What do we know?

Ensuring compression garments & wraps are effective for longer

Compression garments are often an important part of lymphoedema management. There are many variables that may impact on their lifespan including:

  • How often they are worn i.e. daily compared with for certain activities such as flying.
  • The type of fabric. Flat knit garments will often maintain their compression longer than circular knit.
  • Custom made versus off the shelf.
  • How the garments are put on and taken off. Using gloves will prevent snags.
  • Washing and drying.
  • The impact of moisturises on the fibres.

Daily washing of compression garments helps them to restore and retain their elastic properties and by doing this their compression lasts for longer. It also removes perspiration, oils, dirt, bacteria and dead skin that accumulate inside the garment from activities of daily living.

Often our clients don’t want to wash their garments daily as they think it will reduce their lifespan but in fact it doesn’t damage the garments if done correctly.

What does the research say?

What is correct? Is this fact or fallacy?  A review of the research shows two publications (to the best of our knowledge) that sheds some light on this topic.

1.  Compliance and durability in pressure garments

Gallagher JM;  Kaplan S; Maguire GH; Leman CJ; Johnson P; Elbaum L

The Journal Of Burn Care & Rehabilitation, 1992 Mar-Apr; Vol. 13 (2 Pt 1), pp. 239-43.

The full paper wasn’t available. This, now old, study examined the pressure volumetric characteristics (compliance) of Jobst, Barton-Carey, and Tubigrip pressure garments for arms after repeated saturation with lubricating substances and repeated washing/drying cycles. The three treatment groups were each composed of one sleeve from each of the manufacturers and were subjected to 20 washing/drying cycles. In addition, the sleeves in treatment groups 2 and 3 were saturated with cocoa butter and Lubriderm moisturizer, respectively, before each cycle. Circumferential measurements were taken on the proximal forearm of the sleeve at varying degrees of pressure with a Grafco standard sphygmomanometer and a Gulick anthropometric tape measure Measurements were taken initially and after every fifth washing/drying cycle. Analysis of variance revealed significant results for the main effects and some interactions at the 0.01 level. Overall results showed little change in the Jobst and Barton-Carey garments, whereas the Tubigrip garments displayed an inconsistent pattern.

As there has been no opportunity to review the full paper it is unclear what methods were used for both washing and drying. The realibility and vailidity of their measuring tools is questionable. At this point the only conclusion that can be made is that in in 1992 consideration was given to the durability of compression garments.

2.   The Impact of Design Variables and Aftercare Regime on the Long-Term Performance of Pressure Garments

Macintyre, Lisa PhD; Gilmartin, Sian BSc; Rae, Michelle BSc

Journal of Burn Care & Research: September/October 2007 – Volume 28 – Issue 5 – pp 725-733

Click to read the abstract

Abstract

We sought to establish the impact of pressure garment design variables, moisturizer use, and laundry method on the ability of pressure garments to maintain their pressure delivering potential, indicated here by garment tension, over time and use. Twenty-six sets of three replicate pressure garment sleeves were constructed from four powernet fabrics, using three reduction factors and six sleeve dimensions. These pressure garment sleeves were extended for 23 hours on static cylinder models followed by hand or machine laundry up to 28 times. Some sleeves were additionally exposed to moisturizers during their extension. Garment tension and dimensions were measured before and during the simulated wear and wash period to indicate each garment’s ability to maintain its tension and therefore pressure throughout a period of “use.” The results of the investigation were analyzed in groups where each group contained only 1 variable, thereby allowing the variables with the most significant impact on tension degradation to be identified. The investigation confirmed that all pressure garments lost tension and therefore pressure delivering ability over time and use. It further revealed that pressure garments designed to exert greater pressures degraded faster than those designed to exert lower pressures. Contact between pressure garments and moisturizers accelerated tension degradation, and machine-washing pressure garments tended to prolong their pressure-delivering properties compared with hand-washing them. To maintain the initial pressure delivered by pressure garments, powernet fabrics should be prestressed before being designed/constructed and they should be machine-washed by patients.

This more recent research is limited to garments made of  powernet fabric.

