Common Questions

Activa British Standard Compression Hosiery

Apart from wearing compression hosiery, what other self help measures can I apply to take good care of my legs?

DO:

DON'T:

If you would like a copy of our Taking Care of Your Legs leaflet please call our Customer Care number on 08450 606707.

What Kind of Hosiery Should I Wear?

Activa Compression hosiery is available in Class 1, 2 and 3, depending on how much support your legs need. Activa Class 1 unisex socks can be bought from your pharmacist who will measure your leg to get the correct fit, selection by shoe size alone may not give adequate compression.

Class 2 and 3 hosiery provide stronger compression, you will need to be fully assessed by a nurse or your GP before wearing the higher compression hosiery.

What styles are available?

Activa hosiery is available in thigh length and below knee and closed and open toe. British Standard unisex socks are available in black (Classes 1 and 2), brown (Class 2)black patterned (Classes 1 and 2). Tights are available in black (Class 1) and natural (Class 2) but are not available on prescription.

I've been prescribed Class II hosiery and I'm finding it difficult to get on, can you help?

Yes. Actiglide is a stocking applicator which allows your hosiery to glide effortlessly up your leg. It is available on prescription or bought over the counter in pharmacies.

My Activa British Standard thigh length hosiery won't stay up.

The Activa British Standard thigh length needs to be held up with a suspender belt or stuck to the skin with a body adhesive. Venosan Coltex is a body adhesive suitable to use with Activa hosiery and can be purchased on line. There is an NHS suspender belt available on prescription which is suitable for men and women.

I'm going on holiday and I will be flying. Do I need to wear DVT Socks?

We would always recommend that you wear Activa Unisex Sock if you are travelling short or long haul, or indeed on any journey where leg room is restricted. Research has shown that even short journeys of three hours can put you at risk of DVT.

Activa produce a Class 1 Unisex Sock which is perfect for protecting your legs when travelling. However, if you are wearing a Class 2 or above on a daily basis, continue wearing your normal hosiery when travelling.

How do I examine my own legs?

If you have any concerns about your leg health you should see your Practice Nurse or GP.

You should also get into the habit of regularly checking your own legs, and these are the things you need to look out for:

Should pregnant women wear compression hosiery?

Pregnancy and varicose veins

The hormonal changes during pregnancy cause blood vessel walls in the legs to relax. Combined with increased blood volume during pregnancy, blood can pool in the legs, which can stretch the vein walls, making them more visible and protruding. These are known as varicose veins.

Once the baby is born, many women’s veins will return to normal. Unfortunately this does not always happen, especially if it is not the first pregnancy.

Varicose veins can be hereditary. If your parents have them, then it is probable you may have them.

Preventing varicose veins in pregnancy

Hormonal changes in the first ten weeks of pregnancy cause the greatest risk of varicose veins.

It is advisable that, to avoid varicose veins during pregnancy, compression hosiery should be worn as soon as you start trying to conceive, and for the duration of the pregnancy. This will reduce the risk of developing varicose veins, and also prevent aching legs and swollen ankles.

Compression hosiery helps to prevent varicose veins by applying a gentle squeeze on the ankles and calves. This assists blood flow back to the heart, thus reducing the risk of varicose veins.

Free prescriptions for pregnant women

Pregnant women at risk of varicose veins are eligible for free compression hosiery prescriptions from their GP. Always see your Doctor or Midwife if you are worried about your leg health.

The compression level recommended by health professionals for wear during pregnancy is Class I, available from your pharmacist as below knee stockings or socks, or they can be purchased on line.

Hosiery styles for pregnant women

A below knee stocking/sock is probably the most comfortable type of compression hosiery for pregnant women to wear. It is very effective at assisting blood flow without having to incorporate the bump.

For varicose veins above the knee, British Standard Class 1 thigh length stockings are available on prescription. To avoid having to wear a suspender belt, a body adhesive (water based, so it will wash off) is available from Daylong. Similar to an underarm roll-on, you roll it around the top of your leg and adhere the stockings to it.

For compression hosiery to have maximum benefit, it must be the right size. It is therefore essential your legs are measured to ensure the correct fit. Your pharmacist can do this for you.

Professional Questions

How often should the hosiery be replaced?

