Implementation of Tubular Bandaging to Replace Antiembolic Stockings and Elastic Wraps for Management of Orthostatic Hypotension in Spinal Cord Injured (SCI) Patients

Purpose:  This practice innovation began as a student project. The secondary author, completing her BSN program and working with the primary author, noted pressure ulcers associated with antiembolic stocking/elastic wrap use in insensate SCI patients in their facility. 

Objective:  To modify the practice of applying antiembolic stockings/elastic wraps to the legs of insensate SCI patients.  The goal was to promote venous return while decreasing risk of skin injury. 

Change Process:  Although use of abdominal binders, antiembolic stockings/elastic wraps is common practice throughout rehabilitation facilities for orthostatic hypotension management, only anecdotal evidence supports their effectiveness.  Antiembolic stockings provide sustained, not graduated compression.  Elastic wraps provide poor compression. However, since this was a longstanding facility practice, the tertiary author’s aid was enlisted as champion.  With the Chief of Rehabilitation Services’ approval, we proceeded. 

Collaboration between wound care and rehabilitation services created a change in practice. Implementation of tubular bandaging for promotion of venous return in the SCI patient with orthostatic hypotension was one indication for tubular bandaging (others included: venous return in patients with venous disease or peripheral edema and prevention of hypertrophic scarring in patients with burns).  Contraindication was ABI <0.5. 

Wound care and rehabilitation services were inserviced jointly.  SCI patients are now sized for tubular bandaging medium pressure double layer on admission.  Tubular bandaging is applied prior to patient transfer from bed.  Tubular bandaging may be “stepped down” to single layer  or double layer low presssure based on patient response. 

 Outcomes:  The process started July 2010.  No compression-related skin damage nor episodes of orthostatic hypotension have been reported related to tubular bandaging as of the last week of October 2010.

*Tubigrip®; Molnlycke Health Care