Compression bandaging for chronic oedema: applying science to reality.

Among other risk factors, chronic venous insufficiency predisposes an individual to chronic oedema. The use of compression bandaging in the intensive phase of treatment is indicated to reduce distortion, lymphorrhoea, and achieve wound healing. When applying a compression bandage, it is essential that the clinician considers the laws that underpin the theory of compression. Owing to the physical properties of the bandages, the use of inelastic compression is favoured for the management of chronic oedema, in view of the high static stiffness index achieved on application. It is essential that the bandaging regime is individualised to meet the specific needs of the patient. This includes the frequency of bandage change, while considering the extent of oedema reduction and holistic needs of the patient.

Using specialist bandage techniques to improve outcomes.

Chronic oedema is a condition that can become more complex to manage if allowed to progress. With the risk of chronic oedema increasing with age, complex presentations may become more commonplace as projections indicate an ageing population. A full holistic assessment is vital, taking into account venous, lymphatic and arterial elements of a vascular assessment, in order to determine the underlying disease process. Competency-based techniques for the application for below-knee and thigh-length application of inelastic cohesive compression exist and support clinicians in the successful management of chronic oedema. In cases of severe or complex chronic oedema, the specialist clinician can adopt strategies to adapt standard application to achieve volume reduction, shape, and tissue improvement.

Developing a nurse-led integrated 'red legs' service.

This project was developed to set up a nurse-led service based on the needs of patients diagnosed with 'red legs'. These patients are often wrongly admitted into hospital for treatment of cellulitis. Representatives from the specialties involved in caring for those individuals with red legs were invited to participate with patients to create a stakeholder group whose purpose was to develop integrated care pathways focused on referral criteria, diagnostics and treatment to inform a new nurse-led service. There was a commitment to utilising a number of facilitation techniques and practice-development methods in the progression of the project with the support of the Foundation of Nursing Studies. Much of the prescribed care can be carried out by the patients at home and only 25% patients have required a follow-up appointment within the new service. The service has now been fully commissioned and a secondment opportunity has been developed to lead the new service. Significant savings have been demonstrated and regular revision of the integrated care pathways with all groups, including the patients, will take place.

Chronic oedema: impact and management.

Chronic oedema of all causes is thought to be more prevalent than studies have shown. The impact of this chronic condition encompasses many physical, psychological and social domains, many of which are not acknowledged nor addressed. Successful management relies on three factors. The first is early detection and commencement of treatment to prevent complications occurring. The second is an holistic multidimensional approach to address all the associated physical, psychological and social sequellae. Finally, collaboration between specialist and generalist health professionals is essential to ensure the best treatment is delivered in the best healthcare location. To achieve these there needs to be a network of suitably qualified practitioners who are upskilled by robust awareness and education systems, all of which should be supported by stable financial and human resources.

Care for the patient with burns in the trauma rehabilitation setting.

Caring for patients who are recovering from severe burns is not common in most rehabilitation settings. Nursing challenges include patients' physical and psychological changes and their high care demands. Harborview Medical Center, a regional level 1 burn and trauma center in Seattle, Washington, accepted these nursing challenges and developed a successful plan of care consistent with current evidence. This article describes Harborview Medical Center's trauma rehabilitation nursing experiences while caring for patients with burns. Our experiences may assist other rehabilitation units that serve patients with burns. Says one burn survivor: "Nurses make a huge difference in recovery, as they are there 24 hours a day. It is their touch, their caring, and their listening that aid the patient in his journey from fire victim to burn survivor."

Single-blind trial addressing the differential effects of two reflexology techniques versus rest, on ankle and foot oedema in late pregnancy.

This single-blind randomised controlled trial explored the differential effects of two different foot reflexology techniques with a period of rest on oedema-relieving effects and symptom relief in healthy pregnant women with foot oedema. Fifty-five women in the third trimester were randomly assigned to one of the three groups: a period of rest, 'relaxing' reflexology techniques or a specific 'lymphatic' reflexology technique for 15 min with pre- and post-therapy ankle and foot circumference measurements and participant questionnaire. There was no statistically significant difference in the circumference measurements between the three groups; however, the lymphatic technique reflexology group mean circumference measurements were all decreased. A significant reduction in the women's symptom mean measurements in all groups (p<0.0001) was apparent. A 'perceived wellbeing' score revealed the lymphatic technique group (p<0.0001) significantly increased their wellbeing the most, followed closely by relaxing techniques (p<0.001) and then the control rest group (p<0.03). Lymphatic reflexology techniques, relaxing reflexology techniques and a period of rest had a non-significant oedema-relieving effect. From the women's viewpoint, lymphatic reflexology was the preferred therapy with significant increase in symptom relief.