Working with industry.

Hello, my name is Natalie Phillips. I'm a clinical nurse specialist from the UK and specialise in the management of lymphedema. I'm here today to just talk to you for a few minutes about how it does benefit clinicians and patients when we work in partnership with industry to ensure the safe use of products. Quite often clinicians are reluctant to work with industry because of the overall assumption that industry just want to sell products and that they will do anything to ensure that their products are used. Whilst it is apparent and obvious that a company who produce and manufacture medical devices or products for use on patients need to ensure that their business is run effectively, all companies should be working within ethical boundaries that ensure they do not suggest a product that is unsuitable for a patient. With this in mind it is important to remember that whatever product a clinician is using that it is used within the manufacturer's guidelines and they feel safe and competent in its use. Furthermore that the clinician does not assume that a similar product from a different company can be used in the same way. Therefore it is important that support from industry is obtained to ensure that safe clinical practice. This is apparent more so in the use of velcro wrapping devices and toe caps as an alternative to bandaging of the lower limb and toes. These are adjustable compression wraps that can be used in chronic oedema, wound care and instead of bandaging or hosiery. There are many different names so again they can be called adjustable velcro wrapping devices or wraps and they've been previously used in lymphedema for many years but now we are seeing them used more for treating leg ulcers and as I say as an alternative to bandages but also as an alternative to hosiery. It is important to know that there are many velcro wrapping devices on the market and they are not all the same. They are indicated where patients are unable to tolerate bandaging or unable to tolerate hosiery or where patients will struggle to apply a compression device or a compression hosiery. They are adjustable in that they are completely open and close using hook and loop velcro fasteners. They are all graduated so they are all engineered to have a hundred percent compression at the ankle which graduates off and the pressure reduces as they go up the limb. This is where the similarities end. All are constructed differently and the application varies between each product. In terms of construction some may be constructed as single woven textile bands which are low profile, laminated woven bands which are a little bit thicker but these woven bands are attached to a spine ensuring that each band has a 50% overlap. You have laminated foam fabric wrapping devices which are one piece that sits over the calf and then is open at the front and applied either by interlocking the Velcro tabs on the front so they interlock at the front. So you have those that interlock and those that are overlapping. All state that they are based on short stretch bandaging theory however those that overlap are based on bandaging theory in that they have a 50% overlap with the bandwidth increasing depending on the size of the limb which makes it take into account the theories of Laplace's law and they are based on short stretching that much of the material that is used in the construction of these devices has a short stretch, it does not, it has a clear stretch and a clear lockout. The correct pressure is engineered to ensure the correct stretch, so you get the correct pressure with the correct stretch. Some will have useful cards that allow you to ensure you're getting a correct pressure but the majority are engineered to ensure that stretch achieves the correct pressure. They are useful in that they are adjustable so they can be tightened as a patient's limb reduces. They can also be tightened throughout the day as oedema reduces whereas if using a bandage that bandage stays in place and becomes less effective over the time period that the patient wears that bandage. When used instead of bandages they enable the patient to take control of their care allowing for removal and application following skincare and dressing changes. So they are being seen more and more in clinical practice and they're also used in conjunction with toe caps. Now toe caps are becoming more used, more widely used because of the reluctance of clinicians to apply effective toe bandaging. There is many articles and much evidence surrounding the fact that if a toe bandage is applied incorrectly it can cause trauma to the toes. Also toe bandaging can be time-consuming and has to be done every day. So wearing a toe cap instead of a toe bandage reduces the need to see the patient daily. But again we must be mindful that they are different. They vary in their material, vary in whether they are sized or custom-made. Some can be trimmed to fit, others can't, so you have to be clear on the toe cap you're using that you have the manufacturer's instructions. Be aware that some will have different compression levels as well. So it is important that we engage with industry so that we understand the uses of each device that each manufacturer has available on the market. And do remember that you have the correct wrap or toe cap for the correct indication, that you've got the correct application and the correct instructions for caring for that device. And also remember that industry clinicians, although employed by companies, still work within the scope of practice of their regulatory bodies. They are knowledgeable, not only in the products that their company provides, but in high standard of education and support for clinicians. They are there to ensure that you get the right treatment for the right patient at the right time. Thank you. . ♪♪ ♪♪