How to Apply/Remove

3M™ Coban™ 2 Compression System Application for the Full Leg with Toe Boot FootIndications• Thisposterincludesinstructionsonhowtoapplycompressionbandagingtothefootandlowerandupper

legs.• Thesetechniquesweredevelopedforpatientswithlymphoedema.Additionally,forsomepatientswith

venouslegulcers,oedemaisnotisolatedinthelowerleg,and,morebandaging,suchasthetechniquesshownhere,canberequired.

• Thetoeboottechniqueforthefoothasbeendevelopedbecauseitmaybemorecomfortabletowrapthetoesasaunitiftheyareveryswollen.Thetoebootisoptional.Ifyoudonotwishtowrapthetoes,youcanjumpfromstep3tostep9.

Positioning• Formanypatients,itisnecessarytoapplythefulllegapplicationintwostages.

1.Applythelowerlimbbandage(includingtoeboot)withthepatientsittingorlyingcomfortablyand thenhavethepatientstandtoapplytheupperlegbandaging.

2.Forfullbenefitofcompressiontherapy,itisimportantthatthelegissupportedinarelaxedposition throughouttheentireapplication.

Materials• Selectthe5cm3M™Coban™2ComfortFoamLayerandthe5cm3M™Coban™2CompressionLayerfor

thetoes(ifincluded).• Selectthe10cmCoban™2ComfortFoamLayerandthe10cmCoban™2CompressionLayerforlowerlegs.• 15cmor20cmCoban™2ComfortFoamLayerand15cmCoban™2CompressionLayershouldbeusedto

coverthekneeandthigh.• Ifawoundispresent,foamdressingsarerecommendedtomanageexudate.

Application for Below the Knee

Application for Knee and Above the Knee

Step 23: Stopthecompressionlayerapplicationattopofleg.Applylightpressureandcutofftheexcessmaterial.

Step 16: Repositionthepatienttoastandingpositionandflexthekneebyplacingarollofbandageundertheheel.

Step 24: Mouldtheentireapplicationtoconformtotheanatomy.

Step 17: Selecta15cmor20cmcomfortfoamlayer,dependingonthesizeofthelimb.

Step 19: Proceedtothetopoftheleg.Keeptheoverlapsasminimalaspossible.

Step 20: Applytwofullcircularwindingsofcomfortfoamlayeratthetopofthelegtopreventedgeroll.Asyouendtheapplication,applylightpressureandcutofftheexcessmaterial.

Step 18: Applythecomfortlayerbyminimallyoverlappingwiththecomfortlayerbelowtheknee.Coverthekneewithaspiralorfigureofeighttechniquetoensurethatthemiddleofthebandageispositionedoverthearticulatingsurfaceandcreaseofknee.

Step 21: Beginthe15cmcompressionlayerapplicationwitha50%overlapofthebelowkneebandage.Coverthekneeusingspiralwindingsorfiguresofeightasneededtoconform.Ensurethatthecentreofthebandageisinthecentreofthepoplitealcreaseandcenteredoverthepatella.

Step 22: Proceedupthelegwithspiralwindingswith50%overlapat100%stretch.Ensureatleasttwolayersofcompressionmaterialwithasmoothapplication.

Application for the Foot

Layer 2: Compression Layer

Layer 2: Compression Layer

Layer 2: Compression Layer

Step 11: Applylightpressuretothecomfortlayerwithyourhands.Thishelpstomouldthebandagetothepatient.Theendofthecomfortfoamlayermaybesecuredwithtape.

Step 9: Withminimal overlap,proceeduptheleginaspiraltechniquewithjustenoughtensiontoconformsmoothlyalongthecontours.Ifthebandagespiraldoesnotconformwithminimaloverlaps,thebandagemaybecuttoredirecttheapplication.Continueupthelegtocoverallskinwithasthinalayeraspossible.NOTE: Individual windings may be used for highly contoured legs.

Step 13: Completetwoorthreefiguresofeightaroundtheankleensuringthattheentireheeliscovered.

Step 10: Thetopofthebandageshouldendjustbelowthefibularhead,ortwofingerswidthbelowthecreaseatthebackoftheknee.

