Chapter 27: Living with and beyond cancer
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Adjustable wrap compression systems
Definition
Adjustable wrap compression systems (also referred to as Velcro wraps) are generally made from short‐stretch or inelastic, flexible felt‐like fabric which wraps around the limb and is secured with multiple overlapping Velcro straps (Noble‐Jones [209]). Adjustable wrap compression systems are designed to be easier to apply than standard compression bandages and to be adjustable by a clinician, patient or carer.
Evidence‐based approaches
Rationale
Adjustable wrap compression systems are used as an alternative to compression bandaging to reduce swelling during the initial treatment phase or worn daily for long‐term management (Noble‐Jones [209]). Adjustable wrap compression systems can be used on their own or in addition to compression garments where swelling is not being adequately managed with compression garments alone (Mullings [180], Noble‐Jones [209]). A range of garments is available on drug tariff including hand wraps, arm wraps, ankle–foot wraps, and lower leg, knee and thigh pieces (see Figures 27.22 and 27.23). The adjustable wrap compression systems are reusable and should be replaced after 6 months of daily wear. They are supplied with a liner to be worn under the wrap system. Choice of the most suitable adjustable wrap compression system should be decided after a detailed assessment of the patient (Linnitt [146]).
Figure 27.22 Adjustable wrap compression system for the lower leg.
Figure 27.23 Adjustable wrap compression system for the arm.
Adjustable wrap compression systems are useful for patients who are unable to apply and remove a compression garment due to limited dexterity and mobility. They are also useful for patients in the palliative stages of disease or those who have fragile skin that may be damaged during the application and removal of a compression garment (Wigg [284]). The patient or carer can adjust these systems without removing the device in response to changing swelling and to ensure sustained compression (Linitt 2015, Mullings [180]).
Indications
- Reduction in swelling in intensive phase of treatment (Damstra and Partsch [65]).
- Maintenance of limb shape and size in patients unable to apply and remove compression garments (Partsch and Mortimer [220]).
- To control swelling and provide support to patients with fragile skin who would not tolerate the application of a compression garment (Partsch and Mortimer [220]).
- Useful in distorted limbs as the wrap system can be wrapped and readjusted to the limb shape. Made to measure wraps are also available (Linitt 2015, Mullings [180]).
- Useful in patients unable to travel to the clinic daily for multilayer bandaging.
- Useful for patients with reduced mobility as the adjustable wrap system is lightweight and less bulky than multilayer bandages (Linnitt [146], Mullings [180]).
Contraindications (similar to multilayer short‐stretch bandaging)
- Acute cellulitis. The skin may be too tender to tolerate compression.
- Severe peripheral neuropathy. The patient will not be able to feel if the wrap system is causing damage to the skin.
- Allergy to compression materials.
- Arterial disease. Tissue ischaemia can occur.
- Infection in the swollen limb. Pain may occur.
- Uncontrolled cardiac failure. Fluid overload can occur.
- Deep vein thrombosis. Anticoagulation therapy should be commenced prior to the use of any compression.
- Physical or psychological limitations of the patient to comply safely with treatment. For example, lack of manual dexterity or cognitive impairment (Todd [272]).
Legal and professional issues
Pre‐procedural considerations
Several factors need to be taken into consideration before deciding to fit a patient with an adjustable wrap compression system. The patient should be motivated and compliant with the use of garments and have the physical skills to apply and remove the garment safely. A full physical assessment of the patient will determine the condition of the skin and tissues and the shape and size of the limb so that a style and size of garment suitable for the patient can be selected. Patients should be involved where possible in the choice of adjustable wrap compression system. Some have a choice of colour and fabric which will assist with acceptability to the patient and aid concordance (Gray [117]).
Equipment
The aim of an adjustable compression wrap system is to achieve a tolerable resting pressure and a pressure sufficient to counteract gravity when standing (Partsch and Mortimer [220]). This is best achieved by using stiff compression products which result in high pressure when needed in the upright position. The pressure can be sustained over long periods of time during both activity and inactivity of the limb, providing a high working pressure while the muscle is active and a high resting pressure during inactivity of the muscle at rest (Todd [271]). Adjustable wrap compression systems are designed to be easy to use and apply (Wigg [284]). All of them come with the manufacturer's instructions, often with on‐line support and training. These adjustable wrap compression systems support patient self‐management in controlling lymphoedema (Noble‐Jones [209]).
The use of adjustable compression wrap systems (Todd [271]):
- increases interstitial tissue pressure and reduces production of lymph
- promotes lymph movement along superficial and deep lymphatics
- increases lymph reabsorption
- provides an external counterforce during activity which enhances muscle pump action.
