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COVID-19 complicated by high Venous Thromboembolism (VTE) and bleed risk in critically ill patients.

  • Study reports abnormally high VTE and high bleed risk in critically ill COVID-19 patients and calls for more effective prevention strategies.
  • Clinicians at NHS hospitals are supporting the care of COVID-19 patients with the use of geko™ devices to reduce the risk of blood clots in the most at risk patients.
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Wound Therapy

Venous leg ulcers

Chronic wounds represent a silent epidemic that affects
a large percentage of the world population and poses
a major and gathering threat to the public’s health
and the global economy1.

The cause:

  • Wounds, including venous leg ulcers often have impaired blood flow2,3.
  • Impaired calf muscle pump function increases venous stasis and venous hypertension, and can negatively impact the severity of venous ulcerations4,5,6,7.

The treatment:

  • Improved blood circulation results in enhanced wound closure3,8, a natural healing response.
  • The geko™ device increases venous, arterial and microcirculatory blood flow in the lower limb in patients with chronic venous insufficiency9,10 and intermittent claudication11. It also reduces oedema12,13, activates the calf muscle pump14 and maintains TCpO2 – promoting conditions suitable for wound healing15,16.

A case series evaluation conducted by Professor Keith Harding, at the Welsh Wound Innovation Centre (WWIC) in Cardiff (UK), has investigated the therapeutic effect of geko™ neuromuscular electrostimulation device on wound healing outcomes over an 8-week period. Findings support use of the geko™ device in patients with painful venous and mixed leg ulceration in conjunction with best practice standard care. The geko™ device was effective in reducing the wound surface area and increasing the mean percentage of granulation tissue formation. 52% reported a substantial reduction in wound pain17.

Contrast speckle imaging from a single WWIC case study (shown opposite) demonstrates a 225% increase in microcirculatory blood flow in the wound bed, and a 67% increase in microcirculatory blood flow surrounding the peri-wound area, after activation of the geko™ device. The increase in blood flow to the wound bed promotes conditions favourable to wound healing17.

Professor Keith Harding - Welsh Wound Innovation Centre

Professor Keith Harding – Welsh Wound Innovation Centre

The geko™ device – a unique opportunity to think differently!
Speckle imaging video showing microcirculatory blood flow at baseline and with the geko™ device switched on.

Speckle imaging video showing microcirculatory blood flow at baseline and with the geko™ device switched on.

Presentation – Annual Conference of Wounds Canada, Ontario, November 2017
Legs Matter - Gold Sponsor

Legs Matter - Gold Sponsor

“We’re delighted to be partnering with the Legs Matter coalition to help reshape lower leg and foot care together”

What is geko™ wound therapy?

Self-contained and wearable, the geko™ device:

  • Uses low frequency, single short pulses (1 Hz) to stimulate the nerve, compared to the much higher frequency (>30 Hz) required to  stimulate muscle, resulting in a pain-free experience.
  • By stimulating the common peroneal nerve, geko™ activates the extensor muscles and stretches the antagonistic flexor muscles, acting as a calf muscle pump14.
  • Increases superficial femoral venous volume flow by 100%, femoral arterial volume flow by 75%18 and microcirculatory blood flow to the skin on the dorsum of the foot16 and thigh19 by 400%.
  • Increases blood flow equal to 60% of that achieved when walking20.
  • Benefits patients with chronic venous insufficiency over time9,10.
  • Small, lightweight (just 10g) and easy to use – enables the patient to be as mobile and independent as possible.

Benefits of the geko™ device in wound patients

In addition, consider the geko™ device:

  • In the management of lower leg oedema that is contributing to reported pain.
  • In the management of stalled, chronic VLUs that are not progressing along the expected healing trajectory (or wounds that can be predicted to be slow in healing from the onset).
  • In conjunction with compression or when high compression cannot be tolerated.
  • For patients with fixed ankle joints, those who are bedridden or those who have limited mobility.

Unpublished evidence in an Ontario Home Care setting evaluation suggests this may be a first line treatment in conjunction with traditional therapy21.

Downloads & Links

Related Studies & Guidance

References:

  1. Gottrup F - A specialized wound-healing center concept: importance of a multidisciplinary department structure and surgical treatment facilities in the treatment of chronic wounds. Am J Surg. 2004 May; 187(5A):38S-43S.
  2. Clarke-Moloney M, Lyons GM, Burke PE, O’Keeffe D, Grace PA. A review of technological approaches to venous ulceration. Crit Rev Biomed Eng. 2005;33(6):511-56 2.
  3. NHS Choices Venous Leg Ulcers March 2015. http://www.nhs.uk/Conditions/Leg-ulcer-venous/Pages/Introduction.aspx
  4. Milic DJ, Zivic SS, Bogdanovic DC, Karanovic ND, Golubovic ZV. Risk factors related to the failure of venous leg ulcers to heal with compression treatment. JVasc Surg. 2009;49(5):1242-7. Epub 2009 Feb 23. http://www.jvascsurg. org/article/S0741-5214(08)02007-7/fulltext.
  5. Araki CT, Back TL, Padberg FT, Thompson PN, Jamil Z, Lee BC, Duran WN, Hobson RW 2nd. The significance of calf muscle pump function in venous ulceration. JVasc Surg. 1994 Dec; 20 (6):872-7; discussion 878-9. http://www.jvascsurg.org/article/0741-5214(94)90223-2/pdf
  6. O’Brien JA, Edwards HE, Finlayson KJ& Kerr G. Understanding the relationships between the calf muscle pump, ankle range of motion and healing for adults with venous leg ulcers: A review of the literature [online]. Wound Practice & Research: Journal of the Australian Wound Management Association, Vol. 20, No. 2, Jun 2012: 80-85.
  7. Williams KJ, Ayekoloye O, Moore HM, Davies AH. The calf muscle pump revisited. J Vasc Surg Venous Lymphat Disord. 2014;2(3):329-34. doi: 10.1016/j.jvsv.2013.10.053. Epub 2014 Jan 28.
  8. Mosti G, Iabichella ML, Partsch H. Compression therapy in mixed ulcers increases venous output and arterial perfusion. JVasc Surg. 2012 Jan; 55(1):122-8. http://www. jvascsurg.org/article/S0741-5214(11)01816-7/fulltext.
  9. Williams KJ, Babber A., Ravikumar R, Ellis M, Davies AH. Pilot Trial of neuromuscular stimulation in the management of chronic venous disease. 2 Posters from VEINS Conference, UK. 2014.
  10. Williams KJ, Davies AH. Pilot trial of neuromuscular stimulation in the management of chronic venous disease. British Journal of Surgery. 2015;102:20.
  11. Barnes R, Shahin Y, Tucker AT, Chetter IC. Haemodynamic efficacy of the geko™ electrical neuromuscular stimulation device in claudicants. Oral presentation at Society of Academic & Research Surgery, 2014 Annual Meeting (January 8/9, 2014), Cambridge University, England. http://www.surgicalresearch.org.uk/wp-content/ uploads/2013/10/1A_Vascular_Surgery_1.pdf.
  12. Ingves MV, Power AH. Two Cases of Transcutaneous Electrical Nerve Stimulation of the Common Peroneal Nerve Successfully Treating Refractory, Multifactorial Leg Edema. Journal of Investigative Medicine High Impact Case Reports. OctoberDecember 2014: 1–4. Available at: http://journals. sagepub.com/doi/abs/10.1177/2324709614559839.
  13. Wainwright TW, Immins T, Middleton RG, Poster Physiotherapy UK, October 2014, Birmingham.
  14. Zhang Q, Styf J, Ekström L, Holm AK. Effects of electrical nerve stimulation on force generation, oxygenation and blood volume in muscles of the immobilized human leg. Scand J Clin Lab Invest. 2014 Aug;74(5):369-77.
  15. Warwick D, et al. Microcirculation in the foot is augmented by neuromuscular stimulation via the common peroneal nerve in different lower limb postures: a potential treatment for leg ulcers. International Angiology 2015 April; 34(2):158-65.
  16. Jawad H, Bain DS, Dawson H, Crawford K, Johnston A, Tucker AT. The effectiveness of a novel neuromuscular electrostimulation method versus intermittent pneumatic compression in enhancing lower limb blood flow. J Vasc Surg: Venous Lymphat Disord. 2014;2(2):160-5.
  17. Nia.J. Jones & Prof. Keith Harding et al. A case series evaluating the geko™ neuromuscular electrostimulation device on lower limb wounds of differing aetiology.
  18. Williams KJ, Moore HM, M Ellis and Davies AH. Haemodynamic changes with the use of a neuromuscular stimulation device compared to intermittent pneumatic compression. Phlebology. Online 10 April 2014. http://phl.sagepub.com/content/ early/2014/04/10/0268355514531255
  19. Bahadori S, Immins T, Wainwright TW. The effect of calf neuromuscular electrical stimulation and intermittent pneumatic compression on thigh microcirculation. Microvascular Research 2017; 111: 37–41.
  20. Tucker AT, Maass A, Bain DS, et al. Augmentation of venous, arterial and microvascular blood supply in the leg by isometric neuromuscular stimulation via the peroneal nerve. Int J Angiol 2010;19:e31–e37.
  21. Waterloo Wellington Community Care Access Centre Pilot Evaluation. 2017. Data on file
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