Compression Wraps for Lymphoedema - Rapid Review Feb 2016
AWMCDSG commissioned Dr Steve Thomas to undertake a Rapid Review into the role of Compression Wraps in the management of lymphoedema in January 2016.
Review Summary & Key Messages
- The literature contains no records of large scale trials on the use of compression wraps in the treatment of lymphoedema but case studies, together with data drawn from other sources, suggest that these devices may offer some advantages over existing types of compression therapy for this indication.
- Unlike multilayer bandaging systems wraps can be replaced or adjusted by patients themselves, which increases their acceptability and therefore, it is assumed, improves compliance whilst reducing the need for professional interventions.
- Despite a significant initial cost, the literature suggests that because these items can be used for an extended period, after about 12 weeks they become cost neutral after which their continued use results in savings in material costs alone of up to £900 during a six month period. No published evidence was found to suggest that the appropriate use of these new devices will contribute to increased expenditure.
- There is no evidence that compression wraps are more likely than other commonly used lymphoedema treatments to cause adverse events. However, like any other form of compression therapy, these devices should only be supplied and administered by an experienced health care professional to an individual whose underlying medical condition has been properly diagnosed. This is to exclude the possibility that the oedema is caused by some other underlying condition such as untreated congestive heart failure or congestive pulmonary disease.
- As the pressure produced by compression wraps is determined by the tension imparted to them during application, it is suggested that the availability and/or reliability of any application aids or guides should form the basis of a future investigation.
Single-use and multiple-use of Medical Devices
Paper by M. Simmons (Chair of All Wales Decontamination Advisory Group) and and Pete Phillips (Director of SMTL).
The Welsh Decontamination Committee (WDC) have been asked on a number of occasions to provide advice regarding single use items. The questions are generally:
- Does single-use imply single use within a determined period of time on more than one patient?
- Can the device be used more than once on a single patient?
This paper [PDF] attempts to give some advice in this area.
Endoscope contamination and rinse water TVCs
Pamela Ashman, Paul Hay, Emma Lindsay, Fara Shadroo, Joanna Ford and Pete Phillips
October 6th 2015
The link between contaminated endoscopes and outbreaks of infection (both genuine outbreaks of infection and pseudo-outbreaks where positive samples are taken from patients not exhibiting clinical symptoms of infection) has long been established (Srinivasan et al., 2003 and Wang et al., 1995). Failure of procedures can cause contamination (Moses and Lee 2004) and monitoring bacterial levels in rinse water can be a useful indicator of system or technique failures (Leung et al., 2003). The Choice Framework for local policy and procedure (CFPP 01-06) and the equivalent policy in Wales (WHTM 01-06) states that less than 10 colony forming units (or CFUs) of bacteria detected in 100ml of rinse water is considered acceptable. This figure is frequently referred to as the TVC (total viable count).
However, the relationship between rinse water CFU levels and endoscope contamination is still unclear - does a high level of rinse water CFUs correlate with contamination of the endoscope itself?
Strategy Group Review Date: 26th February 2016
Recommendation of AWMCDSG
Following consideration of the Health Technology Assessment on antimicrobial and antiseptic-impregnated urethral catheters (Pickard et al 2012*) and other evidence**, the strategy group were confident to make the recommendation that silver alloy urinary catheters should NOT be used within NHS Wales. The document was considered thorough with robust conclusions and the strategy group through their evidence based approach advised the use of silver alloy-coated urinary catheters did not support positive patient outcomes.
The requirement for exceptionality was considered and the strategy group agreed that none was required.
* Pickard et al. (2012), Types of urethral catheter for reducing symptomatic urinary tract infections in hospitalised adults requiring short-term catheterisation: multicentre randomised controlled trial and economic evaluation of antimicrobial- and antiseptic impregnated urethral catheters (the CATHETER trial) Health Technology Assessment 2012; Vol. 16: No. 47 ISSN 1366-5278
** The AWMCDSG acknowledge and were guided by the conclusions of the HTA** that there is, at best, no clinical benefit compared with standard catheters, that at worst they may increase the risk of UTI and that they are “unlikely to be cost-effective”.
Fluid flow accuracy of syringe drivers
Gavin Hughes, Joanna Ford, Pete Phillips
Syringe drivers are used for controlled administration of fairly small quantities of drugs. They can be set at a particular flow rate or controlled by the patient/healthcare professional in the case of analgesia. This article focuses on the accuracy of flow from syringe drivers that are set at a particular flow rate. Manufacturers often make claims regarding the flow rate accuracy of their products but they do not always stand up to the scrutiny of laboratory tests.
Factors that could potentially affect the accuracy of flow rate in syringe drivers could include the temperature of the medication (increased temperatures decrease the viscosity of fluids) (Capes et al., 1997) or the height of the syringe driver compared with the patient (Donald et al., 2007).
This paper sets out to investigate flow patterns and accuracy using one model of syringe driver over the course of an administration period.