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COMPRESSION THERAPY
T
he benefits of using
compression therapy for
healing leg ulcers is well
documented (World Union
of Wound Healing Societies
[WUWHS], 2008; O’Meara et al,
2012). Traditional guidelines have
promoted a two-step approach to
compression therapy; intensive
treatment using a bandaging
system to promote healing and gain
control of symptoms such as excess
exudate and swelling, then hosiery
as maintenance treatment for
patients once the ulcer has healed
(Lymphoedema Framework, 2006;
Royal College of Nursing [RCN],
2006; Scottish Intercollegiate
Guidelines Network [SIGN], 2010).
Since its introduction in the
late 1970s, four-layer bandaging
has been considered the gold
standard for the healing of venous
leg ulcers. However, many patients
find four-layer bandaging systems
uncomfortable, or even painful, and
their bulk can also create problems
with footwear and reduced mobility.
As a consequence, concordance
and healing rates can be negatively
affected (Puffet et al, 2006; Adderley
and Thompson, 2007; O’Meara et al,
2012; Moffatt, 2014). Furthermore, the
application of four-layer bandaging
requires training, skill and ongoing
competency on the part of the
clinician, since inappropriate selection
and/or application of compression
can have a negative impact on
both quality of life and morbidity
(WUWHS, 2008; Williams, 2014).
‘... two-component leg ulcer
hosiery kits allow hosiery to
be used as first-line treatment
for suitable patients and
overcome some of the
drawbacks associated
with four-layer compression
bandaging’
Joy Tickle,Tissue Viability Specialist,
Shropshire Community NHS Trust
In recent years, there have
been considerable advances in
product options available to
deliver compression for healing
venous leg ulcers. For example,
two-component leg ulcer hosiery
kits that allow hosiery to be used
as first-line treatment for suitable
patients and overcome some of
the drawbacks associated with
four-layer compression bandaging
(Ashby et al, 2014), especially
for those with chronic swelling
(Williams, 2014).
Unravelling practice: compression
therapy for venous leg ulcers
IN BRIEF
Compression therapy is recognised as a vital component of healing
and maintaining healing in patients with venous leg ulceration.
A number of products exist for the delivery of compression.
Compression therapy choice is known to influence patient
concordance with compression products.
Nurses should be aware of the different options available, the
evidence base to support their use, and work with the patient to
find a product that maximises concordance.
KEY WORDS:
Compression therapy
Venous leg ulcers
Randomised, controlled
trial (RCT)
Evidence-based practice
Concordance
Joy Tickle
This article will discuss the
findings of the recently published
VenUS IV trial (Ashby et al, 2014),
which showed that compression
hosiery kits are a cost- and
clinically effective alternative to
four-layer compression bandaging
for healing venous leg ulcers and
preventing recurrence. It will also,
where possible, explain how this
evidence should be incorporated
into everyday practice to improve
outcomes for patients.
Evidence-based practice
The NHS is undergoing great
change in response to current
healthcare reforms, placing
increased demands on care
delivery (Tinkler et al, 2014). This,
in combination with an increasing
range of compression products with
which to treat patients, means that
clinicians are challenged to look
at their daily practice and make
changes that not only lead to better
care for patients with venous leg
ulcers, but also improve clinical-
effectiveness and result in cost-
savings (Gray, 2013; Knowles, 2014;
Williams, 2014).
Decision-making can be guided
by implementing evidence-based
practice, with the best research
evidence (see
Understanding RCTs
)
JCN supplement
2014,Vol 28, No 6
9