{"id":974,"date":"2010-12-02T18:29:04","date_gmt":"2010-12-02T18:29:04","guid":{"rendered":"https:\/\/cloverock.info\/mockosce23\/new\/the-pressure-gradient-bandage\/"},"modified":"2024-03-05T17:32:31","modified_gmt":"2024-03-05T17:32:31","slug":"the-pressure-gradient-bandage","status":"publish","type":"post","link":"https:\/\/www.qpercom.com\/sim\/index.php\/bandages-and-bandaging-techniques\/support-and-immobilising-bandages\/the-pressure-gradient-bandage\/","title":{"rendered":"The Pressure Gradient Bandage"},"content":{"rendered":"<hr \/>\n<p><span style=\"color: #003366;\">The main indication for a <span style=\"color: #33cccc;\"><strong>pressure gradient bandage<\/strong><\/span> is <span style=\"color: #33cccc;\"><strong>venous insufficiency<\/strong><\/span>, which initially manifests itself in the form <span style=\"color: #33cccc;\"><strong>oedema<\/strong><\/span> and can lead to <span style=\"color: #33cccc;\"><strong>venous leg ulcers<\/strong><\/span>. Causal treatment which, together with the diagnostic work-up for venous leg ulcers falls outside the scope of this booklet, can consist of dietary measures, weight reduction, treatment of cardiac or renal disorders, surgical intervention etc.<\/span><\/p>\n<p><span style=\"color: #003366;\">Symptomatic\/curative therapy aims to improve the muscle pump mechanism in the lower leg and also focuses on wound care.<\/span><br \/>\n<span style=\"color: #003366;\">Muscle pump function can be improved by encouraging the patient to carry out exercises and by applying a pressure gradient bandage. By applying a non-elastic or only slightly elastic roller bandage around the lower leg, the superficial and perforant veins are pressed shut and tissue pressure is increased. This stimulates venous return towards the heart. When the calf muscles are being used (i.e., when walking, moving) the active pressure is high, when lying down the rest pressure is low. For this reason it is notnecessary to remove the bandage at night. For the first two weeks, the compression bandage should be replaced twice a week, and thereafter once a week (at the same time as the ulcer dressing is replaced). The lower leg should be bandaged from the proximal side of the toes up to the knee. The pressure should decrease in a distal to proximal direction (hence the name pressure gradient bandage).<\/span><\/p>\n<hr \/>\n<h3><span style=\"text-decoration: underline;\"><span style=\"color: #003366;\"><strong>How to Apply a Pressure Gradient Bandage<\/strong><\/span><\/span><\/h3>\n<h3><span style=\"color: #003366;\"><strong>Material<\/strong><\/span><\/h3>\n<ul>\n<li><span style=\"color: #003366;\">Two undyed ideal bandage rolls, 10 cm or 12 cm wide (dyed bandages could, potentially, cause skin irritation).<\/span><\/li>\n<li><span style=\"color: #003366;\">Two foam rubber pads (around which a piece of cotton can be wrapped to prevent irritation) or non-absorbent cotton wadding.<\/span><\/li>\n<li><span style=\"color: #003366;\">Non-absorbent cotton wadding.<\/span><\/li>\n<li><span style=\"color: #003366;\">Tape.<\/span><\/li>\n<\/ul>\n<hr \/>\n<h3><span style=\"color: #003366;\">Procedure<\/span><\/h3>\n<p><span style=\"color: #003366;\">Apply this bandage at a time when the oedema is minimal, for example in the morning before the patient gets up. How to care for a venous leg ulcer is described in the section &#8220;Contolling bleeding and wound care&#8221;.<\/span><\/p>\n<ul>\n<li><span style=\"color: #003366;\">Place the foot at a 90\u00b0 angle.<\/span><\/li>\n<li><span style=\"color: #003366;\">Start with two or three circular turns around the forefoot, turning in a lateral to medial direction.