Transcript Compression Bandaging

Overview of presentation
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Brief look at the vascular physiology
Ulcers (We will be concentrating on Venous Leg Ulcers)
Assessment of Leg Ulcers
Classification of bandages
Classification of tubular bandages
Sub bandage pressure
Pressure guidelines
Sutherland Medical Tubular Compression Bandages
3 Layer Tubular Form Compression Clinical Study
Resources
Anatomy
Veins and Arteries
Structure of a Vein
Structure of an Artery
valves close behind
blood flow
Calf muscle pump
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The venous pressure at the ankle of a subject who is lying supine is around 10mmHg, but on
standing this will rise by about 80mmHg, due to an increase in hydrostatic pressure.
During walking, as the foot is dorsal flexed, the contraction of the calf muscle compresses
the deep veins and soleal sinuses to a point at which they become totally collapsed,
producing external pressures of up to 250mmHg and emptying them of blood. As the foot is
plantar flexed, the pressure in the veins falls, the proximal valves close, and the veins are
refilled by blood passing through the perforators from the superficial system. During this
cycle, in a normal leg, the distal valves of the deep veins and the valves of the perforators will
ensure that the expelled blood can go in only one direction – upwards, back to the heart.
So what is one of the main
consequences of compromised
Venous blood flow?
Ulcers
An ulcer is a loss of skin integrity. The causes of
leg ulcers are multifactorial and their origins
may be:
 Arterial – involving arteries and arterioles
 Venous – involving veins and venules
 Mixed Arterial/Venous – involving arteries,
arterioles, veins, venules
 Neuropathic – due to loss of protective
sensation
* An ulcer is a sign of underlying disease, trauma or allergic response
Ulcers
 Approx 70% of leg ulcers are due to venous
disease
 10% arterial disease
 10-15% mixed arterial and venous disease
 Remainder vascular, lymphatic, trauma, blood
disorders, metabolic disorders, tumours,
infections, allergic response, self inflicted and
neuropathy
Assessment of Leg Ulcers
 Medical and surgical history
 Clinical examination
 Doppler ultrasound
 Ankle/Brachial Pressure Index (ABPI)
Calculate Ankle/Brachial Pressure Index
Divide the ankle reading by the brachial reading
Ankle
---------Brachial
The ischemic to normal range is expressed as:
Normal
Claudicant
Ischemic
Calcified
> 0.9
0.5 – 0.9
< 0.5
>1.2
Ankle /Brachial Pressure Index
< 0.5
Arterial ulcer
No Bandaging
0.5 – 0.8
Mixed
arterial/venous
ulcer
>0.9
Venous ulcer
>1.2
Possible calcified
ulcer
Tubular stretch
bandage worn
during the day and
removed at night
when leg is
elevated
Pink elastocrepe
bandage
Light elasticated
bandages
Tubular stretch
bandage
Lightly applied
compression
bandage
Compression
bandages over
padding
with/without
Tubular stretch
bandage over
compression
bandage
*Remember, arterial calcification can give a falsely elevated ABPI
(usually > 1.2 ), in which case Compression is used with extreme caution. Seek further advice
Taken from Keryln Carville wound care manual
Classification of Bandages
 Class 1 : retention
e.g. conforming gauze
 Class 2 : support bandages
e.g. heavy cotton crepe
 Class 3a : light compression ( 14 – 17mmHg)
e.g. Nylastic, Idea Flex
 Class 3b : moderate compression (18 – 29mmHg)
e.g. Tubular Form SSB, Tubular Form (double layer), Lastodur light
 Class 3c : high compression (30 – 40mmHG)
e.g. short stretch bandage, Lastolan, Combrilan
 Class 3d : extra high compression ( up to 60mmHg)
e.g. Blue line webbing
Keryln Carville wound care manual
Classification of Tubular Bandages/Stockings
 Class 1 :
Light support (14 – 17mmHg) varicose veins
e.g. Ultra-sheer
 Class 2 :
Medium support (18 -24mmHg) prevention of ulcers
e.g. Tubular Form, Tubular Form SSB
 Class 3 :
Strong support (25 – 35mmHg) server chronic venous ulcers
hypertension, and to prevent venous leg ulcers
e.g. JOBST, Venosan, Varisma, etc
Sandy Dean compression guide
Sub-Bandage Pressure
Laplace’s law :
“pressure is proportional to bandage tension and inversely
proportional to limb radius” P=kNT/R
(smaller circumference greater pressure & narrower bandage width greater pressure)
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Sub bandage pressure is controlled by person
applying bandage
 the greater the extension of the bandage
 the more layers applied
 the smaller the leg
the higher the pressure generated
Sub-Bandage pressure required for
specific clinical conditions
Clinical indications
Recommended ankle pressure
 Prevention of D.V.T.
