Duration: 19:46
Welcome. I'm going to be demonstrating bandaging for the arm today. I have with me Eva, who has lymphedema in her left arm, and we're going to be doing bandaging, which is one of the most important things you can do for helping to control your lymphedema. The first thing you want to do is have all your supplies laid out in order, and that way you won't forget any of them. So the first thing we're going to do is start off. Hopefully, you have a clean arm that has lotion on it. And you're going to want to use the stockinette. So go ahead and put on the stockinette, Eva. And we always use a clean stockinette every time we bandage. We make them extra long because every time you wash them, they tend to shrink. And it is best to hand wash them and let them line dry. So you want to put it all the way to the top. And if you have a little extra, you can just leave it at the very top, and then you can pull it at the wrist. Right now, we're just going to be exposing the hand because what we're going to do is the finger bandages. So we're going to start with the finger bandage. I'm going to show you first how to do it. I'm going to use a sample of my own, and then I'll use these supplies here. So we have the finger bandages. They come in a package that we've already rolled and folded. So it has the fold here. You can see the fold aspect is going to go toward the fingers. You're going to start off, and you're going to anchor it around the wrist. I'm going to anchor it twice around the wrist loosely, and then I'm going to start at the thumb. It doesn't really matter. You can start at the thumb or the little finger. You want to have your fingers completely extended and spread so that way you don't get it too tight. And I'm just going to roll each bandage around the finger two times, and I'm going to keep it fairly taut. And I'm just rolling it on the body. And then I'm going to roll it around my wrist to anchor it. And then I'm going to come up to the next digit and come to the very base of the finger and around twice around each digit. And then to the next one, I'm going to come back and anchor it around the wrist and then go to the next finger.
I'm going to take this off, and now, I'm going to give you yours and help you with it. All right. So you're going to start -- and you want to do the fold side towards the fingers.
Okay.
And you want to anchor it twice around the base of the wrist. Um-hum, that's good. And now you want to spread your fingers. Okay. And you're going to go towards the outside of the thumb. And around twice around the thumb, around the base, so you're going to start here. Okay, and you're going to go one, two times, um-hum. Here let me help you. I'll roll it up. Okay, and now you're going to go around the wrist to anchor it. And now you're going to go around the next finger. You just need to go around one time around the wrist. And now you're going to go around the next finger, one and two. Okay, and then go around the wrist. And remember to keep your fingers spread. So the finger bandaging, the purpose is to keep the fingers from swelling. Some patients will find that they don't have any swelling in their fingers, and their therapist may decide that they don't need to have their fingers wrapped. But generally, initially, we always wrap the hand because sometimes the bandaging proximal can actually push more fluid into the hand and cause the fingers to swell. Okay. Whoops, whoops. We want to come around to the -- base of the little finger. Okay, good. All right, so that's the finished product. And notice we don't have any of the bandage on the palm. We leave the palm open. Okay, now we want to pull the stockinette down, and the next layer we're going to put on is the padding. The padding is very important because it allows some of the bandaging to even out the bandaging. And it -- as the bandages do a good job of pumping the fluid out, they're going to get loose. And so, the padding fills in that space so that the bandaging keeps the pressure on the limb.
I'm going to demonstrate on myself, and then I'll give you yours to demonstrate. I've made a little hole for the thumb. I'm going to go around the thumb here, and I'm going to hold on to it. And then I'm going to come up, overlapping the arm, half and half. Now, if I were doing this for real, I would have the stockinette underneath it, but for demonstration purposes, I'm just doing it this way. I'm just overlapping it half and half, keeping in fairly snug. You don't want it to be loose -- so you want to keep it nice and snug, and you come up the arm. So I'll go ahead and take this off, and let you do it. So we're going to start with this one. You're going to put it -- oh, let's pull this stockinette down. You're going to hold on to it here. And you're going to go around the base of the knuckles, and then around the thumb. And now, it's a little tricky, so if you need to, what you can always do is stick it between your side.
Okay.
