Wound Care - Unna Boot

[nuttin2do78]

Need advise please!!!!I'm a LPN working as a treatment nurse. My supervisor is an RN. One of our treatments is to apply a unna boot to a patients legs who has stasis ulcers and a good bit of edema. He also has a small ulcer on the side of foot. He already had order for calcium alginate drsg and then an order was obtained for unna boot. My supervisor has a note on the treatment sheet to wrap wounds with unna boot , put alginate drsg on top of boot to absorb drainage, and cover w rolled gauze. I only have to do this Tx every other week. The last time I had to do it the drsg was wrapped around the foot ulcer , then cut. Then started back rt above ankle to cover wound with the unna boot against the draining wound. When i reapplied i put alginate to wound and applied unna boot from base of toes to just below knee. She told me i was wrong. Opinions Please!

[Isabelle49]

One 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!

[Nittybelle]

Yeah 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