Experience Summary

In this 360-degree video, observe the procedural steps of applying a compression bandage to a a patient.

Clinical Context

Compression bandaging is a widely used clinical intervention in the management of venous leg ulcers, chronic venous insufficiency, and lower limb oedema. It promotes venous return, reduces swelling, and improves tissue oxygenation, which collectively support wound healing. However, the application of compression must be guided by a clinical assessment, particularly the measurement of Ankle Brachial Pressure Index (ABPI), to ensure arterial blood flow is adequate and compression is safe.

Indications for compression bandaging

Compression bandages are primarily indicated for:

• Venous leg ulcers: To counteract venous hypertension and promote healing.
• Chronic venous insufficiency: To support vein function and prevent complications.
• Lower limb oedema: Especially when caused by venous or lymphatic insufficiency.
• Post-thrombotic syndrome: To manage symptoms and reduce recurrence.
• Prevention of ulcer recurrence: Once wounds have healed.

Before applying compression, an ABPI measurement must be performed. An ABPI of 0.8 or higher typically indicates that high compression (e.g., multi-layer bandaging) is safe. Lower ABPI values may require modified or reduced compression, and in cases below 0.5, compression is usually contraindicated.

Steps for applying a compression bandage

1. Patient PreparationExplain the procedure and ensure patient consent. Have the patient lie in a comfortable, elevated position to help reduce existing oedema. Inspect and cleanse the wound using an aseptic technique, then apply appropriate dressings.
2. Equipment PreparationSelect the correct compression system based on the patient’s condition and clinical guidelines (e.g., short-stretch, long-stretch, or multi-layer systems). Ensure all materials, including bandages, dressings, gloves, and securing tape, are ready.
3. Bandage Application
   • Start at the base of the toes, leaving the toes visible for circulation checks.
   • Use a spiral or figure-of-eight technique, depending on the type of bandage.
   • Apply even pressure throughout, with the highest compression at the ankle, reducing gradually up the leg to below the knee.
   • Overlap each layer by about 50% to ensure even compression and prevent gaps or pressure points.
   • Avoid wrinkles or folds that could damage the skin.
4. Post-Application AssessmentCheck the patient’s toes for colour, warmth, and movement. Ask about discomfort or numbness. Provide patient education on warning signs such as increased pain, numbness, or changes in skin colour.
5. DocumentationRecord the type of bandage used, ABPI results, condition of the leg, patient response, and advice given. Schedule regular reassessment.

Learning Outcomes

1. Understand the indications for the application of a compression bandage.
2. Observe the procedure of applying a compression bandage.
3. Understand the procedural steps of applying a compression bandage.
4. Understand the safety checks that must take place to ensure a compression bandage has been applied correctly.

External Resources

• How to apply effective multilayer compression bandaging