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!

[TheCommuter, BSN, RN]

Moving to the Wound/Ostomy/Continence forum.

[sharlynn]

The Unna boot is a treatment in itself for stasis ulcers. I see no point in doing both. To put the alginate dressing on top of the Unna boot would be inneffective anyway. I would check with the doctor to clarify the order. your supervisor is wrong IMO.

[annaedRN, RN]

I agree with sharlynn - I have sometimes used a dressing on the wound and then used unna boots, but usually it is just the unna boots. Putting the alginate on top of the unna boots is a little silly to me - if it is just to collect drainage then it is an expensive way to do so - you can use an extra roll of Kerlix, or use an ABD on top of the unna boot and then wrap with Kerlix, etc. But it is wasting the alginate dressing by by using on top of the unna boots IMO.

Do you have any WOCN or wound clinics in the area that you can contact for references? That may get you somewhere - most of the PCPs in my area stick with the basics and let us or the wound clinic recommend any changes. Another thing to think about is frequency of dressing changes - every other week is a bit long, especially if using the calcium alginate dressing...I think this order definitely needs clarification.

[nservice]

I thought the purpose of the una boot was to decrease edema in order for the wounds to heal. If it is wrapped on two separate portions of the leg, the edema will be trapped between the wrapped areas. I have used dressings directly to the wound sites before (under the una boot), usually polymem just for the absorbency and cleansing properties.

[annaedRN, RN]

nservice is right. I forgot to mention that aspect of your post. It needs to be continuous the whole way up the leg. If a 2nd one is needed- it needs to be a continuous wrap in order to help manage the edema. It could cause more problems if not applied correctly. May be you can find/print out info an applying unna boots and bring in to your facility and post it. It should be applied as directed not according to the whim of a supervisor.

[divawriter]

I am not a nurse, but I have been dealing with venous iinsufficency/leg ulcers for nearly twenty years. Unna's boots were first applied to my legs nearly eight years ago, and although it went slowly, the wounds did start to heal. Unfortunately, the excellent nurse who was really good at applying my unna's boots retired and I ended up going elsewhere.

The nurses at the clinic I go to have started to apply unna's boots to my legs after efforts at using other methods, didn't seem to be working. The reason I am writing is because these nurses are basically not familiar with using unna's boots and I believe they are not applying them properly. First off, they fold the bandage as they go around the leg, and then they don't even smooth it out. This is not at all how I recall it being done. Also, the last nurse who applied the boots used only one unna's boot for both legs- where I have wounds on both- one quite large.

Doesn't the boot need to be used completely (or at least most of it) on each leg? The leftover from the one boot didn't even go up high enough on my leg.

I wish I knew where or how to get a pictorial instruction that I could take in to my next clinic visit. Any ideas?

[NRSKarenRN, BSN, RN]

waist of money to be applying anything other than abd pad to absorb excess drainage to outside unna boot. could understand using ca alginate nest to skin with unna overtop --please call odering doctor for clarification.

unna boot

an unna boot is a moist, gauze bandage made up of zinc oxide, calamine lotion and glycerine. it promotes healing, increases blood return to the heart and reduces infection. the boot is wrapped from the toes to just below the knee, covering the ulcer and the lower leg. the gauze then dries and hardens. an elastic bandage is wrapped snugly over the unna boot. a new boot is applied every one to two weeks until the ulcer is healed. initially, more frequent changes may be required for heavily draining ulcers. the larger the ulcer, the longer it will take to heal. small ulcers heal in a few weeks; large ulcers sometimes take several months to heal. keep the unna boot dry. do not take a tub bath or shower when wearing an unna boot unless you cover the boot with a large plastic bag. in some cases, sponge bathing may be the only option. you should be able to wear a sock or stocking over an unna boot as well as your regular shoes. if your foot is swollen, a wider shoe or slipper may be needed.

http://www.nmh.org/nmh/heart/vasculardisease/treatments/venousulcertreatments.htm

clinical info: unna boot

pictures:101480. 37743 unnas boot

nursing 2004 nov article: putting the squeeze on venous ulcers

fulltext | pdf (2.27 m)

a randomised controlled study of four-layer compression versus unna's boot for venous ulcers.:

journal of wound, ostomy and continence nursing - selectreference

documentation requirements for unna boot

[BQueenGirl]

are you supposed to put anything under the una boot?

[annaedRN, RN]

A primary dressing is often ordered to apply directly to the wound/ulcer. Such as a silver dressing, a honey dressing, alginate dressing, etc. It's up to the doctor, but yes you can place a dressing on before the unna boot.

[lsyorke, RN]

are you supposed to put anything under the una boot?

Absolutely you can.

[ktrn2b]

You are both wrong in a sense. I have been a nurse for 19 years with a large portion of that spent doing wound care, in fact I have written the wound care protocol for two facilities that I have worked for. With that said, I have never heard such a thing as placing an alginate dressing over an unna boot, in fact its pretty ridiculous. The alginate should be cut to size to fit inside of the wound, not touching good tissues. The unnaboot is then wrapped firmly starting on the bottom of the foot about an inch before the toes and keeping the foot in a neutral position moving up the leg until it an inch below the knees. If you are using an alginate, the dressings should be changed twice weekly, if not then once weekly is suffice (though I recommend twice). You are smart to ask other nurses advice, and keep in mind (not to offend anyone) that just because your boss is an RN doesnt mean she knows her tail from a hole in the ground. I cant believe a physician signed her silly and expensive order!