 |
| Dr. Joel Aronowitz |
(This video is taken from Dr. Joel Aronowitz's Youtube Channel)
Dr. Jessica Olson: "All right, so today we're going to go over how to appropriately place an uniboot dressing. It's composed of three primary layers: the uniboot, and then the casp padding, and a coban layer, basically for a three-layer compression dressing. Unaboots are primarily used in our clinic for wound care purposes for people with chronic swelling, venous ulcers, venous insufficiency, but it can also be used for sprains, strains, and sort of a more sports medicine approach too. So, they are multifunctional and usually very well tolerated. I'll go over a couple of the key pearls with the application as they should be heated in terms of the correct application. So, one thing to keep in mind is that the uniboot is going to extend from the metatarsal heads here all the way up to just distal to the tibial tuberosity, which is the bone right here. And that is for the primary compression for venous insufficiency or venous wounds. If it was more of an ankle sprain type of compression dressing we wanted to put on, essentially to extend from the metatarsal heads, just distal to the gastrocnemius-soleal junction here at the end of her calf muscles. So, usually what we'll see, though 90% of the time, is toes to knee, just about right up here. And the reason I bring that up is because right here is the ankle joint and we need to be careful with this in terms of protecting the skin and from impingement of the uniboot so that the skin doesn't get irritated here, and the patient doesn't have any pinching or worse, develop any wounds from the actual uniboot sitting across that ankle joint.
So, one technique I use, I just put on a little protection dressing there. If she were to have wounds, we'll say this is a wound right here, you can put your application of your dressing, your alginates, your biologics, any type of specific type of dressing you want to put on there, and then put the uniboot on top of that to add that layer of compression. So, set it 90 degrees here, and then the actual application of the uniboot here. One thing you want to take caution with is that it is paste-based, sink-based, so you don't want to be splashing it all around. Be mindful of how you take it out of its sleeve and make sure the patient's clothes are well out of the application radius and that your own scrubs are out of the way.
And in terms of application and comfort and appropriate technique, you start at that metatarsal head level from the top, and then I suggest always wrapping up and into the arch as it's more comfortable for the patient. What I mean by that is you come down and you wrap up, capture those met heads one through five, and into the arch just like that, and I usually recommend cuffing the front of the foot here twice, making a nice thin layer here.
Now, if our patient had significant swelling, one thing you can do is do the accordion technique where you basically allow for a fold. You don't want any wrinkles, but you can do a nice thin fold right here, and what that does is as she stands up and walks with this uniboot, that fold allows for some room for that skin to extend if she has some significant edema without pinching her skin.
So basically, 50% coverage on each turn of the uniboot application and right at the ankle joint, you really want to be mindful to not get any wrinkles and to get the dressing to sit appropriately. Like I said, you can always put a little protection dressing across that ankle joint, and then basically a figure eight, you come around that ankle joint and then capture the heel.
The uniboot will sort of tell you where it wants to go as long as you're applying it in the appropriate way. You should never have to really fight it in terms of where it's laying down on the skin. You can always ask for an assistant to help you with the accordions if you need, and then you start to come up the ankle and the leg here. Once you traverse the ankle joint, you can start doing the herringbone technique which gives more compression.
What I mean by that is the around and up and around and down technique. So, this is around and up, and again, you don't want any wrinkles, so that would be considered a wrinkle right there, and what that can do when it dries, it can cause a little pressure sore, so we don't want to do that because many of our patients have friable skin or PAD or venous insufficiency and so, you could be actually putting them at more risk of developing issues. So, around and up and then around and down, and with that 50% coverage, and you'll see that herringbone pattern once we get up the leg here a little bit, and you just do that around and up and do that 50% coverage,
The accordion, and then around and down, 50% coverage. And around and up, and around and down. And legs will come in various sizes, so usually you only need one of these, but if you need to use two,
If your patient has significant edema or lymphedema, then you can use two. Around and up, around and down, doing the accordion, keeping everything nice and smooth. You don't ever want to put tension across this either, you're not trying to compress through this, you just lay it nice and soft. The compression comes actually through the Unna boot as it dries, and as she walks.
So basically, 50% coverage on each turn of the uniboot application and right at the ankle joint, you really want to be mindful to not get any wrinkles and to get the dressing to sit appropriately. Like I said, you can always put a little protection dressing across that ankle joint, and then basically a figure eight, you come around that ankle joint and then capture the heel.
The uniboot will sort of tell you where it wants to go as long as you're applying it in the appropriate way. You should never have to really fight it in terms of where it's laying down on the skin. You can always ask for an assistant to help you with the accordions if you need, and then you start to come up the ankle and the leg here. Once you traverse the ankle joint, you can start doing the herringbone technique which gives more compression.
What I mean by that is the around and up and around and down technique. So, this is around and up, and again, you don't want any wrinkles, so that would be considered a wrinkle right there, and what that can do when it dries, it can cause a little pressure sore, so we don't want to do that because many of our patients have friable skin or PAD or venous insufficiency and so, you could be actually putting them at more risk of developing issues. So, around and up and then around and down, and with that 50% coverage, and you'll see that herringbone pattern once we get up the leg here a little bit, and you just do that around and up and do that 50% coverage,
The accordion, and then around and down, 50% coverage. And around and up, and around and down. And legs will come in various sizes, so usually you only need one of these, but if you need to use two,
If your patient has significant edema or lymphedema, then you can use two. Around and up, around and down, doing the accordion, keeping everything nice and smooth. You don't ever want to put tension across this either, you're not trying to compress through this, you just lay it nice and soft. The compression comes actually through the Unna boot as it dries, and as she walks.
And then, if you can cuff at the top, there's the tibial tuberosity right there, cuff it, and then you can either cut it, which we'll do, you don't want to, every layer would provide more compression, and you don't want to do more compression if it's not needed, because that can cause issues as well. So, that's step one, and then step two, you have your cast padding, and you follow that same application, wrap up and into the arch, and up and around the ankle,
Come down, capture the heel, and then make your way up the leg, and go around and up, around and down, nice and smooth down. It's sort of like an art to make the dressing go on correctly, and if you learn the technique the right way,
Come down, capture the heel, and then make your way up the leg, and go around and up, around and down, nice and smooth down. It's sort of like an art to make the dressing go on correctly, and if you learn the technique the right way,
It should be pretty simple in terms of applying it, always check with your patient to make sure that they don't feel like it's too tight when you're putting it on, that goes with any sort of ace bandage dressing or Unna boot dressing. And then, the final layer is your co-band layer, and you can get some compression through this if you want. I always recommend doing the around and into the arch, and you can cover,
Make sure you capture that Unna boot on the metatarsal head, so that when the patient steps in their shoe, or on their sock, they're not getting a paste on their shoe or on their sock, and you want that 50% coverage across each wrap with the co-band, and each layer,
So, round and up, round and down, 50%, round and up, round and down, round and up, and then you always check with your patient,
Make sure you capture that Unna boot on the metatarsal head, so that when the patient steps in their shoe, or on their sock, they're not getting a paste on their shoe or on their sock, and you want that 50% coverage across each wrap with the co-band, and each layer,
So, round and up, round and down, 50%, round and up, round and down, round and up, and then you always check with your patient,
Does that feel okay? Feel too tight? Too loose? Feel okay? I feel good. And then, round to earth, and she can actually walk right in this dressing, because the technique of the dressing, the way the Unna boot actually functions is it provides compression with weight bearing. So, you can go ahead and stand up, and make sure you're not getting any pinching on your knee or on your ankle.
How does that feel? Feels good. Okay. Perfect."
How does that feel? Feels good. Okay. Perfect."
Comments
Post a Comment