Unna Boot Application

Vol. 14 •Issue 8 • Page 22
Office Procedures

Unna Boot Application

by Margaret Colyar, NP

The Unna boot is a moist compression paste-and-dressing bandage used mainly to treat ulcers arising from venous insufficiency or ankle sprain with severe swelling. Venous ulceration usually occurs at the medial aspect of the lower leg, especially at the medial malleolus. It accounts for 67% to 90% of all leg ulcers, most of them in elderly women.

The many symptoms of venous insufficiency include pitting edema in the lower legs that responds poorly to diuretics, tenderness, hemosiderin (reddish-brown discoloration of lower calf), scaling, pruritis and erythema.

Unna boots are used to decrease pain, assist venous return and decrease superficial venous distention.¹ The Unna boot decreases venous hypertension and thus diminishes the movement of fluids into the interstitium.

Moist wound healing prevents the release of moisture, allowing higher collagen production, less eschar formation (eschar can diminish wound healing) and an increased rate of epithelialization.

Contraindications to Unna boot application include acute pulmonary edema, cellulitis, deep vein thrombosis, arterial insufficiency, infected venous ulcers, and phlebitis.

Unna Boot Application

See the table at left for a list of necessary equipment. To promote venous return and good ankle alignment, position the patient with the affected leg elevated above the heart and foot flexed at a right angle. Apply a nonadherent dressing over any skin lesions. Moisturize the rest of the leg with mineral oil to decrease pruritis. Avoid putting mineral oil on any skin lesions.

Starting at the base of the toes, wrap the paste bandage snugly in an overlapping method to just below the knee. Each layer should overlap the previous wrap by 50%. Smooth out any wrinkles.

Wrap Kerlex, Kling or soft roll in the same fashion over the paste bandage and cover with an elastic bandage starting at the toes and working upward until the bandage is covered. Secure the elastic bandage with metal clips or tape.

The Unna boot should be kept in place for 3 to 14 days, depending on the amount of exudate from the venous ulcer. Seven days is the average.

Postprocedure Instructions for Patients

Elevate the foot above the heart as much as possible during the day and at bedtime to decrease swelling and pain.

Keep the Unna boot bandage dry by wrapping it in plastic prior to bathing.

Do not scratch under the Unna boot; this may cause wounds.

Report any of the following to the nurse practitioner immediately: change in color of the toes, numbness, swelling, pain, odor, drainage or increased itching.

CPT Coding

To bill for this procedure, use the following current procedural terminology codes: 29580 – Unna boot application.³

References

1. Pfenninger JL, Fowler GC. Procedures for Primary Care Physicians. St. Louis, Mo.: Mosby; 2003.

2. Colyar MR, Ehrhardt C. Ambulatory Care Procedures for Primary Care Providers. Philadelphia, Pa.: F.A. Davis; 2003.

3. American Medical Association. Physicians’ Current Procedural Terminology. Chicago, Ill.: AMA; 2005.

Margaret Colyar is a family and pediatric nurse practitioner who is codirector of the NP program at the University of Utah in Salt Lake City. She is an assistant professor and has a doctorate in nursing science. She is also a member of the ADVANCE for Nurse Practitioners editorial advisory board. Reach her at [email protected].

Equipment for Unna Boot Application²

Nonadherent wound dressing (e.g., Telfa)

Mineral oil

Paste bandage impregnated with calamine, gelatin and zinc oxide

Soft roll, Kling or Kerlex

Elastic wrap (e.g., Ace wrap)

Gloves (nonsterile)

Tape or metal fasteners