ELVAREX CUSTOM MADE MEASURING INTRODUCTORY WORKSHOP

Transcription

1 ELVAREX CUSTOM MADE MEASURING INTRODUCTORY WORKSHOP

2 Learning Objectives Ability to recognise the most appropriate time to measure for garment Understand the differences between flat knit and circular knit, and the rationale for choosing each type of garment construction Demonstrate how to correctly measure and order a knee high, armsleeve, glove and toepiece garment Identify areas where incorrect measuring techniques may cause harm e.g. over joints, end of garment

3 One size doesn t fit all

4 Ankle flare Clinical Characteristics of the Venous Limb Atrophie blanche Lipodermatosclerosis (LDS) Hyperpigmentation (haemosiderin) Venous eczema/dermatitis Prone to cellulitis (infection)

5 Pathophysiology of Venous Disease Normal venous circulation Abnormal venous circulation

6 Aims of Compression Increase total tissue pressure to encourage reabsorption and thereby reduce oedema Reduce fluid accumulation in the tissues Reduce dilated vessels and improve valve function Enhance muscle pump Increase rate of fluid flow in superficial & deep veins Ensure direction of fluid flow from distal to proximal

7 International Leg Ulcer Advisory Board Recommendations Sustained multi-layer compression is confirmed as first-line therapy for venous leg ulcers

8 Gradient Compression Provides Relief Graduated compression is highest at the ankle and reduces proximally along the limb This graduated compression supports the vein wall and helps the calf muscle to pump the blood back up to the heart

9 Ready to Wear Stockings INDICATION mmhg mmhg mmhg Minor venous indications Tired, aching legs Mild varicosis Mild ankle, leg and foot swelling Post Sclerotherapy Prevention of thrombosis (recumbent) Long distance travel Pregnancy Moderate venous indications Moderate to severe varicosis Mild to Moderate oedema Post Sclerotherapy/vein stripping Prevention of thrombosis (ambulatory) Helps prevent recurrence of venous ulceration Superficial thrombophlebitis Venous and lymphatic indications Management of chronic venous insufficiency Pronounced varicosis Severe oedema Post Sclerotherapy Orthostatic hypotension Management of active venous ulcerations Trademark of Smith & Nephew

10 RTW Measuring Guidelines re Trademark of Smith & Nephew

11 Compression Stockings For venous disease, varicosities, with veins or valves which cannot be surgically corrected, stockings are chosen at varying compression levels to assist with the prevention of ulcer recurrence Stockings must be worn for life

12 Science of Compression Law of Laplace Pressure = Tension Radius Pressure mmhg Tension fabric stretch/restoration Radius body circumferences

13 Timing is everything Initially bandaging is used in conjunction with massage to reduce the size of the limb When circumferences and/or oedema is stable then the patient is measured for a compression garment Compression garments assist to control oedema and maintain the reduction in limb circumference

14 Garment Type Selection Ready to Wear Elvarex Custom Powernet Custom Circular Knit Flat Knit-like Cut and Sew Vascular and lymphoedema Lymphoedema Burns, vascular, mild lymphoedema Sizing charts Computer Designers Basic Measuring tapes Paper tapes Upper and lower Upper and lower Body and limbs extremity extremities Thread tensions Thread tension Gram tension fabrics

15 Garment Type Selection Ready to Wear Elvarex Custom Powernet Custom Circular Knit Flat Knit-like Cut and Sew Vascular and lymphoedema Lymphoedema Burns, vascular, mild lymphoedema Sizing charts Computer Designers Basic Measuring tapes Paper tapes Upper and lower Upper and lower Body and limbs extremity extremities Thread tensions Thread tension Gram tension fabrics

16 Circular vs Flat Knit Circular Round knitting cylinder Constant number of needles Straight tube Variable stitch height Variable yarn tension Stitch building in one direction only

17 Circular vs Flat Knit Flat No fabric tension No tendency to curl 2 rows of needles 90 angle opposite to each other Variable number of needles

18 Circular vs Flat Knit

19 Measuring Tools

20 Elvarex Features and Benefits Anatomical fit due to flat-knitting technique and custom manufacture Open, mesh structure provides high air permeability Extremely durable Ability to deliver up to 70mmHg of graduated compression

21 Elvarex Features and Benefits Increased patient compliance as available in Beige and Black Individual solutions for each patient Fabric reduces tendency to indent into skin folds Low stretch thread minimises the risk of odema reoccuring

22 Elvarex Features and Benefits Micro massage effect

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26 Measuring Reports Which circumferences should be used to order garment/s? Judgement is based on: Success of previous garment Therapist experience with patient s response to bandaging Co-morbidities (e.g. heart condition, palliative patient)

27 Knee High Styles and Options Basic Styles Stockings and garments ad Knee high n/a af ag Thigh high ag-t (chapstyle) ag-ht (one leg with panty) a-t (waist high) Silicon-dot band Top edge Inside top edge 2.5cm (ad only) 5.0cm ¾ circle inside Options ab anklet ab1 T-F Bermuda (waist to above knee) Capri (waist to below knee) Zipper from B to (max. D) Medial Lateral Colour Beige Black (20mmHg, 30mmHg and 40mmHg only) Special options Slip Form (pressure panty/panty/leg to D or G) Male Fly Front Adjustable waist band for pressure panty Top Comfort Zone

28 Styles Open Open/Oblique Closed Toe

29 Options Zipper Toe piece

30 T-Heel T-Heel T-Heel vs Standard Heel

31 Position of Patient The patient should be positioned with heel firmly against the measuring board, creating a right angle Feet circumferences should be measured with patient standing and all other circumferences with patient supine

32 Lower Extremity

33 Measuring Horizontal Lengths Y-A Y-Z Open Toe Closed Toe

34 Measuring Oblique Lengths Medial Medial Lateral Y-Z Lateral Open Oblique Closed Oblique

35 Knee High Circumferences Y Measuring point Note: Position tape around the heel and over the dorsum of the ankle, asking patient to actively dorsiflex the foot, while measuring loosely

36 Knee High Circumferences and Lengths B Circumference & length Note: Smallest dimension of ankle above the medial malleolus B1 Circumference & length Note: Approximately 10cm above B

37 Knee High Circumferences and Lengths C Circumference & length Note: Measure firmly if the patient has soft tissue, oedema, fibrosis D Circumference & length Note: Head of fibula or if difficult to locate use a point 2cm distal to the popliteal crease

38 A Circumference Note: Measurement must be done with patient standing on measuring board. Place tape around the widest part of the foot. Measure loosely (A)

39 Donning Techniques Lower Extremity When putting the garment on, patients should remove all jewellery and try to avoid snagging the material with their fingernails and/or rings Rubber gloves are recommended to assist application These instructions are included with each garment Turn the compression stocking inside out all the way to the heel. Pull apart the folded-in foot part using both hands and pull over the foot all the way to the heel. Gradually pull the compression stocking over instep and heel. Then gradually pull the compression stocking upward by returning the stocking to a right-side out position piece-by-piece. Then distribute the stocking evenly by massaging with both hands until the stocking fits without forming creases. It is particularly helpful to war rubber gloves in this step.

40 Donning Techniques Lower Extremity

41 This presentation has been brought to you by Smith & Nephew, proud distributor of JOBST products