Pre‐procedure

ActionRationale

1. 1.Show
   Explain and discuss the procedure with the patient.
   To ensure that the patient understands the procedure and gives their valid consent (NMC [202], C).
2. 2.Show
   If possible, the patient should be seated in a chair with the limb relaxed and supported on the back of a chair or appropriate limb support. The therapist should be positioned in front of the patient.
   To ensure the comfort of both the patient and therapist. To ensure that the skin and muscles are positioned correctly to avoid inappropriate areas of pressure. E
3. 3.Show
   The swollen limb should be clean and well moisturized with a bland emollient (e.g. E45) before being bandaged.
   To promote skin hygiene and integrity. E

Procedure

1. 4.Show
   Cut a length of tubular stockinette long enough to fit the patient's arm. Cut a small hole for the thumb and slip over the patient's arm.
   To protect the skin from chafing and from any sensitivity caused by the synthetic materials of the padding and foam (Quéré and Sneddon [231], E).
2. 5.Show
   The fingers must be bandaged (Action figure 5a and Figure 27.18a). Using a narrow light retention bandage, anchor the bandage loosely at the wrist and bring it across the back of the hand to the thumb. Bandage around the thumb from the tip downwards (start at the level of the nail bed). Do not pull the bandage tight but go gently and firmly. Take the bandage under the wrist and back over the back of the hand to the index finger (Action figure 5b). Again, bandage from the nail bed down to the webs of the finger. Repeat the same procedure for all fingers. Finish by tucking in the end of the bandage (Action figure 5c and Figure 27.18b).
   To reduce or prevent swelling (Quéré and Sneddon [231], E).
3. 6.Show
   Check the colour and temperature of the tips of the fingers.
   To ensure that the blood supply is not compromised (Quéré and Sneddon [231], E).
4. 7.Show
   Check that the patient can move the fingers and make a fist.
   To check that the bandage is not too tight (Quéré and Sneddon 2010, E).
5. 8.Show
   Flat, ridged or contoured foam can be cut to size and used over stockinette in areas of fibrosis or for additional compression (see Figure 27.18c).
   To produce a massaging effect over fibrotic tissue to soften tissue (Quéré and Sneddon [231], E).
6. 9.Show
   Using the roll of padding, cover the hand in a figure of eight, padding out the palm and back of the hand (Action figure 9 and Figure 27.18d).
   Padding out the hand ensures even pressure distribution and protects the bony areas of the hand (Quéré and Sneddon [231], E).
7. 10.Show
   Continue the padding up to the axilla, doubling it over at the elbow (Action figure 10 and Figure 27.18d).
   Doubling it over at the elbow crease protects the delicate skin at the elbow. E
8. 11.Show
   Take a 6‐cm compression bandage and start by anchoring it loosely at the wrist. Advise the patient to hold their fingers apart while the hand is bandaged and take the bandage across the dorsum of the hand to wrap it twice around the hand close to the base of the fingers. Continue bandaging the hand firmly in a figure of eight until all the hand is covered (see Action figure 11). Continue the rest of the bandage up the forearm in a spiral, covering half of the bandage with each turn. Keep the bandage as smooth as possible (Figures 27.18e and f).
   The bandage width must relate to the circumference of the limb with the narrowest bandage used on the smallest circumference (Quéré and Sneddon [231], E).
9. 12.Show
   Take an 8‐ or 10‐cm bandage and, starting at the wrist, bandage in a spiral, still covering half of the bandage with each turn, up to the top of the arm (Action figure 12 and Figure 27.18g).
   Two layers are used on the forearm to ensure that pressure is highest distally (Quéré and Sneddon [231], E).
10. 13.Show
    A top layer of bandages can be applied in a spiral.
    Applying a top layer can even out and maintain optimal pressure. E
11. 14.Show
    Secure the end of the bandage with tape.
    Tape is used instead of fastening clips due to risk of injury. E

Post‐procedure

1. 15.Show
   Once again, check the colour and sensations of the finger tips and check that the patient can move all joints.
   To check that the blood flow is not compromised (Quéré and Sneddon [231], E).
2. 16.Show
   Remind the patient to use the limb as normally as possible, to exercise as advised and to remove the bandages if any pain, tingling or numbness is experienced.
   To ensure good lymph flow and to prevent complications developing. E
3. 17.Show
   Record the details of the procedure followed in the patient's relevant documentation.
   To maintain accurate records and provide a point of reference for subsequent treatment (NMC [202], C).