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- Sep 12, '11 by NittybelleIf you are doing it to prevent further breakdown why not? As long as you are not using it where the breakdown is. I have some pretty big patients and with them i try to keep themunna boot two finger widths below the patella. The compression at the top of the calf isn't supposed to be as tight anyway. The goal is to compress from the bottom up while wrapping with the unna boot. If it provides comfort to the patient without defeating the purpose of the boot, why not?
- Sep 12, '11 by KSA RNWell, my thought process was, as the unna boot is wrapped, it rolls into a tight rope in the VERY deep skin folds below the patella and at the ankle. Not only does the wrap not stay up, it rolls into a tourniquet-neither option good. Thanks for your thoughts.
- Sep 12, '11 by NittybelleSo are you going to put gauze over the folds, wrap with unna boot than secure with coban? Maybe it won't roll as much. Sounds like you are well on your way to figuring this out.
- Sep 13, '11 by KSA RNActually , I'm padding with 1-2 layers of soft roll. These skin folds literally engulf my entire forearm when i reach around her leg to wash it.
- Sep 13, '11 by Isabelle49One of the patients I picked up in home health not long ago had unna boots to BLE for months with VS ulcers to both legs. Skin to BLE was red, bumpy with scattered gray areas. The MD was called, unna boots stopped, since edema was less than +1. Wounds were covered with a silver dressing. Within one week there was significant improvement in the skin and the wounds. Since then, a sequential compression device for home use as been initiated and the patient is doing quite well. Skin to both legs is in very good condition.
Coban: I refuse to apply coban to the extremity of any patient to secure a dressing. Once wrapped this dressing becomes rigid, if there is extensive swelling circulation will be impaired. Had a patient once whose MD applied unna boot with coban outer dressing. She called me on a Saturday to say her leg was painful. I went to see her and removed the dressing, her leg was blackened from knee to almost ankle, actually looked mummified! I called MD and told him, said I was going to leave the boot off and he told me that I would be doing so under my license and that anything that might happen to the patient would be my responsibility. The patient did quite well. I will not use coban!
- Sep 13, '11 by NittybelleYeah you are quite right, it is important to pull a length from the roll and lay the coban lightly while wrapping. If you have to use coban, be careful. Good point