Compression Bandages

NHSL Medicines Guidance
NHS Lanarkshire

General Notes: Chronic Venous Insufficiency (CVI)

Chronic Venous Insufficiency (CVI) is a progressive circulatory disease causing stasis, venous hypertension, oedema and ulceration in the lower limbs.

Graduated or sustained compression therapy is the recommended therapeutic intervention in the treatment and prevention of CVI.

Over 80% of lower leg ulcers are caused by venous insufficiency. To achieve the most effective outcome, it is recommended that following a holistic assessment, including ankle brachial pressure index (ABPI), patients are placed into the highest level of therapeutic compression that can be safely and comfortably tolerated.

Compression bandages should only be applied by those clinicians competent to do so. For this reason, clinicians must ensure that they are up to date with evidence-based best practice.

All holistic assessments and ongoing management of leg ulceration should be documented within the NHS Lanarkshire Leg Ulcer Assessment Tool.

For further information please refer to:

Two-Layer Kit Latex Free - Full Compression

1st Choice: UrgoKTwo® Latex Free multi – layer compression bandage kit

  • Ankle Circumference/Bandage Size:
    • 18-25cm/10cm
    • 25-32cm/10cm

2nd Choice: Coban 2® multi – layer compression bandage kit

  •  Bandage Size:
    •  5cm x 2.7m
    •  10cm x 3.5m
    •  10cm x 4.5m

Prescribing Notes:

  • Achieves the same levels of compression as four layer. It may lead to greater concordance for patients and should therefore be the preferred choice.

  • Indications for Use:

    • For the treatment of venous leg ulcers, venous oedema and lymphoedema.
    • For use in patients with ABPI between 0.8 and 1.3.

  • Contraindications:

    • Arterial disease (ABPI <0.8).
    • Diabetic microangiopathy, ischaemic phlebitis and septic thrombosis.
    • Allergy to any of the components.
    • Ulceration caused by infection.
    • The systems are designed to be used as a kit and should not be used with other wadding or bandages.

Two-Layer Kit Latex Free - Reduced Compression

1st Choice: UrgoKTwo Reduced® Latex Free multi – layer compression bandage kit

  • Ankle Circumference/Bandage Size:
    • 18-25cm/10cm
    • 25-32cm/10cm

2nd Choice: Coban 2 Lite® multi – layer compression bandage kit

  • Bandage Size:
    • One size

Prescribing Notes:

  • Indications for Use:
    • For the treatment of venous leg ulcers, venous oedema and lymphoedema.
    • For use in patients with ABPI between 0.6 and 0.8.

  • Contraindications:

    • Must not be applied to patients with an ABPI <0.6.
    • The systems are designed to be used as a kit and should not be used with other wadding or bandages.

Multi-Layer Kit Latex Free - Full Compression

1st Choice: Ultra Four® 4 Layer System

  • Ankle Circumference:
    • Up to 18cm
    • 18-25cm

2nd Choice: K-Four® multi – layer compression bandage kit

  • Ankle Circumference:
    • <18cm
    • 18-25cm
    • 25-30cm
    • >30cm

Prescribing Notes:

  • The multi-layer kit has been historically used to provide full compression and may be more convenient for certain situations.

  • Indications for Use:

    • For the treatment of venous leg ulcers, venous oedema and lymphoedema.
    • For use in patients with ABPI between 0.8 and 1.3.

  • Contraindications:

    • Four layer bandage systems are not suitable for patients with arterial ulcers and arterial disease.
    • Do not use on patients with an ABPI of <0.8.
    • Do not use on diabetic patients with advanced small vessel disease.
    • For details of precautions please refer to manufacturer's information leaflet.

Multi-Layer Kit Latex Free - Reduced Compression

1st Choice: Ultra Four® Reduced Compression

  • Ankle Circumference:
    • 18-25cm

2nd Choice: K-Four® Reduced Compression

  • Ankle Circumference:
    • 18cm+

Prescribing Notes:

  • Indications for Use:
    • For the management of mixed aetiology leg ulcers, lymphoedema and venous leg ulcers where patients cannot tolerate full compression or where full compression is otherwise inappropriate.
    • For use in patients with ABPI between 0.6 and 0.8.

  • Contraindications:

    • Must not be applied to patients with an ABPI <0.6.