Step 14:Proceedupthelegwith50%overlapsat100%stretch,endingtheapplicationapproximately7.5-10cmbelowtheendingofthecomfortlayer.Thiswillallowthecomfortlayerforthekneeandthightooverlapwiththelowerlegcomfortlayerforsecurecohesion.

Step 1: Withthefootina90˚dorsiflexedposition,starttheapplicationwithacircularwindingatthebaseofthetoes,beginningatthe5thmetatarsalhead.Beginningatthe5thtoeprovidesneutral,comfortablefootalignment.

Step 12: Aftertoewrapping,continuewiththecompressionlayerfortheleg.Withthefootina90˚dorsiflexedposition,starttheapplicationwithacircularwindingatthebaseofthetoes,beginningatthe5thmetatarsalhead.

Step 15: Asyouendtheapplication,applylightpressureandcutofftheexcessmaterial.

Step 2: The2ndcircularwindingshouldcomeacrossthetopofthefootsothatthemiddleofthebandagewidthapproximatelycoversthearticulatingaspectoftheanklejoint.Bringthiswindingaroundthebackoftheheelandlayitoverthetopofthefootwhereitoverlapstheunderlyingmaterial.

Step 3: Cutthewrapandgentlypressintoplace.Theposteriorplantarsurfaceofthefootisnotcompletelycovered.Note: if not doing the toe boot, go to step 9.

Step 4:Filleachwebspacewithpiecesofdouble-foldedcomfortfoamlayer,foamsideoutandtrimmedtoshape.

Step 5:Witha5cmwidecomfortfoamlayer,makeacircularwindingwithouttensionaroundthetoesandtheheelwiththeoverlapoverthe5thtoe.Bringtherollacrosstocovertheopenareasoverandunderthetoes.Conformandmould.Endrollontopofthefoot.

Step 6:Usinga5cmcompressionlayerroll,withouttensionapplyacircularwindingaroundthebaseofthetoestosecurecomfortlayer.

Step 7:Continuewindingaroundtheheelandtoes.Mouldtoconform.Coverthedorsalareawithcompressionlayerappliedatfullstretchinafanfoldtechniquewithsemi-circularwindings.EnclosethetoesusingtheStretch-Press-Mould-Technique.

Step 8:Mouldtheapplicationtotheanatomyoftheforefoot.

Coban™2LayerCompressionSystemmayberemovedwithbandagescissorsorbyunwrapping.

Bandage RemovalDippingthescissortipsintocreamallowscomfortableandeasybandageremoval.

For additional instructions and alternate techniques, please see over the page

Layer 1: Comfort Foam Layer •Applythislayerwiththefoamsideagainsttheskin,usingjustenough

tensiontoconformtotheshapeofthelegwithminimaloverlap.•Covertheskinwithasthinalayeraspossiblewithnogaps.•Whenskinfolds(aprons)arepresent,usepiecesofcomfortfoamlayer

foldedwithfoamsideouttoseparatethem.

Layer 2: Compression Layer •Applyevencompressionwithatleasttwolayers.

Evencompressionisbestachievedwhenthematerialisappliedatfullstretch.

•Itisrecommendedthatyouholdtherollclosetothelimbthroughouttheapplicationforcontrolled,evencompression.

•If“bulges”arenotedaftertheapplication,applyadditionalcompressionlayeruntilthelimbappearssmooth.

Technique Tips

Layer 1: Comfort Foam Layer

Layer 1: Comfort Foam Layer

Layer 1: Comfort Foam Layer

Step 1: Makefirstcircumferentialwindingwithrelaxedtension.

Step 2:Withonehand,pressandholdtounderlyinglayer.Relaxtension.

Step 3:Applythenextsemi-circularwindingatfullstretch.

Step 4:Pressandholdtounderlyinglayerandmouldtotheanatomy.Relaxtension.RepeatSteps3-4.

Toapplyfull-stretchapplicationforcomfortablecircumferentialwindings,applythecompressionlayeratfullstretchwith“relax-breaks”where,aftereachsemi-circularwinding,thatpieceismouldedtotheunderlyinglayer.

