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