How to Apply a Profore Four-Layer Compression Bandage

Liza Braun
4 Layer Elastic Compression Bandage Application Script
This video is intended to demonstrate the application of a 4 layer elastic compression bandage system. This specific technique applies an estimated 40 mmhg of pressure in an even distribution from the edge of the toes to below the knee. Each person will apply this bandage slightly differently but please always keep the patient's comfort in mind. If they cannot tolerate full compression, light compression maybe applied by withholding the third elastic layer.
Also, please always check the patient's pedal pulses and for warm in the feet. Those with arterial insufficiency or an ABI less than 0.8 should not wear compression. If you are unsure, arterial studies may be used to determine perfusion.
[Display four layers and supplementary materials]
These are the four separate layers. Each usually comes individually wrapped with the number on the packaging. You will also need tape, scissors and a primary wound dressing, if you are using one.
Some patients may report contact sensitivity to the cotton layer. To treat pruritus, you can apply a thin layer of aquaphor or petrolatum with or without clobetasol.
If you are using a primary wound dressing, apply it now. It will be held in place by the bandage, if it is not an adhesive.
The first step is to apply the cotton layer. You should start at the base of the toes, getting as close to them as possible both on the dorsum and plantar surface of the foot. You will continue to wrap with 50% overlap between layers. Typically you apply two layers on the foot before you get the ankle, where you wrap along the edge of the foot , the back of the ankle, and then over the heel. Tension cannot be applied to this layer because the cotton will rip. However, you want to avoid wrinkles, which can cut into the patient's skin under compression. Continue in a spiral fashion up the leg with 50 % overlap until you reach the back of the knee.
The next layer is the light conforming bandage. This can withstand tension but should not be pulled tightly around the leg. The bandage is applied in the same spiral fashion as the previous layer and secured with tape at the top.
The third layer has elastic in it. Follow the directions of the specific brand that you use, because sometimes these layers different between products. This specific bandage can be stretched to 100% tension; however you want to apply it with 50% tension, so practice maintaining 50% tension before you apply.
This layer is unique because it is applied in a "figure-eight" fashion with 50% overlap. You should apply the bandage to the foot like previous layers until after the ankle. Then begin the "figure eight". Following the central line with help maintain 50% overlap. Again, secure the bandage at the top with tape. You can cut off excess bandage if the patient's leg requires less material.
The final layer is a coban layer that also requires 50% tension and is applied like the first two layers. Do not use the "figure-eight" technique with the coban. Patients typically find this layer to be the most uncomfortable, so keep in mind how much tension you use.
Tell the patient that they should continue to walk and enjoy daily activities. However they should also elevate their legs at the end of the day. If at any point they experience pain or uncomfortable tingling in their toes, start with removing the fourth layer. It is still too painful, remove the whole bandage immediately and return to the office. These bandages are typically applied for 1 week at a time, however in Europe they are left for up to 3 weeks. In order to shower, the patient will need a garage bag or a shower bag similar to the kind used with casts to protect the bandage from water. The patient should return to have this bandage removed, be reevaluated by a physician and then reapplied if necessary.

Tips:
Due to the nature of advanced chronic venous insufficiency and venous ulcers, the patient may have a "inverted champagne bottle" lower leg shape. Additional padding or cotton can be applied to the narrowest part of the leg to maintain even distribution. This will also help if the patient experiences excess drainage and odor from their wound. If the patient is overweight, they may have difficulty keeping the bandage from falling down. Adding extra layers of cotton on the narrowest part of the leg will help.
Some patients find the coban layer to stick to their clothing. A Tubifast sock with minimal compression can help.