Stretch-Press/Mould-Relax Technique

Application for a Highly Contoured Leg — Follow the Roll

Layer 1: The Inner Comfort Layer

Layer 1: The Inner Comfort Layer

Withminimaloverlap,andwithjustenoughtensiontoconformsmoothlyalongthecontours,windthebandagearoundtheankleandproceedupthelegapplyingthelayerinthedirectiontherolltakesyou.

Thetopofthebandageshouldendjustbelowthefibularhead,ortwofingerswidthbelowthecreaseatthebackoftheknee.Bringthebandagebackdownthelegtocoverallareasoftheskin.Toensureasthinalayeraspossible,trytominimisetheareasofoverlappedmaterial.

Asyouendtheapplication,applylightpressureandcutofftheexcessmaterial.Mouldthelayerstogethertoensurethatthebandagewindingscoheretoeachother.

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Layer 2: The Outer Compression Layer

Layer 2: The Outer Compression Layer

Bringthebandagebackdownthelegtocovertheentirecomfortlayerwithatleasttwolayersofcompressionmaterial.

Ifatanytimeyouwanttochangethedirectionoftheroll,youmaycutthebandageandredirecttheapplication.

Asyouendtheapplication,applylightpressureandcutofftheexcessmaterial.

Mouldthelayerstogethertoensurethatthebandagewindingscoheretoeachother.Continueonwiththeapplicationfortheupperleg(step16onthepreviouspage)

Usingthefigureeighttechnique,bringtherollbackoverthetopofthefoot,acrossthebottomofthefootandbackuptocomearoundthebackoftheheel.Completetwoorthreefiguresofeightaroundtheankleensuringthattheentireheeliscoveredwithatleasttwolayers.Cutthewrapandgentlymouldintoplace.

Withthefootindorsiflexedposition,starttheapplicationwithacircularwindingatthebaseofthetoes,beginningatthefifthmetatarsalhead.

Applythenextwindingbystartingtherollatthepreviouscutedgewitha50%overlaptotheunderlyingmaterial.Bringthebandagearoundtheankleandproceeduptheleginthedirectiontherolltakesyouwiththetopoftheapplicationendingjustbelowthefibularhead.

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Application for a Highly Contoured Leg — Cutting Technique

Withthefootinadorsiflexedposition,starttheapplicationwithacircularwindingatthebaseofthetoes,beginningatthefifthmetatarsalhead.

Usingthefigureeighttechnique,bringtherollbackoverthetopofthefoot,acrossthebottomofthefootandbackuptocomearoundthebackoftheheel.Completetwoorthreefigures-of-eightaroundtheankleensuringthattheentireheeliscoveredwithatleasttwolayers.Forsmoothconformabilityandevencoverage,cutthecompressionmaterialandproceedupthefootandlegwithindividualwindingsat50%overlap,makingsuretopressandconformeachsubsequentlayer.

Endthewrapatthefibularhead,orjustbelowthebackofthekneeandevenwiththetopedgeofthecomfortlayer.Cutoffanyexcessmaterial.Gentlypressandconformtheentiresurfaceoftheapplication.Continueonwiththeapplicationfortheupperleg(step16onthepreviouspage).

Withminimaloverlap,applythenextwindingsoitlayssmoothalongthecontoursandcutitwhenitoverlapstheunderlyingmaterial.

Proceedupthelegwithindividualwindingsusingthesametechnique.Endtheapplicationatthefibularhead,orjustbelowthebackoftheknee.Cutoffexcessmaterial.Lightpressureappliedattheendofthebandageanddownthelegensuresthatitstaysinplaceduringapplicationofthecompressionlayer.

Manypatientshaveextremelegcontours.DuetotheuniquepropertiesofCoban2LayerCompressionSystem,theapplicationtechniquecaneasilybeadaptedtoprovideconformable,effective,sustainedcompression.Therearetwoalternatetechniquesforthelowerleg–FollowtheRoll,and,theCuttingTechnique.Thereisalsoanalternatetechniqueforthetoes,andthatistowrapthetoesindividually.

