Wound Care - Unna Boot

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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!

can more than one unna boot be applied at one time prior to the kerlix and ace wrap? What are some of the complications if an unna is applied incorrectly?

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We use unna boots for many people with venous stasis ulcers or just plain edematous, "weepy" legs. Unna boots are NOT, by manufacturing specifications, indicated for compression, however when physicians write, "unna boots to BLE for compression" this is acceptable, and is the most common use in my experience.

If any dressing is placed under an unna boot it would need to be something that can remain intact for the duration the boot is left on (sounds like common sense but sometimes it isn't). We use Xcell AM covered with adaptic if the wound is dry or has any type of eschar, or just plain adaptic. Then, the unna boot is applied as explained by ktrn2b, from the base of the toes to about two finger widths below the popliteal space. Some instructions will direct you to apply the boot in a figure 8 type fashion, however this can be dangerous if another nurse who is not familiar with the process removes this unna boot to apply another and attempts to repeat the figure 8. Any gaps left in the boot will trap the edema and may cause more ulcerations or tissue death.

An important factor to consider is the pt's ABI--we normally will not compress anyone with less than 0.8 or more than 1.2. We normally use a dressing as described above under the unna boot on any ulcers, followed by the unna boot itself with a 75% overlap on each wrap, then kerlix gauze and finally coban. The kerlix will absorb the exudate that the sorbitol in the unna boot pulls away and the coban will keep the compression of the unna boot in place until removed.

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can more than one unna boot be applied at one time prior to the kerlix and ace wrap? What are some of the complications if an unna is applied incorrectly?

The unna boot contains sorbitol (osmotic diuretic), glycerin (moisturizer), and zinc oxide-aka diaper cream (as a skin protectant). One layer is sufficient to compress and draw fluid from the extremities-if needed more kerlix gauze wrap can be applied if the patient is HEAVILY exudating for absorbency, however this should hopefully be managed by educating the patient on elevation of the BLE above the level of the heart when not ambulating. I have seen people lose toes over unna boots being applied incorrectly (it was done more than one time in a row to the pt, who had diabetic neuropathy and could not feel the ischemia in the toes). I would definitely have a knowledgeable person instruct you on the correct method of application. And remember, just because someone is an LPN, RN or even a WOCN, doesn't mean they automatically know how to do this. I had a WOCN once show me to wrap from the knee DOWN! Anyhow, one of the only reasons that more than one unna boot would need to be applied is if the pt's leg is too long, and in that case the second unna boot roll would need to start about 2-3 wraps below the first so that compression can be continued consistently; this also applies if more coban is needed over the kerlix gauze layer, start 2-3 wraps below where the last one ended. Hope this helps!:D

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ok, now the hard part. How on earth do I get these people to keep the Unna Boot on? I swear, I have so many patients who unwrap the darn thing down to just above the calf because it was "too tight." I thought ok, maybe it was, and wrapped a new Unna Boot to get them through the week till the next WCC apt. Came back the next day and you know it....it was mostly off. I've gotten so I just hate the damn things! Education to put their feet up falls on deaf ears...

Suggestions. If it was a dog I could just put the "Cone of Shame." on so he couldn't get at his dressing!

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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.

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

thanks for the links, i learn so much from this web site! :)

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I work in an advanced wound care center and apply unna boots on a daily basis. why would you place the dressing on top of the boot? this makes no sense at all to me. the dressing is applied directly to the wound bed and then the boot wrapped around the leg. Kudos to you for questioning this! :smokin:

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We never put any other dressings OVER the Unna (except Kerlix and Ace or Coban)

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Does anyone know a reason not to use cotton padding or soft roll in the large skin folds of the upper calf and the ankle prior to applying unna boot to VERY LARGE legs. This young gal is 62" tall and >500#.

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If 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?

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Well, 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.

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So 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.

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Actually , 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.

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