Unna boot

[bethroew]

What is the correct way to apply an unna boot? Is it acceptable to wrap up the leg toward the knee and to continue back down the leg to the ankle?

[nursbaybie, BSN, RN]

First of all, the correct terminology is Unna's Boot.

Second, no it is not acceptable to go back down the leg. to

First, you clean the skin thorougly, then flex the knee. NExt, position the foot at a right angle to the leg, wrap firmly but not tightly around the foot starting right above the toes. make sure the heel is covered. continue wrapping upward overlapping each layer by 50 percent with each turn. make sure the dressing circles the leg at an angle to avoid compromising the circulation. smooth the boot with your free hand as you go. stop wrapping about an inch below the knee. wrap a kerlix roll around the boot to absorve drainage, then finally wrap with an ace wrap in a figure eight pattern. if after hardening, constriction develops, cut a 2 inch slit in the top of the boot.

additional info to know: the way the boot works is when ambulation occurs. the calf muscle contractions are key. as walking occurs, the rigid dressing restricts the outward movement of the calf muscle thereby directing the contraction force inward and improving venous circulation. obviously, a bedridden patient would not much benefit from the unna's boot. if firmness against the ulcer itself is uncomfortable, it may be beneficial to cover the ulcer with duoderm or foam first before applying Unna's boot.

Hope this helps someone.

[Daytonite, BSN, RN]

Hi, bethroew!

Unna's boot (and, by the way, I call it an Unna boot, too!) and I are old friends as I have a tendency to develop stasis ulcers in one leg secondary to phlebectomies that were done for varicose veins. My very handsome vascular surgeon applies them pretty much the way nursbaybie described, but without the outer ACE wrap. The zinc oxide that is in the gauze protects my healthy skin if the ulcer starts to drain. The first one that was applied scared me a bit because it was on for over a week and I was worried about what was going on with the ulcer. I was pleasantly surprised when it was removed.

Welcome to allnurses! :welcome:

[gerikt]

I see that this thread is on the application of Unna's boots. I also have a question about application. We just received an order to apply 10 layers of unna's boot! I have never heard of this and am wondering if this is in any way contraindicated. Thank you, Jan

[lsyorke, RN]

gerikt said:

I see that this thread is on the application of Unna's boots. I also have a question about application. We just received an order to apply 10 layers of unna's boot! I have never heard of this and am wondering if this is in any way contraindicated. Thank you, Jan

ummm, I would question that order. LOL! I believe that would be called a cast!

[missionary]

We have had some Unna's boots donated to take to the villages in the Dominican Republic. I see they can be left on a week -- useful for even sprains and edema. Question: can these be safely used for unsupervised patients? We go to villages one day and then leave. We always give good instructions in Spanish. Besides checking circulation, what other risks do we warn patients about? Thanks, Jan from WA state

[Heather.leah]

Yes Unna Boots can be left in place unsupervised for up to a week as long as they are applied correctly. It would be wise to instruct the patient to remove the dressing if they experience pain that is unrelieved with elevation, or have an increase in shortness of breath. Use unna boots with caution in patient's that have known congestive heart failure, since the unna boot is a compression dressing it can cause a fluid overload in some fragile heart patients. Good luck! Where in the DR are you located at? I am hoping to visit there in December doing some medical mission work.

[JenniferSews]

I am trying to educate myself on wound dressings. I have applied Unna's Boots but after reading this find I was applying them incorrectly. But I'm wondering about the Unna's Boots we have at my facility. If I wrapped them tightly the outer edge (long edge) of the dressings would be much tighter than the inside edge. Because of this I have wrapped loosely because I was afraid of the edges creating a constricting string (for lack of a better word) around the patients leg.

I also see these should be used on walking patients, in the cases I have applied them they were on wheelchair bound patients. Is there any benefit in this case?

[crysmvoll]

Can Unna's boot be applied over blistered areas?

[mommy.19, MSN, RN, APRN]

We apply unna boots in our wound clinic on a daily basis, and usually place a dressing on any ulcerated areas that is deemed appropriate to be left on for up to a week, such as xcell covered with adaptic, or aquacell AG, I have even used santyl on some sloughy venous stasis ulcers under an unna boot and left it intact for a week with great results.

[arm9580]

I also have a question about unna boot application. We have a few patients that come to us for oozing superfical wounds on 30-70% of the lower leg. We have applied the unna boot to these patients. Do we use the entire unna boot/box on each patient or cut it and use only two layers/leg? I have also been wrapping these patients loosely, tring to prevent as many creases as I can, however, these patients also have very lymphatic legs. My concern with cutting the bandage would be introducing more bacteria into the area. We do clean our scissors with alcohol, but do not have anything to clean them any better than that. I am not certified in wound care, but do alot of lymphatic care. My clinic director is not really trained in these areas either so we are tring to get as much info on this as we can. How long can you keep the unsued part of an unna boot if you have extra left over after a patient?

Thanks hope someone can help

[Nittybelle]

I see there are different ways to apply the Unna's (Unna) boot. We use the whole role. I've witnessed a physician do it and he used the whole boot too. He even went over the toes!

I guess the main point is to not compress to much because of the danger with congestive heart failure.

I have ALWAYS seen positive results from the Unna boot wrapping up then back down. When coming back down, I wrap very lightly.

We will then use Kerlix, then either ACE or Coban. Patients come back in a week and NLT 10 days. Which is rare.