Or if you're up against a door, you could stick it up against a wall. You could put it up against the wall to hold it. Now, this is where it gets tricky because you don't want to have too much of a bend in your elbow. You can have it up against your side if you're by yourself.
Okay. Thank you.
That roll is a little bit small, so we're going to use another piece here for an extension. We're going to just slightly overlap that, and then come up the arm. Overlapping half and half. Okay, good. And then we can just pull this down temporarily to hold it in place. All right, so that's the padding.
Now, we're ready to do the brown bandages. These are the special Comprilan bandages that don't have any elasticity. I'm going to get the tape ready. The bandages come with little clips, but we don't use those because they could potentially cut you or scratch you, and your risk of infection makes that not a good thing. So I have my tape ready, we use masking tape. It doesn't have any residue on it. There are three different sizes of bandages. We're going to start with the smallest size for the hand. And again, I'm going to demonstrate on myself, and then I'll have you do it with these bandages. So, again, I would have the stockinette, the padding, and the finger bandages, but for just demonstration purposes, I'm just going to do it on myself. Okay, so I'm going to start. I'm going to anchor it around my wrist. I can anchor it one or two times around my wrist. And then I'm going to go between -- I want to have my hand open to make sure that it doesn't get too tight. I'm going around the base of the hand, okay, once. And then I'm going to go from the little finger around the thumb, and then back up to the little finger and I'm going to do that three times around the thumb.
Um-hum.
So that's one and two -- and each time, coming back to the little finger. And then around the base of the thumb, and one last time around the base of the thumb. Okay. And this time, I'm going to come down, and now, I'm going to make a fist. And I'm going to follow this line and come up overlapping slightly or up to a half. It just depends on how much of the bandaging you have left. So the first bandaging is mainly just for the hand and the wrist. So that's what it should look like, okay? So we have the most layers distally at the hand --
On our hand.
-- To give the most pressure. Exactly. So we're helping to push the fluid from the hand up to the top of the arm.
Okay.
So we're going to start with this one. We want to just anchor it around your wrist one or two times. Okay, and now you're going to want to spread your fingers, and you're going to go between your thumb and your index finger. And then around -- remember, spread your fingers. And around the back of the hand, and now to the edge of the little finger around the thumb. And then back to the edge of the finger -- little finger, here. And between the thumb and this finger, and then back to the edge of the little finger around the thumb. Okay, and one more time. Okay, and then back to the edge of the little finger. Okay, now, make a fist, and then come. Okay, and then just barely overlapping.
Um-hum.
Yeah, a little bit closer together.
Okay.
Okay, and come down. Okay, and then we'll put the piece of tape here. All right. So the first bandage is for the hand and wrist.
Now the second bandage we're going to do -- again, we're going to pretend that I have my hand -- like Eva's is right now. We're going to start the next bandaging, and because we can start -- we can put a little piece of tape and put it on the brown bandage. I wouldn't recommend putting it on the foam though. That could possibly tear the foam, so pretend we have bandages here. So I'm going to come up. I started it at an angle, and I'm going to come up and overlap it half and half. I'm going towards my midline. And I'm overlapping it half and half and just kind of rolling it on my body.
Okay.
Okay. And then when I get to the elbow, I'm going to do this figure of eight. I'm going to come above the elbow.
Okay.
And then right in the center of it and then right in between the elbow here and then come up, so I get this little crisscross at the elbow.
Okay.
All right.
Feels good.
Okay, so we're going to start this one, and we're going to angle it up. You can put a little tape here to hold it, but not on the foam. So that way, when you come around, you're going to cover up that little tail end. And you want to overlap it half and half, and just rolling it on the body. And you're going to keep it fairly snug, so you're going to pull slightly here and here to make it nice and snug.
Okay.
And that's also the beauty of the foam. It's very forgiving. So the bandages don't have any elasticity to them. They have a little bit of stretch by the way they are woven. Now, you're going to come right here to the very crook of your elbow here. And now, this is when you're going to come around above the elbow, way up high here. Okay, go ahead and keep your elbow straight. And then you're going to come right in where the crook of the elbow is, okay, and then come right at your elbow and make this little crisscross or figure of eight above the elbow. There you go. . And then go ahead, and can you kind of put it up against yourself to hold it, and then reach across so you're not bending your elbow quite so much?