Every 3 months. After 3 months of regular wear the garment loses elasticity and is unable to provide adequate compression. We recommend prescribing 2 pairs at once, one to wear, one to wash and replacing both after six months.

Closed or open toe?

The choice of style is decided through discussion with the wearer. It is influenced by foot length i.e. A long foot may fit into a size large but the ankle and calf are size small, so an open toed small would be appropriate.

If wearing the hosiery at night (maximum 7 nights) or for several days, an open toe allows the foot to be washed. If the wearer sees a chiropodist an open toed stocking will probably not need to be taken off. Painful corns on toes may make an open toe more comfortable.

Knee or thigh length?

For most conditions a below knee is as effective as the longer thigh length. Many patients find a below knee easier to put on and wear. However it is important to discuss the style with the wearer.

Some female patients may feel more at home with thigh length stockings and suspenders. (The thigh length stockings need suspenders, NHS versions are available). Swollen or arthritic knees tend to be more comfortable in thigh length hosiery. Thigh length is suitable for patients with painful or protruding varicose veins at the back of the knee.

Male patients can be offered the unisex sock in black or brown, indistinguishable from normal hosiery.

Class 1, 2 or 3?

The class the patient requires is dependent on a full and holistic assessment of the wearer. Local guidelines may influence the choice. More information can be found here.

What is the difference between Activa's British standard compression hosiery and ActiLymph garments?

The ActiLymph® range uses European compression levels.These are slightly higher levels of compression than the British Standard Classes. The fabric used in the ActiLymph® garments is different from the British Standard range as it provides the stiffness required to manage chronic oedema.

My patient has reacted to the hosiery, what should I do?

Activa hosiery contains Lycrasoft. Occasionally some patients may react to this. Reactions more commonly occur from the emollient and Lycrasoft interacting, or the hosiery not being thoroughly rinsed after washing and containing harsh residues from detergent. An inner liner of Actifast under the hosiery may help.

My pharmacist always dispenses a competitor brand although I request Activa.

To ensure you receive Activa hosiery, it is necessary to write Activa on the prescription. Pharmacists must, by law, dispense the brand written on the script. Remember hosiery sizes vary from brand to brand.

If you have used an Activa size chart and written an Activa size on the script, you need to brand it "Activa" to ensure the patient receives the correct size.

All brands cost the same on FP10 so why choose Activa?

Our hosiery is soft and easy to fit; it contains features designed from nurse and patient feedback e.g. large toe area so as not to compress the toes.

The size is right so why is the hosiery so hard to get on?

The ease of fitting the garment is effected by several factors. These may include the expertise and dexterity of the fitter. Fitting hosiery first thing in the morning is generally easier than later in the day. Using a foot powder may help, not regular talcum powder as it may form balls if the foot is damp.

Actiglide is a device to help get both closed and open toe hosiery on. It is available on prescription.

Can the hosiery be worn at night?

Yes, the hosiery may be worn 24 hours a day.. Providing there our no medical conditons which mean compression should not be worn, the hosiery can be worn for up to a week at a time. Activa recommend an open toe so the foot can be washed or chiropody treatments carried out.

Why are the Class I and II tights not available on FP10?

The Drug Tariff Board decides the inclusion of products on FP10. The tights can be bought from your pharmacy.

Does Activa Hosiery contain rubber?

No, the hosiery is made of nylon and lycra

Where do I get NHS suspenders for holding up thigh length stockings?

Two styles of NHS suspender belt can be obtained from Credenhill T: 01159 320 144 They are the Credalast adjustable suspender belt or the Y shape suspender belt for a man (this is attached to the patient's trousers by one strong button).They are both khaki in colour. Both styles are available on prescription.

ActiGlide

Is ActiGlide suitable for everyone having problems putting on their hosiery?

If someone will be using the ActiGlide without assistance they need to be able to bend down to put hosiery on. The wearer also requires the manual dexterity to thread the bendy, plastic pin through the eyelets in the ActiGlide.

Is the ActiGlide just for Below Knee stockings?

The ActiGlide can be used to help apply thigh length and knee high hosiery and tights. The ActiGlide also works on armsleeves.

Can the ActiGlide be used for closed and open toe hosiery and tights?

Yes, it is suitable for both.

Is ActiGlide available on prescription?

The ActiGlide is available on prescription and it is available from pharmacies (pip code 284 - 5196).

