How do I properly use a compression wrap?

How to Properly Use a Compression Wrap

For venous insufficiency and edema, apply compression wraps using "negative graduated compression" with higher pressure at the calf (30-40 mmHg for severe disease, 20-30 mmHg for mild-moderate disease) rather than traditional ankle-focused compression, but ALWAYS check ankle-brachial index first—compression is contraindicated if ABI <0.6. 1, 2

Critical Pre-Application Assessment

Before applying any compression wrap, you must measure the ankle-brachial index (ABI) to rule out arterial disease: 2, 3, 4

• ABI >0.9: Proceed with full compression at 30-40 mmHg 2, 4
• ABI 0.6-0.9: Reduce compression to 20-30 mmHg (safe and effective) 1, 2, 3
• ABI <0.6: Do not apply compression—this indicates arterial disease requiring revascularization first 1, 2, 3

Approximately 16% of venous leg ulcer patients have unrecognized concomitant arterial disease, making this assessment critical. 3, 4

Optimal Application Technique for Venous Disease

Pressure Distribution Pattern

Apply "negative graduated compression" where the highest pressure is at the calf, NOT at the ankle: 1, 2

• This technique achieves superior ejection fraction in refluxing vessels compared to traditional graduated compression (higher at ankle) 1, 2
• Place the compression bandage over the calf rather than just the distal leg for improved pressure distribution 1, 2
• Avoid making the bandage too tight at the knee, as this paradoxically worsens venous return 2

Pressure Targets by Disease Severity

For venous ulcers (C6 disease) or ulcer prevention (C5 disease): 1, 2, 3

• Use 30-40 mmHg inelastic compression
• This pressure is superior to elastic bandaging for wound healing 1, 2

For less severe venous disease (C2-C4) or initial treatment: 1, 2, 3

• Start with 20-30 mmHg as minimum effective pressure
• This range successfully reduces edema and improves venous circulation 3

For patients with compromised arterial flow (ABI 0.6-0.9): 1, 2, 3

• Reduce to 20-30 mmHg maximum
• This remains both safe and effective 2, 3

Application Instructions for Acute Joint Injuries

For acute ankle sprains or strains, compression wraps may provide comfort but have NOT been proven to reduce swelling, pain, or improve recovery time: 1

• Apply the wrap without compromising circulation—you should be able to insert a finger under the bandage comfortably 1
• The wrap should feel "comfortably tight" but not cause numbness, tingling, or color changes 1
• Evidence shows compression wraps do NOT reduce swelling or pain during recovery from ankle sprains, and do NOT improve joint function, range of motion, or time to recovery 1
• One small trial showed potential benefit for return to sports, but this finding is not robust 1

Pediatric Postthrombotic Syndrome Management

For children with symptomatic postthrombotic syndrome after limb DVT: 1

• Start with 15-20 mmHg compression at the ankle or wrist to enhance adherence 1
• Use knee-high stockings for lower extremity PTS and sleeves for upper extremity PTS 1
• Wear 8-12 hours per day, during daytime hours, at least 3 days per week 1
• Adherence is estimated at only 50% but can be enhanced through education and specialized care 1

Critical Pitfalls to Avoid

Most dangerous error: Applying compression without checking ABI first—this can cause tissue necrosis in patients with arterial disease 2, 3, 4

Common application errors: 2, 3

• Using traditional graduated compression (higher at ankle) for severe venous disease—the negative graduated approach (higher at calf) is biomechanically superior 1, 2
• Making the bandage too tight at the knee, which worsens venous return 2
• Starting with maximum compression (30-40 mmHg) in all patients—compliance decreases with higher pressures 3

Adherence failures: 1, 2, 3

• Treatment failure most commonly results from non-compliance rather than inadequate compression 1, 2
• Provide detailed application instructions and proper fitting education 1, 2, 3
• Ill-fitting wraps cause skin breakdown, discomfort, and non-adherence 3

When to Seek Specialist Help

Consider referral to certified lymphedema therapists or vascular specialists for: 4

• Complex compression therapy requiring specialized training 4
• Patients with obesity, gripping difficulties, cognitive impairment, or low social status—these are limiting factors for self-management in elderly patients 5
• Proper fitting, education, and ongoing monitoring 4