Compression Bandages During an Infection

[patoco]

Compression Bandages During an Infection

The Use OF Compression Therapy During Infections
by Renee Romero

Conflicting opinions exist on the use of compression during an episode of cellulitis/infections. Compression is advocated, but when to apply it during an infection has not been clarified.

To review:
In chronic lymphedema there are cellular and biochemical changes, which include decreased phagocytic activity of the leukocytes, (meaning the white blood cells which fight infection are not as effective as in a person without lymphedema). The lymph, which stagnates in the affected limb, provides an excellent culture medium and infections such as cellulitis and lymphangitis can flourish.

Any infection worsens the edema by increasing the local blood flow and capillary permeability, allowing more fluid into the interstitial tissues, which the impaired lymph system cannot remove. The white blood cells (leukocytes) and other cells (macrophages) cannot effectively remove the bacteria and an infection can develop and spread throughout the body quickly. Appropriate measures should be taken immediately at the first sign of infection: redness, localized heat, swelling and possibly red streaks up the limb. If the infection becomes generalized (systemic) there may be fever and chills as well. Advise your patients to discuss the use of antibiotics, both oral and topical, with their physicians.

The literature regarding infections emphasizes the need to intervene quickly; however, there are no clear statements about when to use compression. Dr Olszewski in his article ''Makeup of Lymphedema and Tissue Structure Changes,'' NLN newsletter, April 1994 speaks about the use of ''compression of various types to lessen the fluid.after infection'' but does not recommend when or what form of compression to used.

Casley-Smith in the chapter entitled Skin Changes and Infections in Lymphedema states, ''the best way to handle the attack is to have antibiotics on hand to take as soon as possible.'' It is now advocated, though not published in the texts, that compression can be applied after a localized infection has been treated for 24-48 hours. This includes short stretch bandages and compression devices such as the Reid Sleeve®, CircAid®, etc.

Even after 24-48 hours on antibiotics, the limb may be more edematous than before the infection. A compression sleeve or stocking may be uncomfortable, whereas bandages are more supportive and allow the flexibility of the tension to be adjusted to the size of the limb. Check that the patient's bandages are no more than six months old, the suggested product life recommended by the manufacturer to ensure proper compression.

Bandages can remain on throughout the day and night as long as they are comfortable. If the skin is sensitive, apply soft cotton padding under the short stretch bandages. Two-way stretch bandages such as KompriMed can be applied on the limb without extra padding and is usually well tolerated by sensitive, tender skin. Wrap the fingers/toes if they are swollen. Bandages should feel firm, though not tight. Re-adjust during the day, if necessary. Review the bandaging technique with your patient, especially if you have not seen them for a while or they have not bandaged in a long time. Wash the bandages daily in mild detergent if there is leakage of lymph fluid through the skin. Patients should have two sets of bandages, one to wash and one to wear.

It cannot be over-emphasized that the goal for all who have an impaired lymph system should be to circumvent an infection through diligent care of the skin and prevention of breaks in the skin.

References:
Brennan, M: Lymphedema following the surgical treatment of breast cancer: A review of pathophysiology and treatment. J. Pain Symptom Mange 7:110-116, 1992

Casley-Smith, JR: Modern Treatment for Lymphedema (ed 5) Adelaide, Australia, 1997 pp 128

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About the Author:
Renee Romero
Renee Romero received her Bachelor's Degree in nursing from the University of Florida and later, a Masters Degree in Adult Education from Florida International University.

She is a licensed massage therapist in the State of Florida and a LANA Certified Manual Lymph Drainage Therapist. She received her training from the Vodder School Austria in 1992 and in 1999 attended the month long program at the Foldi Klinic in Germany, receiving her Foldi certification as well.

Mrs. Romero is the Director of the Lymphedema Institute of America and has an active practice treating patients with lymphedema and other edematous conditions. She is a consultant for Bandages Plus, a company that specializes in supplies and products for compression therapy.

Mrs. Romero teaches Advanced Bandaging classes, Wound Care and Compression Classes for the Lymphedema Institute and lectures throughout the US about lymphedema and the application of bandaging products and has published articles about lymphedema in several professional journals.

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Lymphedema People

http://www.lymphedemapeople.com

[coyote]

Hi Pat,

My LE therapist seems to think it is okay to use compression after 3 days on antibiotics.

Personally, I wear wraps on the lower legs all of the time 24/7 , 365 days out of the year, so I have refused to NOT be compressed during infections. But, I don't sit there with my leg throbbing because it has swollen since I wrapped last, I rewrap as often as necessary to accomodate the swelling. I just wrap to maintain my legs to some semblance of what they normally are...and not to get reduction of the limb size during an infection. As a precaution, I do put myself on bedrest for at least 3 days when I have an infection. After an infection, my limbs have noticeable swelling even with this technique, but it is no where near as bad as what it would be if I had gone unwrapped.