How do I keep the ActiGlide clean?

It can be wiped clean with a damp cloth.

ActiLymph

What are the prescription charges for Activa hosiery®?

ActiLymph: A single prescription charge is payable per script, regardless of quantity supplied on script where the compression level and style are the same.

e.g: 1 or more stockings = 1 prescription charge

e.g: 1 or more arm sleeves = 1 prescription charge

Activa British Standard: A pair of stockings = 2 prescription charges. There are a pair in the box.

As a pharmacist can I dispense one stocking from the pair in the box?

You will not be able to claim for broken bulk. Activa recommends a stocking to wear and one to wash for patient convenience.

How long do the hosiery and armsleeves last?

Up to 100 washes

How do you wash the hosiery and arm sleeves?

Hand wash up to 40 degrees. Do not tumble dry and keep away from direct heat. Dry flat if possible.

I find the hosiery and armsleeves difficult to put on, what can I do?

The garments do have high levels of compression which is what makes them control swelling but can also make them more difficult to apply.

If you are applying them correctly and it's still difficult, an ActiGlide applicator may also help for both arm and leg garments. It is a reusable applicator which enables your garments to slide on. The ActiGlide is available on prescription.

What is the difference between Activa's British standard compression hosiery and ActiLymph garments?

The ActiLymph® range uses European compression levels.These are slightly higher levels of compression than the British Standard Classes. The fabric used in the ActiLymph® garments is different from the British Standard range as it provides the stiffness required to manage chronic oedema.

What compression do the European classes give compared to British Standard hosiery?

European Class 1: 18-21mmHg

European Class 2: 23-32mmHg

European Class 3: 34-46mmHg

British Standard Class 1: 14-17mmHg

British Standard Class 2: 18-24mmHg

British Standard Class 3: 25-35mmHg

Does the ActiLymph® range contain latex?

No

Anklets and Kneecaps

Do I need to be measured for anklets and kneecaps?

Yes, it is advised that you are measured by a health professional.

How would a prescription be written for an Activa Kneecap?

The prescription needs to state e.g. Class 2, Activa Kneecaps 2 pairs.

Which way round does the kneecap go?

The square goes on the back of the knee. It is shaped for comfort and to prevent wrinkling at the back of the knee.

Leg Ulcer Hosiery Kit

If a patient applies their stockings in the wrong order, does it matter?

No. We suggest the liner first, as it enables the high compression stocking to glide on more easily.

How many prescription charges does the patient pay?

One charge is paid for the Activa Leg Ulcer Hosiery Kit ( 1 stocking 2 liners) One charge is paid for the pack of 3 liners

What needs to be written on the prescription?

The name of the kit can be written as: 'Activa Leg Ulcer Hosiery Kit' or 'Activa Hosiery Kit.' Plus quantity/number of kits. The pharmacist needs to know it is circular knit.

Washing Instructions

The top stocking maintains its compression for 100 washes. It can be hand washed up to 40 degrees but must not be tumble dried. After 3 months of wear a new prescription is required.

Can the treatment kit be worn over dressings?

In evaluations the Leg Ulcer Hosiery Kit was worn over dressings without dislodging them etc. However, if a patient has a very large ulcer with copious exudate, bandages would be more appropriate and Actico with a Flexiban padding bandage would be more absorbent.

Can the patient sleep in the hosiery kit?

Yes, they can. The hosiery can be worn for a week at a time in the same way as patients who wear compression bandaging. As the top stocking glides on relatively easily over the liner some patients may wish to remove the top stocking at night and re-apply in the morning.

Do some patients only wear the liner?

The liner gives 10 mmHg of compression and may be suitable for patients where lower compression is indicated. Again, any patient needs a full evaluation, including a doppler asssessment, before wearing any compression hosiery.

Is the Hosiery Kit suitable for all patients?

No, the patient's limb needs to fit into the standard hosiery sizes, a leg may need to be reduced with bandages before it is a suitable size and shape. Patients with large ulcers and heavy exudate would be more suited to bandages.

Can normal footwear be worn?

Yes, in most cases as the hosiery is not bulky. Being able to wear normal shoes is also beneficial at encouraging mobility.

Liner Pack

What ABPI (Doppler measurement) is recommended?

More than 0.8 and less than 1.2 then the liners can be worn.