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How to Apply/Remove

Forpatientswithvulnerablebonyprominencessuchasthetibialcrestorthetopofthefoot,youcanprovideadditionalprotectionbycuttingapieceofcomfortmaterialandplacingitoverthetopofthefoot,runningituptheleg.Atthearticulatingarea,makeaslitoneachsideofthestriptoconformattheankle.Gentlypressintoplace.Completethisadditionalstepbeforeyoubeginapplyingthecompressionlayer.

Forskinprotection,werecommend3MTMCavilonTMNoStingBarrierFilmforperi-wound,skinfolds,betweentoesandbehindtheknees.Ifawoundispresent,werecommend3MTMTegadermTMHighPerformanceFoamNon-AdhesiveDressingtomanageexudate.

Vulnerable bony prominences

Additional Materials

3M,Coban,CavilonandTegadermaretrademarksof3M.Pleaserecycle©3M2014.Allrightsreserved.

3M Critical & Chronic Care Solutions Division3MNewZealandLimited94ApolloDrive,Rosedale,Auckland06320800808182www.Coban2.co.nz

3M Critical & Chronic Care Solutions Division3MAustraliaPtyLimitedABN90000100096BuildingA,1RivettRoad,NorthRydeNSW21131300363878www.Coban2.com.au

Application Option for the Toes – Individual Toe Wrapping

Complete steps 1-3 on the previous page.

Beginthetoebandagingwithonecircularwinding,beginningatthebaseofthetoeswithnotension.

Bringthebandagealongthegreattoetothebaseofthenailbedwithnotension.Withthetoeslightlyflexed,proceedwithcircularwindings,distaltoproximal,withminimumstretchand50%overlappinglayers.Mouldthebandagetoconformtotheanatomy.

Atthebaseofthegreattoe,takethebandageoverthelateralborderandacrosstheplantarfootandontothedorsumofthe4thtoeuptothebaseofthenailbed(the5thtoeisleftunbandaged).Withthetoeslightlyflexed,proceedwithcircularwindings,distaltoproximal,withminimumstretchand50%overlappinglayers.Mouldthebandagetoconformtotheanatomy.

Tosecurethebandage,makeonefinalcircularwindingaroundthefoot.Cut,pressintoplaceandmouldtotheanatomy.Aftertoewrapping,continuewiththebelowthekneeapplication(step9onthepreviouspage).

Atthebaseofthe2ndtoe,makeacircularwindingaroundthefootbringingthebandageontothedorsumofthe3rdtoeuptothebaseofthenailbed.Withthetoeslightlyflexed,proceedwithcircularwindings,distaltoproximal,withminimumstretchand50%overlappinglayers.Mouldthebandagetoconformtotheanatomy.

Atthebaseofthe4thtoe,makeacircularwindingaroundthefootbringingthebandageontothedorsumofthe2ndtoeuptothebaseofthenailbed.Withthetoeslightlyflexed,proceedwithcircularwindings,distaltoproximal,withminimumstretchand50%overlappinglayers.Mouldthebandagetoconformtotheanatomy.

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Additional techniques for the Application of 3M™ Coban™ 2 Compression System to the Leg and Foot

For more information, and to view our application videos, please visit our websites: www.Coban2.com.au and www.Coban2.co.nz

Layer 1: The Inner Comfort Layer • Applythislayerwiththefoamsideagainstthe

skin,usingjustenoughtensiontoconformtotheshapeofthelegwithminimaloverlap.

• Covertheskinwithasthinalayeraspossiblewithnogaps.

• Whenskinfolds(aprons)arepresent,usepiecesofcomfortfoamlayerfoldedwithfoamsideouttoseparatethem.

Layer 2: The Outer Compression Layer • Applythislayeratfullstretch.Holdtherollclose

tothefootandlimbthroughouttheapplicationforcontrolled,evencompression.

• Itisrecommendedthatyouholdtherollclosetothefootandlimbthroughouttheapplicationforcontrolled,evencompression.

• If“bulges”arenotedaftertheapplication,applyadditionalcompressionlayeruntilthelimbappearssmooth.

Technique Tips

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Complete steps 1-8 on the previous page.

Complete steps 1-8 on the previous page.