<\/span><\/li>\n<li><span style=\"color: #003366;\">Fill the retromalleolar spaces with the pads or two plugs of non-absorbent wadding.<\/span><\/li>\n<li><span style=\"color: #003366;\">Apply a circular turn around the heel, fixing the foam rubber or non-absorbent cotton wadding [Figure 141].<\/span><\/li>\n<\/ul>\n<hr \/>\n<p><span class=\"jce_caption\" style=\"display: inline-block; color: #003366;\"><img loading=\"lazy\" decoding=\"async\" class=\" size-full wp-image-969\" style=\"margin: auto;\" src=\"https:\/\/cloverock.info\/mockosce23\/new\/wp-content\/uploads\/2010\/12\/Bandages_ba-fig-141.jpg\" alt=\"\" width=\"400\" height=\"295\" srcset=\"https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/12\/Bandages_ba-fig-141.jpg 400w, https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/12\/Bandages_ba-fig-141-300x221.jpg 300w\" sizes=\"auto, (max-width: 400px) 100vw, 400px\" \/><strong><span style=\"width: 400px; display: block;\">Figure 141<\/span><\/strong><\/span><\/p>\n<hr \/>\n<ul>\n<li><span style=\"color: #003366;\">Apply a strip of non-absorbent wadding over the tibial crest <em><strong>[Figure 142]<\/strong><\/em>.<\/span><\/li>\n<\/ul>\n<p><span class=\"jce_caption\" style=\"display: inline-block; color: #003366;\"><img loading=\"lazy\" decoding=\"async\" class=\" size-full wp-image-970\" style=\"margin: auto;\" src=\"https:\/\/cloverock.info\/mockosce23\/new\/wp-content\/uploads\/2010\/12\/Bandages_ba-fig-142.jpg\" alt=\"\" width=\"400\" height=\"295\" srcset=\"https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/12\/Bandages_ba-fig-142.jpg 400w, https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/12\/Bandages_ba-fig-142-300x221.jpg 300w\" sizes=\"auto, (max-width: 400px) 100vw, 400px\" \/><strong><span style=\"width: 400px; display: block;\">Figure 142<\/span><\/strong><\/span><\/p>\n<hr \/>\n<ul>\n<li><span style=\"color: #003366;\">Make two Figure-of-eight turns distally and proximally to the heel turn <\/span><span style=\"color: #003366;\"><em><strong>[Figure 143]<\/strong><\/em>.<\/span><\/li>\n<\/ul>\n<p><span class=\"jce_caption\" style=\"display: inline-block; color: #003366;\"><img loading=\"lazy\" decoding=\"async\" class=\" size-full wp-image-971\" style=\"margin: auto;\" src=\"https:\/\/cloverock.info\/mockosce23\/new\/wp-content\/uploads\/2010\/12\/Bandages_ba-fig-143.jpg\" alt=\"\" width=\"400\" height=\"295\" srcset=\"https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/12\/Bandages_ba-fig-143.jpg 400w, https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/12\/Bandages_ba-fig-143-300x221.jpg 300w\" sizes=\"auto, (max-width: 400px) 100vw, 400px\" \/><strong><span style=\"width: 400px; display: block;\">Figure 143<\/span><\/strong><\/span><\/p>\n<hr \/>\n<ul>\n<li><span style=\"color: #003366;\">Now apply spiral turns towards the knee. Make sure that each turn covers 2\/3 of the previous turn and that the pressure decreases in a distal to proximal direction.<\/span><\/li>\n<li><span style=\"color: #003366;\">Fix the bandage with strip of leukoplast tape and start with the second bandage, at the point where the previous bandage ended. Continue to apply the bandage in turns going in the opposite direction up to the knee.<\/span><\/li>\n<li><span style=\"color: #003366;\">Use up the second bandage by applying circular turns from the knee downwards again, with the pressure increasing in the distal direction <em><strong>[Figure 144]<\/strong><\/em>.