 Superficial or early Varices
 Calf muscle pump failure
18-20 mmHg
 Varices of medium severity
 Ulcer prevention
 Mild oedema
20-30 mmHg
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Ulcer treatment
Gross Varices
Post thrombotic syndrome
Gross oedema
Severe lymphoedema
30-40 mmHg
35-50 mmHg
Sandy Dean compression guide
Compression Bandages
Class/Type
Clinical indications
Type 3a light
Compression
Type 3b light
SSB
Compression
Type 3c moderate
Compression
Average ankle pressure
Bandage
- Mild Varices
15-20 mmHg
Tubular Form
Layered
-Varices of medium
18-25 mmHg
Tubular form
severity
-Gross Varices
30-40 mmHg
-Post thrombotic
leg ulcers
-Gross oedema in ankles
of average circumference
Truepress
Veno 4
Profore
Combrilan
2011 AWMA Guidelines
2011 AWMA Guidelines
2011 AWMA Guidelines
Sutherland Medical
Tubular Compression Bandages
 Tubular Form
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Latex Free
Australian Made
Natural or Beige color
Low fray formula
13 sizes (3cm-37cm unstretched width)
 Tubular Form SSB
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(Shaped Support Bandage)
Latex Free
Australian Made
Provides 18-22 mmHg on a single layer
Unique color coding system incorporated in bandages
Low fray formula
5 Sizes
Half and full leg
Tubular Form
 The only Tubular Bandage to have practice
based clinical evidence for treatment and
healing of Venous Leg Ulcers
Study Overview
 Target 45 Patients
 Open randomized study
 Patients recruited from wound clinics in VIC and QLD
Austin Repat Wound Clinic
 Royal Park (Melbourne Health) Wound Clinic
 Caulfield Wound Clinic (failed to recruit any patients)
 The Prince Charles Hospital (Pat Aldons-Senior Visiting Consulting Physician)
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 Inclusion criteria – Venous Leg Ulcer 1–20cm requiring treatment
 Randomized to either 3 layers of Tubular Form or Short Stretch Bandage
 Followed up weekly for 12 weeks
 Assessments made on Healing of Leg Ulcer, compliance, cost/treatment,??
 Sutherland Medical support acknowledgement in clinical paper
 Tubular Form product acknowledgement in clinical paper
Clinical Results
Tubular Form Group
Short Stretch Bandage Group
No Patients
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22
Leg Ulcer Healed
17 (74%)
10 (46%)
Tolerance
91%
73%
Total Treatment Cost
$200
$618
Time to Treat
30mins
60mins
Layer 1
From Base Of Toes To Back Of Knee
(Long)
Layer 2
From Base of toes to Mid Calf
(Medium)
Layer 3
From Base Of Toes to Mid Point Between Mid Calf And The Ankle
(Short)
3 Layers Complete
Tubular Plus
“Compression in both groups was applied over a padding layer (Tubular Plus. Sutherland Medical)
to protect underlying bony prominences and prevent skin breakdown.”
Weller et al: Wound Repair and Regeneration July 2012
Sutherland Medical Resources
3 Layers Application Posters
Compression Therapy Management Guides
Tubular Form/SSB Measuring Tapes
Tubular Form Measuring Guides
All Boxes and Brochures state circumference measurements for correct sizing
Our Tubular Range
Comparative Product Charts