Actively targeting lymphoedema

Actico instructions for use developed in conjunction with Anne Williams, Lymphoedema Specialist Practitioner, Esk Lymphology, Lothian, Scotland.

M119 V1.1

Actively targeting lymphoedema

Instructions on the use of Actico cohesive short stretch bandages in lymphoedema of the arm
The Actico Short Stretch bandage provides a semi-rigid, resistive support around the limb to produce high working and lower resting sub-bandage pressures, while maximising mobility and flexibility. Used in a multi-layer lymphoedema bandaging system, it reduces limb swelling, improves limb shape and minimises skin and tissue problems. Indications: Persistent limb swelling, shape distortion, tissue fibrosis, lymphorrhoea, prevention of dependency oedema. Contra-indications: Acute cellulitis, untreated cardiac failure, acute deep venous thrombosis, superior vena cava obstruction. Prior to bandaging: A comprehensive medical history and assessment of lymphoedema, skin and vascular status is required (refer to local guidelines). Referral to a specialist lymphoedema practioner may be necessary. Manual lymphatic drainage and specific exercises are commonly used in conjunction with bandaging and an appropriate treatment plan should be identified. Skin care: The limb is cleaned and moisturised with appropriate emollients and suitable dressings identified for open wounds (refer to local guidelines). Padding: Flexiban and/or hypoallergenic polyurethane foam is used to protect vulnerable pressure points, to in-fill skin folds or gaps and to establish a cylindrical/conical shape through the length of the limb. This provides a graduated subbandage pressure profile reducing from distal to proximal to enhance limb volume reduction and reshaping. Once limb shape and skin condition have been assessed, padding materials are prepared. Flexiban can be molded to fit in skin folds or cut into strips to protect finger webs. Layered Flexiban or small foam chips can be packed into ActiFast pouches to pad out the palm of the hand. Foam pieces may be cut to the required shape to protect bony prominences, in-fill gaps or provide additional pressure on the dorsum of the hand. The edges of foam pieces should be bevelled to prevent friction and foam should not be in direct contact with the skin. Flexiban is then spiralled up the length of the limb from distal to proximal. Adequate padding is required to achieve an even, conical shape. Fold the ActiFast over each end of the padding to secure. Step 4: Ask the patient to splay their fingers and start with Actico 4cm or 6cm, depending on hand size. Anchor the bandage loosely at the wrist and bandage the hand making several turns at the base of the fingers using an even tension. Continue bandaging the hand, carefully enclosing the base of the thumb with turns above and below. Step 5: Spiral up the wrist and forearm with the arm in pronation. Use the required 50% overlap and appropriate bandage width (8cm or 10cm), maintaining an even tension. Excess bandage can be cut and layers bonded with gentle pressure to mould the bandage. Step 6: Bandage the elbow in slight flexion using a spiral or figure of eight and continue bandaging up the arm to just below the top of the padding. Step 7: Continue with the second layer of Actico bandages, using a spiral or figure of eight technique as required to create a semi-rigid casing throughout the length of the limb. Consecutive spiral bandages are applied in opposite directions to avoid distorting the soft tissues. Attention should be given to achieving a graduated pressure profile, reducing from distal to proximal. If this is not achieved, oedema may develop distally, causing a swollen hand or fingers. Step 8: A final layer of ActiFast can be applied over the bandages. Bandage length: Lymphoedema bandages are commonly applied to the whole limb. Re-application of bandages: Bandaging usually takes place over a 2-4 week period. Oedema reduction is greatest in the first week of bandaging and can lead to bandage slippage as the bandages loosen. Bandages may need to be re-applied daily in the initial week. Actico Cohesive bandages may then require less frequent application. Please note: One layer of Actico short stretch bandage will be adequate to provide support and palliation, for example in patients with advanced cancer or dependency oedema. Two layers will alllow for greater reduction of oedema with additional layers being used by experienced practioners.
Step 1. Bandage the fingers using a 4cm or 5cm retention bandage. Step 2. Apply a layer of ActiFast tubular retention bandage, cutting a hole for the thumb. This will secure wound dressings and padding inside skin folds. Step 3. Reshape and protect the limb using appropriate padding. Step 4. Extra layers of Flexiban may be used in the cubital fossa.

Application instructions for two layers of Actico

Ensure the limb is adequately supported Hold Actico at tension and keep the bandage close to the limb. Step 1: Bandage the fingers using a 4cm or 5cm retention bandage. Ask the patient to splay their fingers and anchor the bandage loosely around the wrist, come across the dorsum of the hand and evenly bandage the thumb with several layers. Take the bandage back across the dorsum of the hand, under wrist and repeat as with thumb to ensure adequate coverage of each finger. Step 2: Apply a layer of ActiFast tubular retention bandage, cutting a hole for the thumb. This will secure wound dressings and padding inside skin folds. An extra 6cm of ActiFast can be provided at each end and folded over to secure the padding and prevent fraying prior to Actico application. Step 3: Reshape and protect the limb using appropriate padding. Extra layers of Flexiban may be used in the cubital fossa, in the thumb web and the palm of the hand.

Warnings and precautions: Not suitable for patients with diabetes and rheumatoid arthritis unless after specialist referral and under supervision, due to the risk of micro-vascular disease. Actico contains Latex which may cause allergic reactions in some people. It is important that the patient is fully assessed as suitable for high compression. If reduced arterial flow is present, tissue damage may result. Actico sizes and their PIP Codes 4cm x 6m PIP Code: 314-0860 8cm x 6m PIP Code: 314-0886 12cm x 6m PIP Code: 314-0894 6cm x 6m 10cm x 6m PIP Code: 314-0878 PIP Code: 271-5431

Step 5. Secure Actico 4cm or 6cm loosely at the wrist (4cm for smaller hand) and bandage the hand, starting with several turns at the base of the fingers with an even tension.

Step 6. Bandage the elbow in slight flexion using a spiral or figure of eight and continue bandaging up the arm to just below the top of the padding.

Step 7. Continue with the second layer of Actico bandages, using a spiral or figure of eight technique as required to create a semi-rigid casing throughout the length of the limb.

Step 8. A final layer of ActiFast can be applied over the bandages.

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