Short Stretch Inelastic System

Please note: Layer or Orthopaedic Wadding must be applied under short stretch bandage. This should be ordered/prescribed separately.

1st Choice: Actico® (cohesive, contains latex)

  •  Bandage Size:
    • 10cm x 6m

2nd Choice: Comprilan® (non-cohesive, latex free)

  •  Bandage Size:
    • 10cm x 5m

Prescribing Notes:

  • Indications for Use:
    • Varicosis.
    • Chronic venous insufficiency.
    • Venous leg ulcers.
    • Thrombophlebitis.
    • Deep venous thrombosis.
    • After venous surgery.
    • Primary and secondary lymphoedema.

  • Contraindications:

    • Advanced peripheral arterial occlusive disease.
    • Decompensated cardiac insufficiency.
    • Septic phlebitis.
    • Phlegmasia coerulea dolens (painful “blue” oedema, caused by an uncommon, severe form of deep venous thrombosis).

Layer 1 – Orthopaedic Wadding/Soft Padding

Ultra-Soft® (latex free)

  • Bandage Size:
    • 10cm x 3.5m

Prescribing Notes:

  • Indications for Use:
    • Designed to absorb and protect bony prominences.
    • Use as layer 1 as part of the 4 layer compression system.
    • Use under short stretch bandaging.
    • May also be used to reshape the leg around the calf and ankle, to ensure correct pressures are achieved.

  • Contraindications:

    • Known hypersensitivity to any of the component materials.

Layer 2 - Light Support Bandage

Ultra-Lite® (latex free)

  • Bandage Size:
    • 10cm x 4.5m

Prescribing Notes:

  • Indications for Use:
    • Use as layer 2 of the 4 layer compression bandage system.
    • Knitted viscose and elastomer fabric.

  • Contraindications:

    • Known hypersensitivity to any of the component materials.
    • Refer to information on 4-layer compression bandage kit regarding ABPI information.

Layer 3 - Type 3A Light Compression Bandage

Ultra-Plus® (latex free)

  •  Bandage Size:
    • 10cm x 8.7m

Prescribing Notes:

  • Indications for Use:
    • Provides first compression layer as part of 4 layer compression system.
    • Layer 3 of 4.
    • Application as per manufacturer’s instruction.
    • Viscose, polymide & cotton blend.

  • Contraindications:

    • Known hypersensitivity to any of the component materials.
    • Refer to information on 4-layer compression bandage kit regarding ABPI information.

Layer 4 - Type 3B Cohesive Compression Bandage

Ultra-Fast® (latex free)

  • Bandage Size:
    • 10cm x 6.3m

Prescribing Notes:

  • Indications for Use:
    • Provides second compression layer as part of 4 layer compression system.
    • Layer 4 of 4.
    • Application as per manufacturer’s instruction.
    • Adhesive coated elastomer fabric.

  • Contraindications:

    • Known hypersensitivity to any of the component materials.
    • Refer to information on 4-layer compression bandage kit regarding ABPI information.

Paste Bandages

ZipZoc®

  • Bandage Size:
    • One size

Prescribing Notes:

  • Sterile rayon stocking impregnated with an ointment containing 20% zinc oxide
  • Indications for Use:
    • As an aid in the treatment of chronic leg ulcers.
    • Chronic venous insufficiency.
    • A primary contact layer under compression bandaging or hosiery.
  • Contraindications:
    • Known sensitivity to any of the constituents of the bandage.
    • Arterial disease/leg ulcer.

Ichthopaste®

  •  Bandage Size:
    • 7.5cm x 6m

Prescribing Notes:

  • Open woven cloth bandage impregnated with a paste containing 6.32% zinc oxide and 2% ichthammol
  • Indications for Use:
    • Management of venous leg ulcers.
    • Venous insufficiency.
    • Eczema/dermatitis.
    • Can be used under compression bandages.

  • Contraindications:

    • Known sensitivity to any of the ingredients.
    • Arterial disease/leg ulceration.
    • Diabetic patients with small vessel disease.

Up-to-Date Costs/Sizes

For up to date costs/sizes please see Scottish Drug Tariff (SDT).

Editorial Information

Last reviewed: 31/01/2022

Next review date: 31/01/2025

Author(s): NHSL.

Version: Please refer to the introduction section for an explanation of the review dates above.

Approved By: ADTC

Reviewer name(s): ADTC.