<\/span><\/li>\n<\/ul>\n<hr \/>\n<p><span class=\"jce_caption\" style=\"display: inline-block; color: #003366;\"><img loading=\"lazy\" decoding=\"async\" class=\" size-full wp-image-972\" style=\"margin: auto;\" src=\"https:\/\/cloverock.info\/mockosce23\/new\/wp-content\/uploads\/2010\/12\/Bandages_ba-fig-144.jpg\" alt=\"\" width=\"400\" height=\"295\" srcset=\"https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/12\/Bandages_ba-fig-144.jpg 400w, https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/12\/Bandages_ba-fig-144-300x221.jpg 300w\" sizes=\"auto, (max-width: 400px) 100vw, 400px\" \/><strong><span style=\"width: 400px; display: block;\">Figure 144<\/span><\/strong><\/span><\/p>\n<hr \/>\n<ul>\n<li><span style=\"color: #003366;\">Fix the bandages by applying leukoplast along the length of the lower leg and under the sole of the foot to create a \u2018stirrup\u2019 <em><strong>[Figure 145]<\/strong><\/em>.<\/span><\/li>\n<\/ul>\n<hr \/>\n<p><span class=\"jce_caption\" style=\"display: inline-block; color: #003366;\"><img loading=\"lazy\" decoding=\"async\" class=\" size-full wp-image-973\" style=\"margin: auto;\" src=\"https:\/\/cloverock.info\/mockosce23\/new\/wp-content\/uploads\/2010\/12\/Bandages_ba-fig-145.jpg\" alt=\"\" width=\"400\" height=\"295\" srcset=\"https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/12\/Bandages_ba-fig-145.jpg 400w, https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/12\/Bandages_ba-fig-145-300x221.jpg 300w\" sizes=\"auto, (max-width: 400px) 100vw, 400px\" \/><strong><span style=\"width: 400px; display: block;\">Figure 145<\/span><\/strong><\/span><\/p>\n<hr \/>\n<ul>\n<li><span style=\"color: #003366;\">Check the colour of the toes: bluish discoloration indicates that the bandage is too tight.<\/span><\/li>\n<li><span style=\"color: #003366;\">Encourage the patient to walk.<\/span><\/li>\n<\/ul>\n<hr \/>\n<p><span style=\"color: #003366;\"><em>The pressure gradient bandage has been correctly applied if:<\/em><\/span><\/p>\n<ul>\n<li><span style=\"color: #003366;\">the heel is fully covered;<\/span><\/li>\n<li><span style=\"color: #003366;\">the toes are uncovered and a normal colour;<\/span><\/li>\n<li><span style=\"color: #003366;\">there are no wrinkles or creases in the bandage;<\/span><\/li>\n<li><span style=\"color: #003366;\">the pressure gradually decreases in the distal to proximal direction and is applied from two different directions (herringbone pattern).<\/span><\/li>\n<li><span style=\"color: #003366;\">if the patient experiences a \u2018massaging\u2019 pressure when walking.<\/span><\/li>\n<\/ul>\n<hr \/>\n<p>&nbsp;<\/p>\n","protected":false},"excerpt":{"rendered":"<p>The main indication for a pressure gradient bandage is venous insufficiency, which initially manifests itself in the form oedema and can lead to venous leg ulcers. Causal treatment which, together with the diagnostic work-up for venous leg ulcers falls outside the scope of this booklet, can consist of dietary measures, weight reduction, treatment of cardiac [&hellip;]<\/p>\n","protected":false},"author":83,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[85],"tags":[149],"class_list":["post-974","post","type-post","status-publish","format-standard","hentry","category-support-and-immobilising-bandages","tag-bandages-bandaging-techniques"],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.4 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>The Pressure Gradient Bandage - Qpercom | Skills in Medicine<\/title>\n<meta name=\"description\" content=\"Online Mock OSCEs with examiners, patient actors, instant results and personalised feedback. 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