ELVAREX CUSTOM MADE MEASURING - ANZSVN - Home · e.g. over joints, end of garment. One size doesn’t fit all. Clinical Characteristics of the . Venous Limb ... Upper and lower extremity

ELVAREX CUSTOM MADE MEASURINGINTRODUCTORY WORKSHOP

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

One size doesn’t fit all

Clinical Characteristics of the Venous Limb

– Ankle flare

– Atrophie blanche

– Lipodermatosclerosis (LDS)

– Hyperpigmentation (haemosiderin)

– Venous eczema/dermatitis

– Prone to cellulitis (infection)

Pathophysiology of Venous Disease

Normal venous circulation Abnormal venous circulation

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

International Leg Ulcer Advisory Board Recommendations

Sustained multi-layer compression is confirmed as first-line therapy for venous leg ulcers

• 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

Gradient Compression – Provides Relief

™Trademark of Smith & Nephew

Ready to Wear Stockings

15 – 20 mmHg 20 – 30 mmHg 30 – 40 mmHgINDICATION 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

RTW Measuring Guidelines

re

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

Science of Compression

Law of Laplace

• Pressure = TensionRadius

• Pressure – mmHg

• Tension – fabric stretch/restoration

• Radius – body circumferences

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

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 extremity

Upper and lower extremities

Body and limbs

Thread tensions Thread tension Gram tension fabrics

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 extremity

Upper and lower

extremities

Body and limbs

Thread tensions

Thread tension

Gram tension fabrics

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


Flat• No fabric tension• No tendency to curl• 2 rows of needles• 90° angle opposite to each other• Variable number of needles

Measuring Tools

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


• 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


Micro massage effect

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)

Knee High Styles and OptionsBasic StylesStockings and garments

aD Knee highn/aaFaG Thigh highaG-T (chapstyle)aG-HT (one leg with panty)a-T (waist high)

Silicon-dot bandTop edgeInside top edge2.5cm (aD only)5.0cm¾ circle inside

OptionsaB ankletaB1 T-F Bermuda (waist to above knee)Capri (waist to below knee)

ColourBeigeBlack (20mmHg, 30mmHg and 40mmHg only)

Zipperfrom B to ____ (max. D) MedialLateral

Special optionsSlip Form (pressure panty/panty/leg to D or G)Male Fly FrontAdjustable waist band for pressure pantyTop Comfort Zone

Styles

Open Open/Oblique Closed Toe

Options

Zipper Toe piece

T-Heel

T-Heel T-Heel vs Standard Heel

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

Lower Extremity

Measuring Horizontal Lengths

Open Toe Closed Toe

Y-A Y-Z

Measuring Oblique Lengths

Open Oblique Closed Oblique

Y-Z

Late

ral

Medial

Late

ral

Medial

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

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

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

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)

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.

Donning Techniques – Lower Extremity

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

products

Slide Number 1Learning ObjectivesOne size doesn’t fit allClinical Characteristics of the Venous LimbPathophysiology of Venous DiseaseAims of CompressionInternational Leg Ulcer Advisory Board RecommendationsGradient Compression – Provides ReliefReady to Wear StockingsRTW Measuring GuidelinesCompression StockingsScience of CompressionTiming is everythingGarment Type SelectionGarment Type SelectionCircular vs Flat KnitCircular vs Flat KnitCircular vs Flat KnitMeasuring ToolsElvarex Features and BenefitsElvarex Features and BenefitsElvarex Features and BenefitsSlide Number 23Slide Number 24Slide Number 25Measuring ReportsKnee High Styles and OptionsStylesOptionsT-HeelPosition of PatientLower ExtremityMeasuring Horizontal LengthsMeasuring Oblique LengthsKnee High – CircumferencesKnee High – Circumferences and LengthsKnee High – Circumferences and Lengths A CircumferenceDonning Techniques – Lower ExtremityDonning Techniques – Lower ExtremitySlide Number 41

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ELVAREX CUSTOM MADE MEASURING - ANZSVN - Home · e.g. over joints, end of garment. One size doesn’t fit all. Clinical Characteristics of the . Venous Limb ... Upper and lower extremity