Okay.
Okay, and then come down here. So come up a little bit higher, and put it right up against yourself to hold it. And keep your elbow straight. So, since the bandages are so very rigid, they do a good job of giving the muscle something firm to pump up against, to help those muscles pump that lymphatic fluid back to the heart. Okay, now we're ready for the last two bandages. These are the two larger bandages. We're going to start at the wrist where it feels very firm here.
Um-hum.
And then right here, it feels very soft. So that's where we're going to start this bandage. Now, the first two we did towards your midline. The last two, we're going to do away from your midline to help encourage the fluid to go to the outer portion of the arm and back up. So we're going to start. We can put a little piece of tape here, and now, you're going do that pattern of coming up the arm, overlapping it half and half.
Okay.
Good. And you pull it here and here. Right, and just rolling it on the body. Okay, and now we're not going to have to worry about the figure of eight. The figure of eight is just for the first bandage.
Right.
And again, try to keep your elbow a little bit straighter. So if you can hold the bandage in towards your side or up against the wall if you're at home. And right now, I'll be your assistant. So as the bandages do a good job of helping the muscles pump the fluid out, they're going to get a little loose. And then that's what I was saying about how the padding then fills in and keeps those bandages nice and firm up against the skin to help them do their job. Then you can come up just a little bit higher here to cover up this foam. Okay, and then we have the tape here. All right, now we're ready for our fourth and final layer. So again, it feels very nice and firm here at that hand. And then about right here, you can feel it's a little bit softer.
Right. Way softer.
So that's where we're going to start the next one. So we're going to start right here. We're going to angle it up again. We're going to put the piece of tape to hold it and just come up your arm overlapping it half and -- oops.
Oh, oops.
All right. That happened, so I'm just going to roll it up. And this gives me a perfect example to explain about rolling. So when you go to reroll your bandages, you want to slightly give them a little bit of tension to them when you reroll them so that when you put them on, they're nice and firm. And that way you don't have to pull them so hard. And that also gives them the little bit of tension that's already in there so you don't have to pull them as you apply them. So you want them nice and firm when you first use the bandages. And that also makes it easier to put the bandages on yourself.
Okay.
Okay. There we go. I'm going to get a last piece of tape. What I wanted to also show at the very top of the arm, what you can do, is you can slightly kind of curve it up and make, like, a little cap and then bring it underneath the underarm, so we're making kind of -- shaping it around your shoulder.
Okay.
And then pulling it down so it doesn't go into the underarm. And then we're going to put our tape here. And then we can pull it down. Right. And you might want to put more layers on the bandage, too. So now we have the finished product, and it's always best to -- even though it feels very cumbersome, it's important to exercise and move your arm as much as you can, and especially do your lymphedema exercises.
Right.
Because the bandaging, that is their purpose is to give the tissue something -- for the muscles, something firm to pump up that you can't pump the fluid back to the heart, so the more you move and exercise your arm, the better. And it'll loosen up with time, and that's why it's recommended that every day, you change the bandages and wash them every three days to help maintain that little bit of stretch that they have to them. So it should feel tighter here at the hand and then gradually less firm as you come up the arm. And the pressure is determined by how many layers you put on it, or how tight you pull them. And generally, that's why we use so many layers because that's what gives the compressive forces.
So how does it feel, Eva?
Feels wonderful. Feels like the fluid is moving.
Oh, great. So I just wanted to reiterate, while you're in the treatment phase, I want you to keep the bandages on 23 hours a day, only taking them off to bathe. And then we're going to do that until we see results, and your arm has gotten -- the lymphedema has gone down. And then once it has gone down, we'll be fitting you for a compression garment. And then you'll be wearing that during the day, and then you will continue to bandage at night.
Okay.
And that should give you the best results.
Thank you. Yes, ma'am.
Okay, great. You did a good job. I'm impressed.
Feel wonderful.
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