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?

[AZRNHH]

The Unna Boot packaging we use has directions in how it is to be applied. The directions say to wrap from the toes upward and NOT to go back down. Be sure to follow instructions as indicated by the product packaging or by MD orders if you are doing anything else. :) I use the whole roll. When in the past I used less (per patient request not to wrap his entire calf) the results were not at good-he ended up with edema right above the top of where the unna boot ended. Since then I wrap the entire calf and get much better results. It was good that the patient saw it was better this way as well.

[AZRNHH]

arm9580 said:

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

I do not think it is a good idea to "share" any dressing products among patients. This would never be done in a hospital and I don't think it should be done in a clinic either. There are too many risks of spreading bacteria (as you pointed out). The only way I could conceive of "sharing" supplies that would be safe would be if you precut everything using clean scissors before any patients were there-ie in the supply room where you would divide up the product and put it in separate packaging to be used that day for the clients that come in. I have a client I apply unna boots to his LE every week and sometimes I do have leftover-I seal it up in it's original packaging and have been able to use it 1-2 weeks later and it is still moist. I only do that because he is the only client and it is in his home where dressing changes are done in a "clean" and not "sterile" fashion. ?

[Miatigah]

nursbaybie- Kerlix types of non conforming bandaging is not desirable for wrapping extremities, particularly if there are edema issues, as the kerlix causes linear wounds into the edematous tissue. Could you please provide the evidence that supports not wrapping down the leg? Since a short stretch bandage, an Unna's boot basically dries out, preventing further edema, and "compression" isn't really applied with the zinc layer... Thanks in advance.

[LDRNMOMMY, BSN, RN]

Miatigah said:

nursbaybie- Kerlix types of non conforming bandaging is not desirable for wrapping extremities, particularly if there are edema issues, as the kerlix causes linear wounds into the edematous tissue. Could you please provide the evidence that supports not wrapping down the leg? Since a short stretch bandage, an Unna's boot basically dries out, preventing further edema, and "compression" isn't really applied with the zinc layer... Thanks in advance.

I would like to see that evidence as well. I was taught go up once then down once and then Coban for the compression. No kerlix or using the entire roll. We use Unna Flex in our clinic.

[almost20yrnurse]

I was instructed on my current job that you only wrap up toward the knee. There are other wraps that provide more compression such as profore and Dauerbinde. I am by no means an expert but just thought I'd pass that along.

[313RN, BSN, RN]

We call them Unna boots, too.

We wrap from just above the toes to just below the knees. We also put a fan fold more or less centered on the tiba with each layer to provide a little relief when it dries. We never wrap toes.

Santyl, silver impregnated materials, dermagrafts and apligrafts with iodoform or iodosorb when appropriate all go under the boot in my clinic.

We use the calomine lotion impregnated boot with Kerlix and coban. We may place an ABD pad between the boot and the kerlix if there's a lot of drainage. Coban gets wrapped in a spiral like the kerlix with decreasing compression as we go up.

We also use Coban 2 and Profore Unna's boots for patient who won't tolerate the gelocast or who need more compression (extreme lymphedma, etc). I know some clinics that use Dynaflex instead of Profore but they're very similar as far as I can tell.

Before getting a boot we make sure there's no CHF and the ABI has to be >0.6