Authors (including presenting author) :
Lee SC, Tang V, Wong OK, Lam MY, Chan HT, Cheung BY, Mok HT, Li WH, Liu TC
Affiliation :
Advanced Practice Nurse of Community Nursing Service, Kowloon Hospital
Wound and Stoma Nurse of Community Nursing Service, Kowloon Hospital
Introduction :
Patients with venous leg ulcers (VLC) often suffer from prolonged wound healing time and impact to patients’ healthy and quality of life. For those patients, it is more acceptable when pressure is in linear graduation compression as it is more comfortable (Lim & Davies, 2014). A number of studies showed that nurses are difficulty to achieve the desired sub-bandage pressure on various types of compression bandaging (Zarchi & Jemec, 2014, Weller et al., 2012, Welsh, 2017). Some patients even refused to follow the compression therapy while they could not tolerate the prolong heat, pain and discomfort (Welch, 2017). In Community Nursing Service of Kowloon Hospital, same problems happen to VLC patients and community nurses. Not all community nurses receive the training on using various types of compression bandage. Therefore, win-win care should be brought to both VLC patients and community nurses to improve the VLC care and focus on the practical issue rather than only on theoretical study in the community. An Australia study showed that three-layer tubular bandaging system dose not require same level of expertise to apply as other compression bandages and reported higher tolerance at all treatment visits (Weller et al., 2012). A pilot trial of three-layer tubular bandaging system has been applied to treat VLC for patients in the community.
Objectives :
1.Improve patients’ tolerance and safety on using three-layer tubular bandage system and compliance rate for treating VLC can be improved
2.Community nurses showed competency and confidence to use a three-layer tubular bandage system for VLC
Methodology :
Patients with VLC wound be invited.
Two phases are used to carry out the pilot trial
First Phase
1. Wound nurse select the appropriate participants according to the inclusion criteria. Length and size of tubular bandage would be measured by wound nurse to each participant individually
2. Skill transfer and knowledge are provided to community nurses on application and care of three-layer tubular bandaging system
Second Phase
1. Participants are educated on proper application, observation and care of lower limb circulation, and care of tubular bandages during home visits.
2. Participants are educated to self-record and report any discomfort of using three-layer tubular bandages.
After starting two phases, participant’s wound condition and progress, leg circumference, compliance of participants wound be assessed in six months or till wound heals together with usual wound care.
Result & Outcome :
From June 2020 till December 2021, the VLC care recruited 7 patients to apply three-layer tubular bandaging system, one participant dropped out. Characteristics of participants were two female patients and 5 male patients, mean age is 75. All contained chronic diseases, included Hypertension or Diabetes. The average length of treatment is 70.8d days (range: 60-91 days). Among compliance rate of the treatment, 100% participants followed the treatment during the treatment period. They agreed that they can easily reapply the system by themselves and autonomy was gained when they felt leg discomfort or the tubular bandaged getting dirty. Two participants had complete wound closure, two participants had wound size reduction 75% and two had wound size reduction 25% to 50%. 100% of community nurses agreed that they can handle the three-layer tubular bandage system easily and the constant pressure of the tubular system was ensured at the same time.
To conclusion, three-layer tubular bandaging system is more comfortable and easy to be applied by patients themselves. The compliance rate to treat VLC has been improved as the result and it is a safe and effective intervention of VLC in the community. In compare the number of home visits among wound care, this pilot program has significant in reduction of number of home visits with 40%. Community nurses also gained confidence to care VLC patients when application of three-layer tubular bandaging system is not required professional training.
