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.
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.
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
About the Author:
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.