Compression Bandaging - Sutherland Medical

Compression Bandaging - Sutherland Medical

Sutherland Medical Tubular Bandage Compression Presentation Overview of presentation 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 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 member, arterial calcification can give a falsely elevated ABPI ally > 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 Laplaces 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) 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. 18-20 mmHg Superficial or early Varices Calf muscle pump failure Varices of medium severity Ulcer prevention Mild oedema 20-30 mmHg

Ulcer treatment 30-40 mmHg Gross Varices Post thrombotic syndrome Gross oedema Severe lymphoedema 35-50 mmHg Sandy Dean compression guide Compression Bandages Class/Type Clinical indications Average ankle pressure

Type 3a light Compression Type 3b light SSB Compression Bandage - Mild Varices 15-20 mmHg Tubular Form Layered

-Varices of medium 18-25 mmHg severity Type 3c moderate -Gross Varices 30-40 mmHg Truepress Compression -Post thrombotic Veno 4

leg ulcers Profore -Gross oedema in ankles Combrilan of average circumference Tubular form 2011 AWMA Guidelines 2011 AWMA Guidelines 2011 AWMA Guidelines

Sutherland Medical Tubular Compression Bandages Tubular Form Latex Free

Australian Made Natural or Beige color Low fray formula 13 sizes (3cm-37cm unstretched width) Tubular Form SSB

(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) Inclusion criteria Venous Leg Ulcer 120cm 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 No Patients 23 Leg Ulcer Healed Tolerance 22

17 (74%) 91% Total Treatment Cost Time to Treat Short Stretch Bandage Group 10 (46%) 73%

$200 30mins $618 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 Ezy As Applicator

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