Less than 0.8 and more than 1.2 then the liners should be used with extreme caution and only under specialist referral and under strict supervision.

What needs to be written on the prescription?

Quantity: 1 x Activa Liner Pack

Toe style: Open toe

Size: Large

Pip code if possible: 340-3573

Can the liners be machine washed?

Yes, up to 40 degrees but must not be tumble dried. The liner will maintain its compression for 100 washes. After 3 months of wear a new prescription is required.

Can the patient sleep in the liners?

Yes, they can. The hosiery can be worn for a week at a time in the same way as patients who wear compression bandaging. If the liner is being used with another stocking or other liner, then sometimes wearers remove the top stocking at night and reapply it first thing in the morning.

Can normal footwear be worn?

Yes, in most cases as the liners are not bulky. Being able to wear normal shoes is also beneficial at encouraging mobility.

British Standard Made to Measure

How do I order Made to Measure hosiery?

Print off the form from here or Activa can fax it to you - just call 08450 606707. Then measure your patient and fill out the form ( see tips for filling out the form). The pharmacist will fax off the form to Credenhill (not Activa) to the number clearly printed on the M2M form. The hosiery will then take 5 working days to arrive. The hosiery is manufactured for Activa by Credenhill tel. 01159 320 144

Are Made to Measure stockings available on prescription?

Yes

How long will a Made to Measure stocking take to make?

5 working days from the pharmacist faxing the measurements to Credenhill and the hosiery arriving back at the pharmacy.

Are Made to Measure stockings more expensive than stock sized ones?

They do cost more than stock sized hosiery because they are bespoke garments. Our Made to Measure hosiery is soft, comfortable and popular with wearers.

Tights

Are tights available on prescription?

Unfortunately not at this time. Charges are decided by the Department of Health not by hosiery companies.

Do Class 1 and Class 2 tights give more compression than the below knee and thigh length garments because they go up higher?

At the same points on the limb Class 1 and Class 2 tights give exactly the same compression as a below knee and thigh length stocking. However as the tights have a panty section, compression is given up to the groin area.

ActiLymph Made to Measure

How do I obtain a Made to Measure form?

Click here and print one off, or call Activa Customer Care Team on 08450 606 707.

What is the turnaround on the hosiery?

10 days

How should the hosiery be washed?

ActiLymph MTM hosiery is manufactured using high quality materials. We advise you to wash the stocking every time after use.

Actico

Does the Actico two layer system work?

Actico two-layer system works in the same way as the short stretch bandages and exerts the required level of compression to reverse venous hypertension and so effect healing.

Ref: Tests carried out on the MST at Edinburgh demonstrated the sub bandage pressures exerted by the bandage to meet the requirements for listing on the drug tariff

( Data on file , October 1998 )

Are short stretch bandages as effective as 4 layer bandages in the healing of venous leg ulcers?

A randomized trial conducted at the Churchill Hospital in Oxford compared the short stretch bandages, the four-layer bandage system and a long stretch bandage. This study showed that the reduction in oedema and the complete healing rates were significantly higher in the four-layer and short stretch group than in the long stretch group. There was no significant difference in the efficacy between the short stretch bandage and the four- layer bandage system. Care should be taken when describing bandages as "single layer", so that there is no confusion between long stretch and short stretch bandages.

Ref: Duby T, Hoffman D, Cameron J, Doblhoff-Brown D, Cherry G, Ryan T, ( 1993 ) A Randomised Trial in the Treatment of Venous Leg Ulcers Comparing Short Stretch Bandages, Four Layer Bandage System and a Long Stretch-Paste Bandage System.

Wounds: A Compendium of Clinical Research and Practice, 5,6 Nov-Dec 276-279

A poster on a Community based project by Hildegard Charles and Kate Ballard in London described the experiences of the authors and the efficacy of short stretch bandages in the control of oedema and the healing of venous ulcers. The study also included cost comparisons.

Ref: Charles H, Callicott C, Mathurin D, Hart J, Ballard K ( 1996 ). Short Stretch Compression. An effective and cost saving system for venous ulcer management. Poster presentation at 2nd National Wound Care Conference on Managing Wounds, improving Patient Care, Harrogate November 1996.