On a good day, if I don't wrap, without an infection, my legs swell to nearly twice their size in one day, with elevation. Which then tears my non-healing leg wound into a deep gash that takes soooooooo long to improve. So, I am motivated to go against the grain on this and take some risks. I shudder to think of the pain and swelling I would have today if I didn't handle my particular case this way!

I have never been put in a hospital for my chronic infections, btw. Though, if doctors around here understood LE better, I'm sure I would have been, early on at least. Even with the pleural effussions, I have never been hospitalized.

[Queenie EJC]

I like what you say about maintaining compression during a bout of cellulitis, provided the skin is not too sensitive to wear them. Like you, my leg would swell terribly without them. I agree too that rest and elevation during cellulitis is key, at least for the first three days of antibiotic therapy.

[Charlotte]

I am new here and from South-Africa,after my Modified Radical Mastectomy in 2009 i suffer from time to time with arm Lymphedema,in both arms lymphnodes removed 17 in left and 19 in the right arm,from all this cancer treatment lymphedema is the worst,not only the swelling but the pain is sometimes terrible.Yes the doctors here dont know how to treat this and my phisotherapist only believe in kinesio plaster and you know what it does not help maybe for the rugby guys but not for my lymphedema.

My right arm is the problem over two months now it is still swelling and burning pain sensation if i wear my arm stocking it makes it worst!so when the pain is to mutch i use crape bandages i dont do my exercise while my arm is swelling.

And one big problem!!My gp all ways take my bp on my arms does not help to ask them to take it on my legs.after they done this my arm pain and the next day it is full of big red spots.I will see my oncology doc next month and ask him to gave me a letter that they must not took my bp on my arms it makes me sick after diagnosed with cellulitis last month in my arm why is it still swelling after 5day antibiotic tabs i`m concern about this never before it took so long to heel.Some info please can cellulitis give you eye infection?

[Charlotte]

Thanks for the reply,i used crape bandages it helps for the pain the swelling still bad and the red spots smaller see my oncology doc next week on Tuesday,here where i stay could not find the right Compression bandages

[patoco]

Hi Charlotte

I haven't heard of anyone using crape bandages before. Do they have the same elasticity of an ace bandage?

Pat

[Charlotte]

Hi pat i don`t know!All what i can get here was crepe bandage.seeing my oncology doc Tuesday and will ask him where i can get hold of compression bandages.
The crepe bandages did help,my swelling is down and the pain better.All what i experience was while my arm is swelling i cannot use my arm sock it makes it worst.

You know before Christmas i was diagnosed with pink eyes and my one arm start swelling so my GP put me on antibiotics after finish this my second eye start with the same symptom and my arm start again with the same diagnoses second time was worst swelling pain red spots and under my skin of my arm some lumps i phoned my oncology doc and send a photo of my arm he put me on stronger antibiotics the arm is still swelling on the elbow and wrist side but not so bad as before.

I did not knew this will make me sick flue symptoms,nausea and vomit and my swallowing was also affected.

[patoco]

Hi Charlotte

Sorry you have been having such a tough time ...prayers for a soeedy recovery.

I can usually tell when an infection is setting in. I get this all over terrible ache - kinda like the flu, I'm totally listless and feel blah all over.

The infection and the antibiotics can both make you nauseated.

If you can try eating lots of yogurt while taking the antibiotic. It replaces the good bacteria that the antibiotic kills.

best to you

Pat

[Charlotte]

Hello Pat,Did get me a trained Lymphedema Theraspist after my hand start swelling with edeem and edeem in my elbow,Oh My!i was realy scare!The bumps on my forearm is fluid that have blocked there.
I am scedule for 20 sessions massage and a new path for the fluid to drain.We did not start with the treatment yet,waiting for the compression bandages.
The begining of March my Tumor marker rise from 9 to 57
Months back i download so i start with the breakfast cottege cheese and Flaxseed oil,boiling water with lemon and green tea that i have mixed with organic rooibos tea.
2weaks back we done the blood test again,u wont beleive this but it drop from 57 to 10 and it allways was 9 from day one,from last week i could wear a arm sleeve,the swelling is down and no more edeem,this bump on my forearm is flat,i am still on the BudWig breakfast.
I have phoned my oncology doc with this excited news,i can see my veins! and feel my puls!
This diet did something and i want to share it with all of you!Hugs Charlotte.

[Charlotte]

Hi Pat,Oh my!I am still struggle to get hold of the compression bandages,stockinette,and the foam to do the proper wrapping!Well in the meantime i did purchase a jovi upper night time sleeve,with this sleeve i wrap compression bandage over it for about three hours,what i am concern about this wrapping my hand feels dead dont wrap it to tight.Do you know where in South-Africa can i purchase a flexitouch system?

[patoco]

No, I sure don't.

You can write the company here in the US and they can probably let you know of any distributors down there.

Pat