Gradient Compression Research Articles

JOBST® Opaque compression hosiery in the management of venous disease

Prevention of leg ulceration is a simple process involving assessment, accurate measurement of the leg and application of appropriate compression hosiery along with appropriate care of the skin. Persuasion of at-risk individuals to be aware of and follow prevention options needs to be incorporated in the ongoing health promotion activities of the practitioner (Price and Harding, 1996). This product focus examines the potential contributions of the new JOBST Opaque gradient compression hosiery (with the innovative JOBST soft care yarn) in prevention and management of venous disease and deep vein thrombosis, without sacrificing comfort and style in order to promote patient concordance.

Compression therapy.

Compression therapy, either active or passive, is the cornerstone of treatment for all venous and lymphatic disorders. Its major limitations are poor patient compliance, difficulty to apply in the elderly, and insufficient knowledge and skill in the majority of physicians. New modalities, such as four-layer bandage, tubular gradient compression, or new textile technologies, may secure a better application in difficult cases such as leg ulcers.

Standards of care for venous leg ulcers: Compression therapy and moist wound healing

Venous ulcers are the most common type of cutaneous ulceration of the lower extremity, accounting for 70% to 90% of all cases. Despite recent advances in treatment and the development of new modalities, the current standard of care remains compression therapy in combination with appropriate moist wound care principles. The physiology of the venous system and the pathophysiology of venous disease leading to ulceration are described. A review of the use of gradient compression therapy is provided, including a discussion of several types. The history of moist wound healing and the use of hydrocolloids also are included. It is essential for the vascular nurse to be well versed in the areas of compression therapy and moist wound principles as the most effective treatment for venous ulcers at this time. (J Vasc Nurs 2001; 19:20-7)

Cost and Cost Effectiveness of Venous and Pressure Ulcer Protocols of Care

To meet the challenge of an aging population, providers andpayors must optimize chronic wound care outcomes and contain costs. To explore the costs, outcomes, and effects of outcomes on costs of pressure and venous ulcer woundcare protocols. Modeling study using outcomes from a literature review. The cost of 12 weeks of wound care was modeled for a hypothetical managed-care plan. This included 100 000 covered lives and used a peer-validated wound care protocol. Only modalities with a pooled evidence base of at least 100 wounds were used to populate the model. Costs excluded supportive treatments. 26 studies of three pressure ulcer protocols (n = 519) and three venous ulcer protocols (n = 883) qualified for inclusion in the models. After 12 weeks, the weighted average proportion of ulcers healed, and cost per ulcer healed, ranged from 48 to 61% and from $US910 to $US2179 (2000 values) for pressure ulcers, and from 39 to 51% and $US1873 to $US15 053 for venous ulcers. For a hypothetical managed-care plan, the difference between the least and most cost-effective modalities was $US1.9 million for pressure ulcers and $US5.8 million for venous ulcers. Observed differences were generally attributable to variances in outcomes and cost differences related to frequency of dressing changes. Pressure ulcer care takes place in inpatient care settings; venous ulcers are managed on an outpatient basis. Physician visit frequencies are once every four weeks for pressure ulcers and once each week for venous ulcers. Wound sizes ranged from 2.5cm2 to 5.6cm2 for pressure ulcers and 5.4cm2 to 10cm2 for venous ulcers. All patients with pressure ulcers required pressure relief, nutritional support and incontinence management; venous ulcers required gradient compression. Costs per patient healed were lowest for pressure ulcers with hydrocolloids and highest with saline gauze (this is a manpower issue). Costs to heal venous ulcers were highest with human skin construct and lowest for 12-week management with hydrocolloid. Despite the limitations of the models (as a result of incomplete study data), this analysis confirms that defining wound care costs solely as cost of products used is inaccurate and can be expensive.