A recent case study by Jackie Hawkins showed " Actico cohesive short stretch bandage to be the optimum choice of treatment as the wound healed within 7 weeks ( under the national average i.e. 12 weeks, for healing with compression )

Ref: Hawkins,J. ( 2001)A New Cohesive Bandage and its Application, British Journal of Nursing, 2001, Vol 10, No.4

What are the differences between working and resting pressures?

The working pressure is the internal pressure directed towards the bandage by the calf muscle on exercise (40-50mmHg), whilst the resting pressure is the force exerted by the bandage when the calf muscle is not working ( 20mmHg). "This difference in pressures gives a pulsating, massaging effect to improve venous return"

Ref: Charles,H ( 1999); Short stretch bandaging in the treatment of venous leg ulcers;

J of Wound Care, June, Vol. 8; No.6: 303-304

Are short stretch bandages safe?

Bandages that are applied at full stretch are less likely to overcompress the limb. "Long stretch bandages because of their elasticity, can be overstretched during application resulting in greater sub bandage pressures, precipitating ischaemia and worsening of the ulcer ( Raj et al., 1980)"

Ref: Krishnamoorthy, L; Melhuish, J; (2000), Short Stretch Compression Bandaging, Journal of Community Nursing, September 2000, Vol.14; Iss.9; 29-37

Ref: Raj, TB, Goddard,M; Makin,GS; ( 1980); How do compression bandages maintain their pressure during ambulatory treatment of varicose veins?", British Journal of Surgery, 67;122-124

"Elastic bandages with a high recoiling force e.g. long stretch and the 4LB system, can cause ischaemic pain if applied too strongly, whilst rigid, inelastic material exerts a much lesser resting pressure"

Ref: Tuckwood-Smith, J ( 1996); Which compression therapy, Journal of Community Nursing, Nov. Vol. 10; Iss. 11; 26-30

Is Actico difficult to apply?

Actico bandages are applied in a straight spiral at full stretch with 50% overlap, so the application method is simple.

Ref: Application instructions, Activa Health Care

Ref: Hawkins,J (2001), A New Cohesive Short Stretch Bandage and its Application, BJN, Vol.10, No.4, 249-243

How can I become trained to use Actico?

As the effectiveness of any bandage system depends on correct understanding and application, Activa Healthcare is firmly committed to nurse training and education. The team of trainers and specialists regularly teach on study days, ENB and post-graduate courses. Practical training on bandaging and hosiery application skills is provided and the office-based staff is always on hand to answer enquiries and to provide support.

Do patients have to be fully mobile to wear Actico?

The amount of mobility required to activate the calf muscle pump sufficiently to improve venous return is not dependent on brisk walking, therefore even less mobile patients can be treated with this system. Jaine Tuckwood-Smith states in her article that "The desired effect can be achieved in the less mobile patient by the district nurse encouraging ankle flexion, extension, rotation or just weight bearing. Weight bearing alone activates the foot pump, situated in the in the sole of the foot. Ankle movements have no effect on it."

Ref: Tuckwood-Smith J, (1996) Which compression therapy. Journal of Community Nursing, Nov. Vol. 10; Iss.11

Ref: Partsch H, ( 1991 ) Compression Therapy of the Legs - A Review. Phlbology, Journal of Dermatological Surgical Oncology, 17: 799-805

Does Actico slip?

As Actico is a cohesive bandage, it stays in place even when the limb size reduces. However, as with all compression bandages ( including the elastic bandages ), rapid reduction in the grossly oedematous limb may necessitate more frequent application.

"Actico removes the potential of slippage and resolves the problem; although, like the multilayer bandages, there is the possibility it will be looser during the first application following the reduction of oedema. This is resolved on the second application"

Ref: Hawkins, J ( 2001), A New Cohesive Short Stretch Bandage and its Application, BJN, 2001, Vol.10, No.4, 249-253

"Why are inelastic bandages more effective than elastic bandages when treating patients with lymphoedema?"

Because short stretch bandages do not yield to muscle expansion they are effective at treating lymphoedema. They can easily be reapplied following reduction in limb size.

"The elastic compression bandages were comfortable but too elastic to control or reduce the oedema"

Ref: Richards,Y (1998); SSB for Lymphoedema, NT, April; Vol.94; No.16

"We use reduced compression using three layers on patients with ulcers of mixed aetiology - Are short stretch bandages safe to use on this group of patients?"

