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, position the patient seated upright on a bed or couch and raise the height to a comfortable level.
   To ensure the comfort of both the patient and nurse. E

Procedure

1. 3.Show
   Apply a liner to the leg, or apply the patient's compression garment if the adjustable wrap compression system is being used as adjunct to a compression garment.
   To protect the skin. E
2. 4.Show
   Unfasten all of the straps of the adjustable wrap compression system and fold back each strap securing the Velcro pads.
   To ensure the wrap is open and flat and to ensure Velcro pads do not stick and tangle, making application difficult. E
3. 5.Show
   Position the adjustable wrap compression system under the lower leg with the position of the top of the wrap below the knee crease and base of the wrap above the ankle.
   To ensure correct fitting and that the wrap is not rubbing behind the knee or at the ankle. E
4. 6.Show
   Follow the manufacturer's instructions for securing the Velcro straps until all of the straps are securely fastened.
   To ensure that the wrap is applied securely and that straps overlock without gaps.

   To ensure the correct compression is applied and is even (Wigg [284], E).
5. 7.Show
   Check compression as per manufacturer's instructions; some recommend inserting your index, middle and ring fingers between the straps. If fingers do not fit comfortably the wrap may be too tight.
   To check correct compression is being applied and to reduce the risk of applying too much compression. E
6. 8.Show
   Once the adjustable wrap compression system is in place, check that there are no creases or wrinkles, particularly around the joints.
   Wrinkles cause chafing of the skin and constricting bands of pressure. E

Post‐procedure

1. 9.Show
   Check that the patient finds the adjustable wrap compression system comfortable and that they are not experiencing any feelings of pain, tingling or numbness. Check the toes for any visible signs of altered circulation.
   Pain, tingling or numbness indicates that the adjustable wrap compression system has been inappropriately applied or fitted. E
2. 10.Show
   To remove the adjustable wrap compression system, unfasten each Velcro strap, folding back and fastening it on itself.
   To prevent the wrap sticking to itself or becoming tangled, so that the wrap is ready for future application. E
3. 11.Show
   Inspect the skin; a mild indent where the straps have been is normal.
   To ensure skin is not reddened and ensure compression is not too tight; the patient may need a thicker liner if their skin is fragile. E
4. 12.Show
   Document the manufacturer and style and size of the adjustable wrap compression system that the patient has been provided with.
   To maintain accurate records (NMC [202], C).

   To ensure continuity of care when subsequent garments are required. E