Compression therapy for venous ulcers requires accurate monitoring to ensure successful delivery and the desired compression dose. However, according to a study presented at the American College of Phlebology annual meeting (ACP; 2–5 November, Austin, USA), the level of pressure actually delivered is “highly variable” even after a training and feedback period, which suggests that pressure monitoring devices may be required.
Felix Trinh (Jobst Vascular Institute, Toledo, USA) explained that the use of compression therapy for venous ulcers has grade 1, level A evidence, as documented by Society for Vascular Surgery and American Venous Forum guidelines. However, there remains no recommendation for the ideal amount of compression to be used. Existing evidence is limited, and current practice commonly uses 30–40mmHg of compression for patients without significant arterial disease.
Trinh told delegates that pressure-measuring devices are not routinely used at the skin-bandage interface to ensure that adequate pressure is being achieved, meaning that users cannot be sure of variations in pressure delivery. Trinh and colleagues thus designed a study to investigate whether wound clinic staff could be trained to consistently deliver the desired amount of pressure.
The study was carried out at a community-based wound clinic. Pressure was measured during compression bandage application using a PicoPress device (MediGroup), with measurement taken at position B1.
The trial ran for 12 months. In the first three months, nurses were blinded to the 163 pressure measurements taken. After this, nurses applied bandages and were unblinded to pressure measurements for six months, which formed the training period. For the final three months of the study, nurses were again blinded to 38 pressure measurements during bandage applications.
During the first three months, “there was quite a bit of variability” in pressure levels achieved by the nurses, Trinh said. In the final three months of the study, variability was slightly reduced and application was “a little better,” but variability remained relatively high. Trinh said that there was no difference in the mean pressure ratings in the two periods.
“Delivered pressure was highly variable both before and after the training and feedback periods,” Trinh said. “We conclude that to really know what kind of pressure we are delivering, we have to use measurement devices. Training seems like it can improve variability, but maybe not to the level that we need to ensure proper treatment.”
“Further studies are now needed to increase the number of measurements to provide more statistical power, using multiple points of compression to measure levels of graduated compression”, he added.