"Research studies ( Dale, 1990: Ertl, 1992 ) show that SSBs are the safest form of compression theray for patients with an arterial component to the ulcer"

Ref: Hampton, S.( 1997 ) Venous Leg Ulcers: Short Stretch Bandage Compression Therapy, British Journal of Nursing, 1997, Vol.6, No.17, 990-998

Ref: Dale, J ( 1990 ). Compression - How and Why? Care Science Practice 8(2): 63-6

In a published case study Susan Poore describes how the short stretch bandaging system was used successfully on a patient whose ulcer was of mixed aetiology. "…In contrast to a highly elastic bandage which continues to impair the venous flow by exerting pressure on the relaxed muscles when the patient is resting, the muscles within the (short stretch) sleeve can relax without any pressure from the bandage"

Ref: Poore,S (1998); How a Short Stretch can work wonders, NT Wound Care, Nov., Vol. 94; No.45; 87-90

Actico and Exudate Levels

In the initial stages when the exudate levels are excessive, the extra layers within the 4 layer system may allow greater absorption. However, as the effective compression system ( short stretch or 4 layer ) reduces the oedema, exudate is usually reduced to a manageable level and extra padding is not always needed. Some practitioners may choose to use high absorbency dressings under the compression bandage to control the exudate.

Ref: Hampton, S ( 2000), Case study on Dispersion Dressings and SSB compression

Some practitioners may choose not to use the 4 layer bandage system where there is copious exudates due to the cost of frequent rebandaging. In this case, they may choose a washable bandage e.g. cotton short stretch bandage.

Ref: Charles H, Callicott C, Mathurin D, Hart J, Ballard K, (1996). Short Stretch Compression. An effective and cost saving system for venous ulcer management. Poster presentation at 2nd National Wound Care Conference on Managing Wounds, improving Patient Care, Harrogate November 1996.

Patient Preference

If a patient is accustomed to a particular bandage system, it may be preferable to continue with that regime to encourage compliance. It may be that they prefer the extra warmth of 4 layers. However, the comments on the use of Actico bandages suggest that many patients are more likely to comply with the less bulky two-layer system.

Ref: Hawkins, J ( 2001). A new cohesive bandage and its application, BJN, Vol.10, No.4

Non Compliance

Confused / non-compliant patients sometimes need a bandage that is not easily removed. Coban and Coplus bandages may then be more difficult to remove. In some cases, practitioners may even apply an adhesive top layer or casting material to prevent interference with the bandages. The early reports on the Actico system indicate that the cohesiveness of the bandage has been sufficient to keep it in place, even in the more mobile patients.

Ref: Hawkins, J ( 2001). A new cohesive bandage and its application, BJN, Vol.10, No.4.

Immobile Patients

If a patient is completely bed bound & immobile and it is not possible to do passive exercises, it may be preferable to use a system that exerts a constant compression of 40mmHg. This is usually a rare occurrence and most practitioners find that even the less mobile can be successfully treated with short stretch bandages (see section on mobility).

Lymphoedema

Inelastic e.g. short stretch bandages work better on lymphoedematous limbs as elastic bandages are often too elastic to control the oedema.

Ref: See section on lymphoedema.

Patients wishing to wear shoes

Patients who wish to wear normal footwear e.g. protective boots may find the short stretch bandages easier to accommodate footwear than bulkier bandages.

Ref: Moody M. 2001. A simple solution to non-compliance. Poster presentation UWMEF conference, Cardiff, June 2001.

Reduction of oedema on the dorsum

Short Stretch bandages applied with some compression on the foot together with the compression applied by footwear if worn, can help control gravitational oedema which can occur.

Where ease of application is an issue

"It ( short stretch bandages) are an easy technique to learn as a single layer bandage, compared to multi-layer systems."

Ref: Hampton S.( 2001) Short Stretch Bandages, Infection UK, April 2001: 16 - 18

Use of compression on diabetic patients

Patients with diabetes should be screened thoroughly i.e. full holistic assessment and full vascular assessment. If there is any doubt following Doppler assessment, patients should be referred for further vascular investigations (Duplex scanning) at a specialist centre, to ensure that there is no danger from compression being applied inappropriately to a limb with an impaired arterial supply.

