Ace wraps for edema in foot/leg

  1. I have a question regarding ace wraps for edema in legs/feet.

    I have a resident that has severe edema in both LE for as long as I've been employed at my facility (approx. 1 year). I believe she's had the edema to this extreme even before I became employed there. Her Dr. has ordered Ace wraps to her legs throughout the day, removed at night while she's sleeping. The whole time I've been employed there, we have "spiral" wrapped her legs, beginning right above the toes and working our way to just below the knee. By mid afternoon, her legs begin to have the "mushroom" top ().

    The other day, a nurse who has had a lot of experience in a cardiac unit informed me that she had always been trained to "figure 8" wrap LE, it is better for circulation. I did this for her the following morning to see if it would help reduce the edema; but I'm not sure if it had made any difference. The morning after that I went in to wrap her legs and they appeared as ballooned as they would normally appear. I wrapped them in "figure 8" again though, because I do believe this nurse would know more about circulation from her past experience.

    I'm curious, does anyone know if there are certain ways to wrap the LE to alleviate edema? Are there any other techniques I could do for her to try to get her legs in a somewhat normal state (besides raising the foot of the bed when in bed, using pillows to prop them up, etc). Her legs get so edema filled then when I wake her in the AM to put her wraps on, she has wrinkles in her ankles/calf areas from the pillows she uses to prop her legs and the fluid returning. I feel for her!!
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    About yooperPN

    Joined: Dec '09; Posts: 63; Likes: 52
    from US
    Specialty: 1 year(s) of experience in LTC


  3. by   mazy
    I usually do a figure eight, it's just the way I learned to do it. It provides much better support than a spiral, without having to wrap as tightly, and the wraps don't slip around and get undone as easily. If your resident is getting a mushroom top it could be that the ace wraps are too tight.

    Also, it could be that the doc needs to take another look at her meds, doesn't sound like the current regimen is working too well.
  4. by   morte
    by figure 8 i am presuming you are leaving the heel open......not good.....if she is getting the mushroom effect, she either needs wraps up the thigh and/or med changes,, or leaving the wraps on 24/7 for a few days...... If this of long standing, it probably will never go away, only contoled to some extent.
  5. by   yooperPN
    Thank you for your responses! I do ask her when I put the spiral wraps on if it's too tight, she wiggles her feet and says "no". I'm not sure if this sounds right, but I think there is just so much fluid in her LE that when there is something preventing the fluid from going there, it just gets the mushroom top. I don't know how the figure 8 looks during the day though, it could be doing the same thing.

    She did, at one time, have the legs wrapped 24/7. I think the Dr. changed the order though because it was uncomfortable for her to have them on all the time. And she's always said to not wrap her heels (she's very with it and very in control of her care, if you know what I mean).
  6. by   tyvin
    The graded compression that is attempted per the figure eight wrap doesn't keep it's strength during the day; that's what I've read. I've read that the ace are outdated in many places and fitted teds stockings are better for the condition. Why doesn't this person have teds or another compression grade stocking?

    How's her meds ... perhaps a review.

    Then of course you know that whether it's teds or wraps the stocking or wrap needs to be initiated before the person gets out of bed in the am. It has always floored me to see nurses or aids putting on the teds/wraps when the person is sitting up in a chair after getting out of bed.
  7. by   VivaLasViejas
    Quote from tyvin

    Then of course you know that whether it's teds or wraps the stocking or wrap needs to be initiated before the person gets out of bed in the am. It has always floored me to see nurses or aids putting on the teds/wraps when the person is sitting up in a chair after getting out of bed.
    Yeah.....that's like locking the barn door after the horse gets out. I wish I could get my staff to understand that too.
  8. by   Momto2boys2011
    For our residents that have the "mushroom" effect with ace wraps (which we don't really use anymore) or tedhose, we try tubigrips. Different options work different for different people of course, but this is another option.
  9. by   Tammy,LPN
    I just watched a webinar on LE edema by Jeri Lundgren ( She trained the state surveyors on what to look for) Any way, she says Ace wraps are not good for edema. If you can get the doctor to change the order, Unna boots are the best for reducing edema as well as elevation (depending on the underlying cause of the edema). Unna boots are spiral wrapped with 50% overlap and they are rated for compression. After the edema is under control, then compression stockings should be used to maintain. Why does she have so much edema? Has she been diagnosed with CHF? Does she have venous insufficiency? There a lot of meds that cause fluid retention.
  10. by   yooperPN
    Thank you all for your replies. I'm not sure why the Dr. has ordered ace wraps, but she does also have TED hose. We have another resident (with not nearly as much edema) that uses ted hose daily, but every now and then the doctor will switch the order to ace wraps.

    **I'm in a rural community so it may also be that the Dr. is just not aware of new and improved things out there**

    She does receive lasix, and I believe it could be a dose of 80mg/daily. I don't believe she has CHF, I believe it's venous insufficiency. I'm a float nurse, so I don't see her daily. I'm working that floor tonight so I'll take a look at her diagnoses.

    As far as when we put the wraps on, absolutely in bed! I go in there between 5:15 am and 5:30 am so she hasn't started her day yet and put them on. I wont even put them on when she's on the commode, I want her in bed with her feet up. (It's also easier on my back )

    I'll talk to the RCC about the Unna boots, that sounds like a good idea to at least try for her. I can't explain what exactly her feet/legs look like... but the best description I could think of is 3-4+pitting edema up to her knees. And, in the AM before I put her wraps on she truly has deep wrinkles from the pillows she uses under her legs and between her legs (she's a side sleeper) from all the fluid going back to her mid-section (or wherever fluid goes). Her feet usually stay the same with the edema though
  11. by   aposRN
    where I work we do consultations with an APRN who is a lymphadema specialist. She recommends the figure 8 wrap. She likes to wrap from toe to knee and use a mesh edema wear from knee to groin for a week or so and then continue with the teds/ or juzos
  12. by   TF. LPN
    Ask the doctor to increase lasix and also in a boots are effective for 8 hours and needs to be re applied they can stay on for up to 7 days, just learned of that at a wound confrence. Wild on wounds. There are different kinds of unna boots out there.Also unna boots should be used in ambulatory patient the calf muscle pump is working when your ambulatory and active and has about 20-30 mmHg of compression,im effective for wc and bed ridden patients. Ted hose should be used in bed. Teds are for Beds, dvt immobile patient's and comoression stockings are for ambulatory patient's . Comoression stockings range from 15 to 60 mmHg of pressure requiring a prescription for anything above 20mmhg. Comoression and Ted hose are different and used for different types of compression.