Unna's Boot Application

1. Wash and dry the extremity and place a topical dressing on any wounds
2. Flex the patient's foot to 90 degrees so that bunching doesn't occur.
3. Using either a lose wrap or open wrap method, start at the base of the toes and continue to the knee. An Unna's boot should never stop mid-calf, and the bandage must be applied in such a manner that swelling can occur.
4. A variety of materials can be used to wrap an Unna's bandage.



Purpose

As a wound or foot care nurse, you'll encounter a variety of ailments requiring specialized treatment. For patients with chronic swelling due to edema or venous disease in the lower extremity, an Unna's boot could help drain fluids, reduce pressure and pain, increase blood flow and encourage skin health and wound healing.

Precautions

An Unna's boot isn't for everyone. Because it is designed to work with the contraction of the muscle to force one-way bicuspid valves open in order to move fluids, an Unna's boot is recommended for patients who are active and not bed or wheelchair bound.

Once applied, an Unna's boot can remain in place for up to a week. However, if drainage causes leaks, the dressing must be promptly changed. Similarly, the boot is not intended to be worn while showering or bathing. For either of these to occur, the wearer must cover the entire bandage in a plastic protector in order to eliminate contact with water.

Preparation

The layers of the Unna's boot are designed to work together to reduce swelling from fluid and improve circulation. Before applying the first layer, wash and dry the extremity and place a topical dressing on any wounds.It is also a good idea to gently smooth lotion or cream on the skin of the leg for addition skin health and protection. It is best to apply the cream or lotion after the wound dressing is in place so that the dressing will stay in position.

Next, flex the patient's foot to 90 degrees so that sores aren't created by the bunching of material on the front of the ankle.

Bandaging

Purchase paste bandage.
Purchase self-adhesive wrap.
Start with the Unna's boot paste dressing. There are a variety of paste bandages you can work with, however, a zinc paste will reduce the possibility of allergies occurring. Wearing gloves during this process will ensure your hands aren't soiled by the paste. Ensure your patient's clothing is out of the way as well.

Paste bandages do not contain elastic fibers and therefore do not stretch. The bandage must be applied in such a manner that swelling can occur. It is therefore extremely important never to wrap the bandage tightly; there should be no tension on the bandage while you wrap your patient's foot and leg.

How to Apply Unna's Boot Dressing

There are several techniques when wrapping the bandage: "loose" and "open".

Always suspect that more swelling might occur, even with the Unna wrap in place.

To protect the patient from serious skin and vascular damage the Unna should be applied by one of the two methods below.

Overlay or Loose Wrapping

This type of wrap can be created using a folding technique. Much like an accordion has expandable folds, so does a loose wrap. Ensure that your accordion folds are smooth and reside at the top of the foot so that no pressure points or sores can develop. As with basic spiral wrapping, begin at the top of the foot at the base of the toes.

Open Wrapping
An open wrap is another variation of a loose wrap. However, here, instead of creating an accordion fold that can expand, we never close the bandage at all. To create an open wrap, start at the base of the toes, as with both other methods. Release some of the bandage as if to wrap the bottom of the foot, and stop. Now fold the bandage back over onto itself and wrap in the opposite direction. When you have reached the top of the foot again, reverse the direction of your wrap once more. In this way, the top of the bandage wrap always remains open.

With both methods, it is important to apply the wrap from the base of the toes up to the top of the fibula, about two or three fingers distance below the knee. An Unna boot should not stop partially up the calf.

Finishing

A variety of materials can be used to wrap an Unna bandage. A 4 inch wide cohesive (eg. Coban) wrap is the most common top layer after the Unna is applied. This cohesive layer will add about 15 mmHg compression and protect clothing from the paste of the Unna. Other alternatives for a top layer are cast padding or an ace wrap. These do not have the advantage of assisting in edema reduction.