Specialist practitioners have successfully treated diabetic patients with high compression bandages (including short stretch bandages) left on for one week. These practitioners are very experienced in leg ulcer management, and it is not recommended that inexperienced nurses attempt treatment if they are unsure of the vascular status, the presence of peripheral neuropathy or infection.

Most diabetic patients require frequent monitoring of their feet & wounds and sustained compression may therefore be contraindicated as injuries and / or infections can progress rapidly.

Ref: Bowering, CK. (1998). Use of layered compression bandages in diabetic patients. Experience in patients with lower leg ulceration, peripheral insufficiency and features of venous and arterial disease. Adv Wound Care. 11(3) 129-135.

Rosidal K

Can the bandage be washed?

Yes up to 20 times.

Does it contain latex?

No it is 100% cotton.

What are the differences between working and resting pressures?

The working pressure is the internal pressure directed towards the bandage by the calf muscle on exercise (40-50mmHg), whilst the resting pressure is the force exerted by the bandage when the calf muscle is not working ( 20mmHg). "This difference in pressures gives a pulsating, massaging effect to improve venous return"

Ref: Charles,H ( 1999); Short stretch bandaging in the treatment of venous leg ulcers;

J of Wound Care, June, Vol. 8; No.6: 303-304

Are short stretch bandages safe?

Bandages that are applied at full stretch are less likely to overcompress the limb. "Long stretch bandages because of their elasticity, can be overstretched during application resulting in greater sub bandage pressures, precipitating ischaemia and worsening of the ulcer ( Raj et al., 1980)".

Ref: Krishnamoorthy, L; Melhuish, J; (2000), Short Stretch Compression Bandaging, Journal of Community Nursing, September 2000, Vol.14; Iss.9; 29-37

Ref: Raj, TB, Goddard,M; Makin,GS; ( 1980); How do compression bandages maintain their pressure during ambulatory treatment of varicose veins?", British Journal of Surgery, 67;122-124

"Elastic bandages with a high recoiling force e.g. long stretch and the 4LB system, can cause ischaemic pain if applied too strongly, whilst rigid, inelastic material exerts a much lesser resting pressure"

Ref: Tuckwood-Smith, J ( 1996); Which compression therapy, Journal of Community Nursing, Nov. Vol. 10; Iss. 11; 26-30

ActiFast

Is ActiFast washable?

Yes, it can be hand washed.

What is ActiFast made from?

Viscose 52% Elastane 48%

ActiWrap

Do I need to secure ActiWrap with pins or tape?

No, ActiWrap is cohesive, meaning it sticks to itself but not to skin etc. So there is no need for pins or tapes.

Can ActiWrap be cut?

Yes, it can be easily cut and does not fray.

ActiFormCool®

How does the dressing work?

ActiFormCool® is a sheet hydrogel that works in several ways:

The dressing has a cooling effect which provides pain relief.

It hydrates dry tissue (necrotic or sloughy) to prepare the wound bed for healing. It also improves skin condition by hydrating hyperkeratotic skin. This action is achieved when the dressing top liner is left in place to occlude the wound and skin.

For exuding wounds the dressing works by absorbing fluid and by allowing water vapour to escape through the back of the dressing. In this case, the dressing top liner should be removed to improve moisture vapour transmission.

ActiFormCool® absorbs the exudate in such a way that it spreads within the whole dressing, and does not allow it to sink to the lower part of the dressing with gravity. Some dressings can remain dry at the top and become sodden at the bottom of the dressing which then becomes heavy and dislodges from the skin. It therefore works well even when the patient is upright and on awkward areas of the body.

What is the MVTR (Moisture Vapour Transmission Rate) of the dressing/top liner?

For highly exuding wounds when the film top liner is removed the MVTR of the dressing is 3000 gm/m2 over 24 hours. This is the equivalent of the MVTR of a highly effective film dressing, thus allowing good fluid handling properties. Fluid handling is the amount absorbed by the dressing plus the amount of fluid that passes through the back of a dressing as moisture vapour (Bishop 2003). However, the MVTR is affected by a cover dressing or bandage.

Will the drop in temperature effect healing?

The drop in temperature is only temporary and it is not always the objective to achieve healing at each stage. There are a variety of aims in wound management e.g. pain relief and patient comfort. (Hollinsworth 2002) The case studies on ActiFormCool® demonstrate clearly that the dressing allowed significant healing to take place, often on wounds that had been present for some time, whilst still providing the cooling, soothing, pain relief (ActiFormCool® case studies 2004).

