Wound Care - Unna Boot - page 2

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.... Read More

  1. by   mommy.19
    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.
  2. by   mommy.19
    Quote from psjrn
    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!
  3. by   nola1202
    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!
  4. by   nola1202
    Quote from nrskarenrn
    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!
  5. by   medasst1997
    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!
  6. by   Nittybelle
    We never put any other dressings OVER the Unna (except Kerlix and Ace or Coban)
  7. by   KSA RN
    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#.
  8. by   Nittybelle
    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?
  9. by   KSA RN
    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.
  10. by   Nittybelle
    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.
  11. by   KSA RN
    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.
  12. by   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!
  13. by   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

Must Read Topics