PRODUCTS FOR PRACTICE


Application technique The technique for 3M™ Coban™ 2 and 3M™ Coban™ 2 Lite is easy to learn and results in comfortable and effective compression during wear. Full details can be found in 3M™ Coban™ 2 Layer Compression System Application and Removal Techniques28


.


The outer compressive layer of 3M™ Coban™ 2 and 3M™ Coban™ 2 Lite is designed to be applied at full stretch and requires an application technique that is different from many other systems (Box 5).


Full stretch application Full stretch can be determined by stretching the compression layer the few centimetres necessary until it just reaches its limit. This degree of stretch should be maintained throughout the application to the limb. The bandage should not be applied more tightly as this confers no benefit and may cause damage through constriction. If 3M™ Coban™ 2 is not tolerated at full stretch, then 3M™ Coban™ 2 Lite may be applied. It should be noted that compression bandages become more comfortable after a few hours of movement.


The 3M™ Coban™ 2 Compression System can be used on highly contoured or thin legs with minor modifications to the application technique: see 3M™ Coban™ 2 Layer Compression System Application and Removal Techniques28


then this may initially be applied at less than full stretch, with the intention of increasing the stretch at subsequent bandage changes as tolerance improves.


When to replace the bandages 3M™ Coban™ 2 and 3M™ Coban™ 2 Lite should be changed if they become loose fitting, no longer conform to the shape of the leg, become soiled with wound drainage, or have been in place for seven days. Care should be taken to keep 3M™ Coban™ 2 and 3M™ Coban™ 2 Lite dry to prevent any wound getting wet and the bandages becoming heavy and uncomfortable.


When should treatment be discontinued? If patients experience pain, numbness, tingling, discolouration or swelling of their toes, they should be advised to promptly remove 3M™ Coban™ 2 or 3M™ Coban™ 2 Lite and contact their healthcare provider.


What are the economic arguments for using compression systems? There are a number of challenges


involved when presenting a robust cost- effectiveness argument for any wound management intervention.


Using a theoretical model, Franks and Posnett (2003) were able to demonstrate that high compression therapy was a cost-effective intervention in the management of venous leg ulcers, with leg ulcer healing as a key clinical outcome29


.


However, they stressed that a thorough evaluation of the cost- effectiveness of compression therapy systems is awaited29


.


Romanelli et al assert that factors such as frequency of dressing/bandage change, nursing time, avoidance of ulcer recurrence, cost of care setting and the ability to return to paid employment are factors that should always be considered by clinicians when assessing the cost-effectiveness of treatments30


.


It is likely that compression systems that are quick and easy to apply, enhance healing of venous leg ulcers, and encourage concordance seem likely to have economic benefits.


Figure 2 Results of a controlled laboratory study measuring slippage of various compression systems27 Light shading: slippage after 24 hours for full details.


Patients new to compression therapy Patients new to compression therapy may not initially tolerate pressure levels delivered by multi-component compression systems. However, bandages often become more comfortable after a few hours, especially if the patient is encouraged to walk as much as possible. Should a patient have problems with even 3M™ Coban™ 2 Lite,


15 12


9 6 3


0 Dark shading: slippage after 48 hours


S.4


3MTM


CobanTM


2 Lite 3MTM CobanTM 2 Layer Rosidal® sys (Lohmann & Rauscher)


Long-stretch (Dauerbinde F®, Lohmann & Rauscher) Short-stretch (Rosidal K®


, Lohmann & Rauscher) Proguide®


Profore®


(Smith & Nephew)


Lite (Smith & Nephew) Profore®


(Smith & Nephew) K-Two®


(Urgo Medical) Actico®


(Activa Healthcare)


Slippage in cm after 24 and 48 hours


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