Sutherland Medical Tubular Bandage

Compression Presentation

Overview of presentationBrief look at the vascular physiologyUlcers (We will be concentrating on Venous Leg Ulcers)

Assessment of Leg UlcersClassification of bandagesClassification of tubular bandagesSub bandage pressurePressure guidelinesSutherland Medical Tubular Compression Bandages3 Layer Tubular Form Compression Clinical StudyResources

Anatomy

Veins and Arteries valves close behind blood flow

Structure of a Vein

Structure of an Artery

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 arteriolesVenous – involving veins and venulesMixed Arterial/Venous – involving arteries,

arterioles, veins, venulesNeuropathic – 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 UlcersMedical and surgical historyClinical examinationDoppler 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 > 0.9Claudicant 0.5 – 0.9Ischemic < 0.5Calcified >1.2

Ankle /Brachial Pressure Index

< 0.5Arterial ulcer

0.5 – 0.8Mixed

arterial/venous ulcer

>0.9Venous ulcer

>1.2Possible calcified

ulcer

No Bandaging

Tubular stretch bandage worn during the day and removed at night when leg

is elevated

Pink elastocrepe

bandageLight

elasticated bandages

Tubular stretch bandage

Lightly applied compression

bandage

Compression bandages over

paddingwith/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

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

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)

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 20-30 mmHg Ulcer prevention Mild oedema

Ulcer treatment 30-40 mmHg Gross Varices Post thrombotic syndrome Gross oedema Severe lymphoedema 35-50 mmHg

Sandy Dean compression guide

Compression BandagesClass/Type Clinical indicationsAverage ankle pressure Bandage

Type 3a light - Mild Varices 15-20 mmHg Tubular FormCompression Layered

Type 3b light -Varices of medium 18-25 mmHg Tubular form SSB

Compression severity

Type 3c moderate -Gross Varices 30-40 mmHg TruepressCompression -Post thrombotic Veno 4

leg ulcers Profore -Gross oedema in ankles Combrilan of average circumference

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 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 23 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

Ezy As Applicator