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 upright on a bed or treatment couch. Raise the bed or couch to a comfortable height.
   To ensure the comfort of both the patient and nurse. 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 (Cooper [52], E).

Procedure

1. 4.Show
   Cut a length of tubular stockinette long enough to fit the patient's leg. Slip over the leg.
   To protect the skin from chafing (Quéré and Sneddon [231], E).
2. 5.Show
   If the toes are swollen or tend to swell, they must be bandaged. The little toe can be omitted. Using a narrow light retention bandage, anchor the bandage around the foot and bring across the top of the foot to the big toe (Action figure 5a and Figure 27.19a). Bandage around the toe from the tip downwards (start at the level of the nail bed). Do not pull the bandage tight, but proceed gently and firmly. Take the bandage under the foot and back over the top of the foot to the next toe (Action figure 5b). Repeat the same procedure for each toe that needs to be bandaged. Finish by tucking in the end of the bandage (Action figure 5c).
   To reduce or prevent swelling (Quéré and Sneddon [231]).

   To prevent friction to and around the little toe. E
3. 6.Show
   Foam pads can be cut to size and placed over the dorsum of the foot, around the ankle and behind the knee (Action figures 6a, 6b).
   To protect bony prominences and joint flexures (Quéré and Sneddon [231], E).
4. 7.Show
   Secure the pads firmly in place with light retention bandages.
    
5. 8.Show
   Using padding, even out any exaggerated contours of the limb. Corrugated or contoured foam can be used over areas of fibrotic tissue.
   To create a smooth profile on which to apply the bandages. To apply additional compression or to treat fibrotic areas (Cooper [52], E).
6. 9.Show
   Using a 10‐cm roll of padding, apply firmly in a spiral up the leg, starting around the foot. Use the 20‐cm padding over the thigh (Action figure 9 and Figures 27.19b and c).
   To protect the skin and create a smooth profile on which to bandage (Quéré and Sneddon [231]).
7. 10.Show
   Advise the patient to hold their foot at a 90° angle while it is bandaged. Use 8‐cm compression bandage and begin by anchoring it with a double layer wrapped around the foot close to the base of toes (Action figure 10, Figures 27.19d and e). Continue bandaging the foot firmly, forming a figure of eight to cover the heel and ankle without leaving any gaps. Any surplus bandage should be taken up the leg in a spiral.
   To avoid constriction at the ankle. Fluid will accumulate in any unbandaged areas (Quéré and Sneddon [231], E).
8. 11.Show
   Using a 10‐cm bandage, continue from where the first bandage finished, using a spiral up the leg and covering half of the bandage with each turn (50% overlap). Remember to bandage firmly. Use the widest bandage over the thigh. Secure the end of the last bandage with tape (Figure 27.19f).
   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
   Apply a second layer of bandage, from ankle to thigh, using a spiral or figure of eight. Secure the end with tape (Action figure 12, Figures 27.19g and h).
   To keep the bandages in place and provide additional pressure along the length of the leg (Quéré and Sneddon [231], E).

Post‐procedure

1. 13.Show
   Check the colour and temperature of the patient's toes. It may be difficult for the patient to flex the knee at first but this should get easier as the bandages loosen slightly.
   To check that the blood flow is not compromised (Quéré and Sneddon [231], E).
2. 14.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 (Quéré and Sneddon [231], E).
3. 15.Show
   Record the details of the procedure in the relevant patient documentation.
   To maintain accurate records and provide a point of reference for subsequent treatment (NMC [202], C).