of cellulitis

what are compression stockings usually not indicated for?

open wounds (compression wrapping is best)

Compression Garments:

Class 1: ___-____mmHg is most common

Class 2: ___-____mmHg recommended for DVT

Class 3: ___-____mmHg

Class 1: 20-30 mm Hg most common

Class 2: 30-40 mm Hg recommended for DVT

Class 3: 40-50 mm Hg

what mmHg compression garments are recommended for DVT?

30-40mmHg

what mmHg compression garments are most common?

20-30mmHg

How do we instruct and educate our patients on compression therapy?

-Instruct patient in compression garment use:

-Wear during waking hours, whenever out of bed

-Wash regularly

-Take 45-60 minute breaks 3 times per day to elevate legs above heart

-Limit prolonged standing (>10 minutes) and prolonged sitting (>30 minutes) without getting up

-Move legs every 15-20 minutes while sitting