Lecture 8: Edema in Wound Management

Define Edema:

Abnormal accumulation of interstitial tissue fluid

Edema Basics:

• Edema commonly occurs where in the body?

• What type of edema is this called

• Legs and Feet

• Peripheral Edema

Edema Basics:

• What are the 7 main types of edema that occur in the legs?

• What is Venous Edema caused by?

• Types:

  • Venous

  • Cardiac

  • Lymphedema

  • Inflammatory

  • Idiopathic

  • Hypoproteinaemic

  • Renal

• Venous Dysfunction

Edema Basics:

• Pitting Edema =

• Non-Pitting Edema =

• Early Edema

• Progressed w Fibrosis

What is the 6 main tretaments for Edema?

• Medical team managing medical conditions

  • Heart Failure, Kidney Disease

• Compression

• Exercise

• Elevation and moving often during dat

• Skin care

• Manual lymph drainage if indicated

Compression Benefits:

• Compression reduces the diameter of veins causing what?

• Endothelial cells to become tighter therefore reducing fluid leakage from the veins

Compression Benefits:

• Compression produces an increase in what? and reduces what?

• Compression facilitates what?

• Increase in blood flow towards the heart

• Reduces venous reflux

• Lymphatic fluid movement

The Degree of Compression is determined by what 5 main factors?

• Elasticity of bandage

• Number of bandage layers

• Shape and size of limb

• Skill and technique of bandager

• Nature of physical activity undertaken by patient

Compression Pressure:

• What does Laplace’s Law show?

Sub-bandage pressure:

• 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

Compression Pressure:

• When tension is applied evenly:

  • There will be greater pressure at the _______ radius rather than ______ radius due to what?

• Greater pressure on SMALLER rather than LARGER

• Due to:

  • Distribution of the same tension over the greater or lesser area

Compression Pressure:

• Increased Bandage Tension =

• Increased Number of Bandage Layers =

• Increased Leg Circumference =

• Increased Bandage Width =

• Increased Bandage Tension = Increased Sub Bandage Pressure

• Increased Number of Bandage Layers = Increased Sub Bandage Pressure

• Increased Leg Circumference = Decreased Sub Bandage Pressure

• Increased Bandage Width = Decreased Sub Bandage Pressure

Bandage Types:

• 2 Main Categories

  • Example

• Long Stretch

  • Ace Wrap

• Short Stretch

  • Unna Boot

Bandage Type:

• Long Stretch Bandage is used for what?

• Short Stretch Bandage is SAFER than….

• LS:

  • Used for more aggressive compression

    • So not use by itself and on pts w fragile veins/skin

• SS:

  • Safer than Long Stretch due to LESS extensibility and therefore less tension to limb

What is Resting Pressure?

Pressure bandage excerts on tissues at rest

What is Working Pressure?

Pressure bandage exerts against working muscles

• Ex. When walking, moving around, exercise

• NOT when standing

Bandage Type:

• Describe Long Stretch Bandage Characteristics: (5)

• High resting pressure

  • Stiff like boot

• Low working pressure

• Higher risk of damage

• > 140% extensibility

• Made of polyurethane

Bandage Type

• Describe Short Stretch Bandage Characteristics:

• Low resting pressure

• High working pressure

• Lower risk of damage

• ~ 60% extensibility

• Made of cotton fibersC

Compression Precautions (Pt 1 - 4)

• DM

• PAD

• Acute Cellulitis/Infection

• Neuropathy

Compression Precautions (Pt 2 - 3)

• Acute Heart Failure

• Low Ejection Fraction

• Fragile Skin

  • Can cause bruising

Compression Contraindications (2)

• ABI < 0.5

• High Compression (30-40 mmHg) w ABI < 0.8

Compression Progression:

Open Wounds » Closed Wounds

• Open:

  • Compression Wraps

    • May consider Velcro Compression garment but NOT ideal

• Closed:

  • Compression Stockings OR Compression Garments

Compression Stockings are INDICATED for legs w what? (5)

• Hx of Ulcers

• Hx of DVT

• Hx of Cellulitis

• Edema or Risk of Edema

• Varicosities or Spider Veins

Compression Stockings are NOT INDICATED for legs w what?

Open wounds

• Use compression wrapping instead for open wound

Compression Garment

• 4 main classes of mmHg:

• 15-20 mmHg

  • Pts who cannot tolerate higher level or cannot put garment on

• Class 1: 20-30 mmHg

  • Most Common

• Class 2: 30-40 mmHg

  • Recommended for DVT

• Class 3: 40-50 mmHg

  • More severe lymph conditions

What to include in pt education: (3)

• Edema progression

• Importance and purpose of wraps and compression stockings

• Monitoring for changes

  • heart failure, cellulitis, signs od arterial probs

Pt Education:

• What to instruct pt regarding compression garment use?

• How long and how many break per day to elevate legs above heart?

• Compression Garment Use:

  • Wear during waking hours, whenever out of bed

  • Wash regularly

• Take 45-60 min break 3x/day

Pt Education:

• Limit what 2 activities?

• Move legs how often while sitting?

• Limit

  • Prolonged Standing (> 10 min)

  • Prolonged Sitting w/o Getting Up (> 30 min)

• Every 15-20 min