The impact of the following variables on fabric tension over a period of simulated wear (static extension) and wash cycles were measured:

1   Pressure garment design variables:

    • reduction factor;
    • garment dimensions;
    • different fabrics;

2    Moisturizers

3    Washing method

The main limitation of this study was the effect of fabric stress, brought about by patient movement, was not examined. For this study laboratory simulation of wear was the only way to establish whether different moisturisers, laundry methods, and garment design variables were impacting on the tension (and therefore pressure) degradation over time and use. They were unable to simulate wear using dynamic models because of the number of variables.

There were two parts to this study. The first considered the impact of pressure garment design and the second the impact of aftercare regime which this discussion will concentrate on. Part 2 of the investigation measured the tension loss in six sets of three replicate pressure garment sleeves made from each of the 3 powernet fabrics A, B, and C (totalling 18 sets of three replicate pressure garment sleeves). Each sample was subjected to two wear and wash cycles per week for a total of 21 wear and wash cycles. All samples were washed (both hand and machine samples) at 40°C.

Each wear and wash cycle involved the sleeves being stretched over the appropriate cylinder model (which was used as a static limb substitute) for 23 hours ± 1 minute. They were hand washed together for 2 minutes in 5 litres of 30°C water containing 20 ml of Lux flakes. Samples were rinsed thoroughly in three basins of 30°C water, dried flat on a towel overnight, and left to condition in the laboratory for 24 hours before the next cycle commenced.

No information was provided on the type of washing machine, cycle chosen and the length of cycle time.

Three different moisturises were used for part 2 of the study. Olive oil, E45 (moisturising lotion) and Vasogen (barrier cream).

Results

Choice of moisturiser

Olive oil tended to have the least detrimental impact on the pressure garments’ ability to maintain their tension (and therefore pressure) during 21 wear and wash cycles. E45 and vasogen had a greater and similar effect on most of the garments’ ability to maintain tension during the test period.

Machine wash or hand wash

Machine washing pressure garments resulted in less tension degradation than hand washing in seven of nine sets of pressure garment sleeves. However, these differences between the tension lost when sleeves were hand washed and machine washed were only statistically significant in 1 sample set.

The study claims, that although the results cannot claim to show that machine washing pressure garments maintains their pressure delivering properties it significantly longer than hand washing them, it concludes it can dispel the popularly held belief that pressure garments should be hand washed. This is useful because laundering pressure garments in washing machines is more convenient than hand washing for most patients.

It was also noted that washing pressure garments and leaving to relax for a couple of days allowed them to recover their tension so that they exerted more pressure when they were first put on compared to when they were last taken off.

It once again must be remembered that this study only includes powernet fabric. The impact of laundering and moisturises on circular and flat knit garments is still to be explored.

Take home messages from this study

  • Pressure garments designed to exert higher pressures lost their tension and therefore pressure-delivering ability at a greater rate than pressure garments designed to exert lower pressures.
  • Pressure garments that are in contact with moisturisers during use will lose their tension and pressure delivering ability more quickly than pressure garments that do not come into contact with moisturisers.
  • There was no benefit to hand-washing pressure garment sleeves in terms of maintaining their tension and pressure-delivering ability. Therefore, unless there are non-machine washable wires, fastenings, or linings in pressure garments, pressure garments made from powernet fabrics composed of nylon and elastane (as they nearly always are) should be machine washed and not hand washed if this is more convenient for patients. However, patients should be instructed not to wash their pressure garments with anything that might snag or tear the garment during the laundry cycle (such as zips, Velcro, hooks/eyes), nor should they machine wash their pressure garments if the garment itself contains components that may be dislodged in the washing machine. Patients may wish to further protect their pressure garments by ensuring that any Velcro or zip fastenings are properly closed and place their pressure garments into a net laundry bag during the machine wash cycle.
  • Contact with moisturisers hastens the pressure degradation effect. Therefore, patients should apply small quantities of moisturiser to their skin/scars and allow it to absorb fully before donning their pressure garments. Anything that could be done to improve moisturiser absorption and/or remove it more efficiently at the end of the wear period would be likely to prolong the useful service life of pressure garments.

Compression garment company recommendations

Taking into consideration the lack of scientific research in this area, what should we tell our clients? At this point in time it is best to encourage them to follow the manufacturer’s recommendations. As part of this review compression garment companies were asked to provide information on washing, drying and moisturiser recommendations. A fact she has been developed to assist you when educating your clients.

To receive a flyer with care instructions from a number of manufacturers of compression garments and wraps to distribute to your clients, sign up for our newsletter.