12 / 16
COMPRESSION THERAPY
12 JCN supplement
2014,Vol 28, No 6
For these patients, ongoing
assessment and treatment review
is an essential component of care.
Where appropriate, and when
wound and limb conditions permit,
the patient can be ‘stepped-down’
into a leg ulcer hosiery kit, bringing
about cost-savings and benefits for
patients in their ability to self-care,
without compromising healing
(Ashby et al, 2014).
When selecting wound
dressings, clinicians regularly
change the dressing to meet the
changing needs of the wound;
for example, switching from a
superabsorbent dressing to a
dressing with less absorption
capacity once exudate volume is
reduced. Product choice along with
clinical evidence now enables a
similar approach to compression
selection (
Figure 1
).
The case report outlined in this
article (Beston, 2012) illustrates
how a step-down approach to
›
Key points
Compression therapy is a vital
component of healing venous
leg ulcers.
Four-layer bandaging has been
considered the gold standard
of treatment to obtain healing,
however, its bulk can result in
poor concordance.
TheVenUS IV randomised,
controlled trial highlighted
that two-layer hosiery kits are
as effective at healing as four-
layer bandaging, can reduce
recurrence, achieve cost-savings
of £302.40 per patient episode,
and aid patient self-care.
Enabling patients to self-care
can increase concordance
with treatment.
For patients who require initial
treatment with bandaging, a
step-down approach can be
taken, using leg ulcer hosiery
kits as soon as wound and limb
conditions permit.
compression selection improved
quality of life for a patient with a
chronic leg wound.
Conclusion
If used appropriately, compression
therapy can dramatically
improve an individual’s quality
of life (Moffatt, 2014). Clinicians
have a responsibility not only
to the patient, but also to the
organisation to make the right
choices regarding product
selection. The VenUS IV trial has
highlighted the benefits of using
leg ulcer hosiery kits to achieve
comparable healing rates and
times to four-layer compression
bandaging, with the added
Patient with venous leg ulcer
Two-layer leg ulcer hosiery kit (Activa/ActiLymph
®
Hosiery Kit)
Activa British Standard hosiery or
ActiLymph
®
European Class hosiery (Bianchi, 2013)
Maintenance /
prevention of
reoccurrence
Carry out four-stage holistic assessment (Jones, 2014),
as per practice point above
Compression bandaging, Actico
®
/Actico 2C
®
Healed wound
Low-to-moderate
exudate, minimal
distortion to limb
Highly exuding and /
or distorted limb
Management phase
Figure 1.
Four-step approach to assessment.
Step-down approach
benefits of reduced recurrence and
costs, along with improvements
in quality of life. It is the
responsibility of clinicians to apply
such robust findings to practice.
If, initially, the use of compression
hosiery to facilitate healing due
to clinical need is inappropriate, a
step-down approach will help to
strike the balance between clinical-
effectiveness, cost-effectiveness
and quality of life.
References
Adderley U, Thompson C (2007) A
study of the factors influencing how
frequently district nurses re-apply
compression bandaging.
J Wound
Care
16:
217–21
Akobeng A (2005) Understanding RCTs.
Arch Dis Child
90:
840–44
Ashby R, Ghabe R, Ali S, et al (2014)
Clinical and cost-effectiveness
of compression hosiery versus
compression bandages in treatment
of venous leg ulcers (Venous leg Ulcer
Study IV, VenUS IV): a randomised
controlled trial.
Lancet
383(9920):
871–9
JCN
‘Where appropriate, and
when wound and limb
conditions permit, the patient
can be ‘stepped-down’ into a
leg ulcer hosiery kit...’