Venous ulceration: Compression as the mainstay of therapy

A significant number of patients with chronic venous insufficiency, venous hypertension, and venous ulceration are cared for by WOC nurses and other health care practitioners in the hospital, at home, or in an office setting. Although chronic and complicated in nature, all 3 of these disease processes may be successfully treated with gradient compression therapy. Many practitioners, however, are unaware that compression is the treatment of choice for venous ulceration, venous insufficiency, and venous hypertension. Instead, they rely primarily or exclusively on topical treatments to promote ulcer healing, and frequently become frustrated when such treatments fail or when ulceration recurs. The purpose of this article is to present an evidence-based rationale for the use of gradient compression therapy as the mainstay of venous ulcer treatment.

Presidential address: Venous disorders—Reflections of the past three decades

Presidential address: Venous disorders—Reflections of the past three decades

Long-Term Prevention of Sequelae of Chronic Venous Disease with Graduated-Compression Stockings

Chronic venous insufficiency (CVI) with associated venous hypertension may lead to stasis dermatitis and ulceration. This sixty-month study determined whether compliance with the use of below-the-knee graduated-compression hosiery affected long-term clinical manifestations. At one year, 105 patients of 284 (37%) were compliant and 179 (63%) were not. At 2 years, of the available compliant patients (89), none had skin changes; 28% of the available (51) noncompliant patients had skin changes; and 13 of this group (51) had ulceration. At sixty months, of 79 compliant patients available, none had ulceration and 11 had stasis changes. Of noncompliant patients (119) available for assessment, 63 (53%) have chronic skin changes. Compliance with the use of gradient compression below-the-knee stockings reduces the incidence of venous stasis disease and ulceration.

Management of Extremity Lymphedema

Chronic lymphedema is almost always a permanent and often progressive condition. In most cases, neither medical nor surgical means can completely relieve the effects of lymphedema. Surgical management of chronic lymphedema has high morbidity and a success rate of only 30%, and many patients return to their presurgical limb girth within three to four years. Nonsurgical treatment of chronic lymphedema can decrease overall lymphatic edema. Sequential gradient compression systems, which compensate for impaired lymphatic flow, return protein-rich lymphatic fluid from the extracellular regions of the tissues back into the circulatory system where the fluid can be excreted.

Assessment of Intermittent Pneumatic Compression by Strain-Gauge Plethysmography

Objective: To compare the physiological effects of a sequential gradient pneumatic compression device (SCD) with a single-chamber pneumatic compression device (Venodyne). Design: Single patient group with treatment crossover. Setting: Department of Surgery, University College and Middlesex Hospital, London, UK. Subjects: Thirty-four limbs of 17 normal adult volunteers were studied. Interventions: Sequential gradient compression was applied to one leg and single-chamber compression to the other lower limb for 10 min. The compression devices were then swapped to the opposite leg for a further 10 min period. Outcome measures: The increase in foot volume (distal venous distension) in response to each compression, and the subsequent decrease in foot volume (distal venous emptying), were measured. The overall reduction of foot volume (net effect) during the period of compression was calculated. Results: The results indicate the net effect was a decrease in foot volume (median decrease 0.35 ml%, 95% CI: 0.21% to 0.45%) with the SCD and no change with the Venodyne (median decrease 0.09 ml%, 95% CI: −0.25% to 0.22%). Conclusion: We conclude that sequential intermittent pneumatic compression of the calf and thigh is less likely to cause distal blood trapping and foot swelling than single-chamber calf compression.

Type of compression for reducing venous stasis. A study of lower extremities during inactive recumbency.

Determination of the optimal compression to reduce venous stasis was studied in terms of the amount of pressure and manner of application (graded or uniform pressure). Both lower extremities of seven inactive recumbent subjects were tested using transcutaneous Doppler ultrasonic measurement of femoral vein blood flow velocity. Optimal compression was defined as the externally applied pressure that produced the greatest increase in femoral vein flow velocity consistent with safety and the practicality of hospital use of elastic stockings. Optimal compression for elastic stockings to be used by hospitalized patients who spend substantial time in bed should be 18 to 8 mm Hg (ankle to midthigh). At this compression, average femoral vein blood flow velocity is increased to 138.4% of base line. Gradient compression at this level was found to produce a greater femoral vein flow velocity than the same amount of compression distributed uniformly over the lower extremity.