From the Guidelines
A negative graduated compression bandage is formed by applying more pressure at the distal end of a limb and less pressure at the proximal end, which is achieved by wrapping the bandage with decreasing tension as it moves up the limb, creating a pressure gradient that's highest at the extremity and gradually decreases toward the heart 1. This technique is the opposite of standard graduated compression, where higher pressure is applied proximally and lower pressure distally. The use of negative graduated compression bandages has been shown to improve ejection fraction in refluxing vessels and higher extrinsic pressures when higher pressures are exerted at the calf over the distal ankle 1.
Key Points to Consider
- The application of a negative graduated compression bandage involves wrapping the bandage with decreasing tension as it moves up the limb, creating a pressure gradient that's highest at the extremity and gradually decreases toward the heart.
- This technique can be useful in specific conditions where fluid movement toward the distal extremity is desired, such as in certain types of edema management or specialized wound care protocols.
- However, it's essential to note that negative graduated compression is not commonly used in standard clinical practice, as it can potentially impede normal venous return and may worsen conditions like venous insufficiency or lymphedema 1.
- Most therapeutic compression bandaging uses positive graduated compression (higher pressure proximally, lower distally) to promote venous and lymphatic return toward the heart.
Important Considerations for Clinical Practice
- When using compression therapy, a minimum pressure of 20 to 30 mm Hg is recommended, with pressures of 30 to 40 mm Hg advised for more severe disease 1.
- Adherence to compression therapy should be encouraged with proper fitting, education, and detailed instructions 1.
- Caution is advised when the ankle-brachial index is <0.6, as it indicates an arterial anomaly needing revascularization 1.
From the Research
Formation of Negative Graduated Compression Bandage
- A negative graduated compression bandage is not directly mentioned in the provided studies, however, the concept of graduated compression is discussed in the context of stockings and intermittent pneumatic compression devices 2, 3, 4, 5.
- Graduated compression stockings (GCS) are designed to apply varying pressure levels and gradient distribution profiles to the lower extremities, with the goal of improving venous function and reducing edema 2.
- The pressure levels and gradient distribution of GCS can influence their performance, and studies have investigated the effects of different pressure profiles on venous anatomy and haemodynamics 2.
- Intermittent pneumatic compression (IPC) devices, which apply periodic compression to the affected limb, have also been studied as a treatment for lymphedema, with research focusing on their effectiveness in reducing limb circumference and improving tissue elasticity 6, 3, 4, 5.
- While the specific formation of a negative graduated compression bandage is not addressed in the provided studies, the principles of graduated compression and IPC may be relevant to understanding how such a bandage could be designed and used to achieve therapeutic effects 2, 3, 4, 5.