Construction
Garments are manufactured from synthetic fibres and are readily available in a variety of sizes and lengths ‘off the shelf’ to accommodate the needs of most patients. Some manufacturers offer a range of inelastic materials, from softer ‘lite’ wrap systems to firmer, stiffer compression wrap systems. The pressure under these adjustable wrap compression systems will be higher while the muscle is active. Made to measure adjustable wrap compression systems are also available. These can be adjusted during manufacture to suit patients’ specific needs, and the provision of accurate measurements before manufacture ensures a good fit. Some adjustable wrap compression systems can also be trimmed for optimal fit.
Compression class
It is important to follow the manufacturer's instructions for using the adjustable wrap compression system to achieve correct compression over the correct circumference of the limb (Wigg [284]). Laplace's law dictates that the highest compression provided by a garment when fitted can be found at the wrist or the ankle. The compression is then graduated along the length of the limb to encourage movement of the fluid out of the limb (Wigg [284]).
Style
All areas influenced by swelling must be contained within the adjustable compression wrap system or further swelling will develop. The patient should be instructed concerning the application, removal and care of the adjustable wrap compression system to ensure that maximum effectiveness is achieved through its use. The patient's physical ability must be considered when choosing an adjustable wrap compression system as some degree of dexterity will be required during its application and removal (Wigg [284]).
Size
The manufacturer's guidance for choosing the correct size is based on simple limb measurements.
Procedure guideline 27.16
Adjustable wrap compression system: application to the lower leg
Procedure guideline 27.17
Adjustable wrap compression system: application to the arm
| Problem | Cause | Prevention | Action |
| Wrinkling of the adjustable compression wrap along the length of the limb. | Poor application and positioning of the garment. | Supply written instructions with diagrams/pictures showing the application and removal of the garment. | Demonstrate application and removal of the compression wrap and observe the patient's technique; the patient may need assistance from a carer, especially for an arm wrap. |
| Change of sensation in the limb during wear of the compression wrap. | Compression wrap straps applied too tight/incorrect size. | Ensure the correct measurements are taken to guide the therapist in the selection of the correctly sized wrap. | Assess for other possible reasons for a change in sensation, e.g. musculoskeletal or circulatory impairment. Reduce stretch of straps during application to reduce compression.
Review the size of the wrap and consider alternative garments. |
| Poor compliance with the use of the compression wrap. | Limited information given to patient about the importance of wearing the compression wrap. Lifestyle commitments. | Ensure the patient is given sufficient information to become compliant with treatment. | Explore the problems the patient is experiencing. Explain the purpose of the compression wrap thoroughly and the intended benefits. |
| Swelling extending beyond the edge of the compression wrap: fingers or toes, upper thigh or upper arm. | Inappropriate style of garment for the patient's needs. | Thorough assessment to establish the history and extent of swelling. | If fingers or toes are swollen, use a compression garment. If the upper thigh or upper arm is swollen, the garment must extend into the adjacent truncal quadrant. |
Post‐procedural considerations
Immediate care
Evaluate the overall fit of the compression wrap system. There should be an even pressure throughout the compression wrap, with no areas of loose‐fitting material. The compression wrap should be comfortable so that the patient can use their limb.
Ongoing care
The shape and size of the limb may change due to an increase or decrease in swelling. Compression wrap systems should be checked regularly to ensure they remain appropriate in size, style and fit.
Education of patient and relevant others
- Ensure the patient knows for how long the adjustable wrap compression system should be worn each day. As each patient is different, the therapist should advise appropriately. Adjustable wrap compression systems used to maintain swelling reduction are generally worn during waking hours and removed at night. If the adjustable wrap compression system is being used as an alternative to multilayer bandaging, it should remain in place day and night (Wigg [284]).
- Advise the patient on the care of the garment. Instructions vary so care instructions should be followed. The adjustable wrap compression system should be worn over a liner or compression garment and should not need daily washing. Most adjustable wrap compression systems can be machine washed, but some thicker, stiffer wraps need to be hand washed; all should be air dried flat.
- Advise the patient about how to acquire replacement or additional garments. Many garments are available on drug tariff from the patient's doctor. It is advisable to replace adjustable wrap compression systems after 6 months of daily wear.
Websites
British Lymphology Society: www.thebls.com
Lymphoedema Support Network: www.lymphoedema.org/lsn
International Lymphoedema Framework: www.lympho.org
Australasian Lymphology Association: www.lymphoedema.org.au
Lymphedema People: www.lymphedemapeople.com
National Lymphedema Network: www.lymphnet.org
Free online product information and training can be sourced from individual companies:
