Policy Manual sample

MDT Home Health Care Agency, Inc. 136 UNNA BOOT APPLICATION PURPOSE: The application of Unna's boot will be performed in accordance with the physician's medical plan of care. Unna boot is a continuous bandage impregnated with zinc oxide, calamine, and gelatin and used for various conditions of the extremities, such as varicose ulcers when protection and support is needed. The roll should be cut frequently during application to prevent constriction as it dries. The boot should be applied in a "pressure gradient manner". That is, more pressure should be applied at the ankle and lower third of the leg with progressively diminishing pressure over the upper two thirds. At no time should the bandage be given a reverse turn. The ridges formed by reverse turns may cause discomfort as the bandage hardens. Each turn should overlap one-half of the preceding turn. The extremity should be covered approximately three times with the bandage reaching 1-2 inches below the knee. Store Unna boot in a cool, dry area. Avoid freezing. Observe for any skin sensitivity to the product. If sensitivity or irritation develops, discontinue use and consult physician. RESPONSIBLE PERSONNEL: RN, LPN EQUIPMENT: Disposable gloves, wound cleanser and dressing supplies as ordered, Dome Paste Unna Boot PROCEDURE: 1. Explain procedure to the patient. 2. Wash hands. 3. Put on disposable gloves. 4. Cleanse area with wound cleanser or normal saline as ordered. 5. Pat dry with gauze. Use care to be gentle. 6. Begin bandaging with unna boot; start at base of toes and bandage to the proximal end of the arch. Cut the bandage. 7. Bandage over the heel to the bottom of the ankle. Cut the bandage. Cutting prevents constriction as the boot dries. More pressure should be used when applying the boot to the ankle and lower third of the leg with less pressure applied over the upper portion of the leg. The dressing should be checked to make sure there is no pleating or ridges; reverse turns should not be used; the bandage should lay smoothly. 8. Apply the self-adherent bandage starting at the center of the ball of the foot near to the base of the toes. While holding bandage with thumb, pull bandage from roll. While it is stretched, wrap around the heel. 9. Continue the process of holding the bandage with the thumb, pulling the bandage from roll, stretching and wrapping while maintaining proper tension. 10. Overlap bandage while wrapping the leg by half the width of the roll until the area is wrapped to just below the knee. If necessary, cut any excess and gently press to adhere bandage 11. Remove gloves. 12. Wash hands. 13. Patient education should include: a) Normal care of the skin of legs and feet.