From the Guidelines
A negative graduated compression bandage works by applying varying levels of pressure to the limb, with the highest pressure at the distal end and gradually decreasing pressure as it moves proximally, thereby improving venous and lymphatic return and reducing edema. This pressure gradient helps to force fluid to move from areas of higher pressure to areas of lower pressure, which in turn improves circulation and promotes healing in conditions like venous ulcers, lymphedema, and post-surgical swelling 1. The bandage is typically applied in a spiral or figure-eight pattern, starting at the toes or fingers and working upward.
Key Points to Consider
- The compression helps reduce edema by preventing fluid accumulation in the tissues, and improves circulation, which is essential for promoting healing in various conditions 1.
- For effective use, the bandage should be applied with consistent tension, replaced regularly, and monitored for complications such as skin irritation or circulatory compromise.
- The physiological basis for its effectiveness lies in Starling's forces, where external pressure counteracts hydrostatic pressure that would otherwise cause fluid to leak from blood vessels into surrounding tissues.
- 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.
Application and Monitoring
- The bandage should be applied by a healthcare professional to ensure proper fitting and to provide education and detailed instructions to the patient 1.
- Regular monitoring is necessary to assess the effectiveness of the treatment and to identify any potential complications early on.
- The use of negative graduated compression bandages has been shown to be effective in preventing ulcer recurrence and healing ulcers, particularly in patients with venous leg ulcers 1.
From the Research
Mechanism of Negative Graduated Compression Bandage
- A negative graduated compression bandage works by applying higher pressure over the calf than at the distal leg, which enhances venous pump function 2.
- This type of compression bandage is more effective than traditional graduated compression in improving venous haemodynamics, especially in patients with severe venous incompetence 2.
- The increased pressure over the calf helps to reduce venous stasis, venous hypertension, and venous edema, which are common symptoms of chronic venous insufficiency 3, 4.
Comparison with Graduated Compression
- Graduated compression bandages, which apply higher pressure at the distal leg than at the calf, are less effective in enhancing venous pump function compared to negative graduated compression bandages 2.
- However, graduated compression stockings with different pressure profiles can still have a positive effect on venous function, with lighter pressures being more suitable for subjects who require long-term inactive standing or sitting, and mild pressures being sufficient for most clinical applications 5.
Clinical Applications
- Negative graduated compression bandages can be used in the management of lymphedema and chronic venous insufficiency, particularly in patients who require long-term treatment and have limited mobility 6.
- The use of compression therapy, including negative graduated compression bandages, can help reduce swelling, improve venous return, and enhance overall quality of life for patients with these conditions 3, 4, 6.