How does it control pain?

Temporary drop in temperature cools and soothes irritated skin, bathes the nerve endings, allows easy removal from wound. The pain relief effect lasts as long as the dressing remains in place because the nerve endings are occluded and bathed.

What evidence is there to support the dressing, and do we need a randomised controlled trial?

There is a 16 patient (20 wound) study that has been presented as a poster presentation at TVS conference in April 2004. The case studies shown in this booklet form powerful evidence to support patient acceptance and efficacy. The dressing is CE marked, demonstrating that it is safe, effective and appropriate for use. ActiFormCool® has also been accepted for DT listing from June 1st 2004.

Can the dressing be used on bleeding wounds?

As with most wound dressings, haemostasis (stopping bleeding) should be achieved prior to use where there is free-flowing bleeding. It can be used on exuding or granulating wounds that have haemoserous (bloody) fluid.

Can the dressing be used on infected wounds?

The dressing can be used on contaminated and colonised wounds. However clinical infection also requires systemic antibiotics and this should be assessed by the nurse.

Will the dressing remove bacteria from a wound?

We cannot make bacterial handling claims as we have not yet carried out any bacterial count studies. However, the dressing will absorb exudate with bacteria, and this is evident in the photographs that show the wound with bacteria (noted by its distinctive colour e.g. green pseudomonas), and the subsequent picture with the dressing swollen with exudate of the same colour.

Can the dressing be used under compression?

ActiFormCool® remains conformable and comfortable under compression. The case studies section showed healing with ActiFormCool® and Actico cohesive short-stretch compression bandages.

Can the dressing be used in cavities?

It is not advisable to use the dressing to pack into cavities, as these wounds can often be long, narrow sinuses with no obvious ending. In these cases biodegradable dressings are preferred in case pieces of the dressing become dislodged in the wound.

What about sensitivities associated with the preservatives in hydrogels?

Most amorphous hydrogels have propylene glycol which is a known irritant, and some trusts have taken them off the formularies for this reason.

ActiFormCool® has phenoxyethylene which has not shown sensitivities.

How does the dressing manage to stay intact if it is mainly water?

The hydrogel is held in a blue mesh to give the dressing its integrity and this makes it easy to handle and to apply.

This mesh gives it the characteristic blue colour.

Can the dressing be used with other dressings?

Practitioners should rationalise why they are using dressing combinations e.g. adhesive film dressing cover to provide waterproofing, compression bandaging to address venous problems. There are no known interactions between ActiFormCool® and other dressings (see separate sheet on applications).

How will I know when to change the dressing?

The dressing initially becomes transparent then, as fluid is absorbed, it becomes swollen and cloudy. The dressing will simply fall apart when it has reached full absorptive capacity. When the dressing is first applied, it should be checked frequently (e.g. daily) as absorption of fluid is usually rapid.

How long can the dressing stay in place?

It depends on the wound and the conditions. If the dressing is being used under compression it can stay in place for as long as the compression bandage (e.g.one week). In the initial stages it should be checked and changed frequently (e.g. daily or on alternate days, according to individual wound needs.

How much fluid will the dressing absorb, and can this be measured in a lab test?

There are no test methods for measuring the fluid absorptive capacity of hydrogels as they will continue to absorb until they fall apart and the best way to assess absorption is in the clinical setting.

How much exudate is High/Moderate/Low?

Individual assessment of patient and cause of exudate production is required as fluid management will vary from patient to patient, wound to wound. The balance between effective fluid management and the prevention of skin maceration is a matter for the practitioner to decide. ?It requires good assessment and critical thinking skills?

(Fletcher 2002)

There are some guidelines on how to assess the volumes of exudate but these are not always accurate as the amount absorbed depends on the dressing.

(Graham 2004)

Will the dressing stick?

At some time all dressings can stick, and low/non-adherent dressings are preferred to reduce trauma at dressing changes.

(Hollinsworth 2002)

It is recommended that, in general, highly exuding wounds may need more frequent dressing changes until the levels of exudate reduce.

(Anderson 2002)

When using ActiFormCool® if there is minimal or no exudate the top liner should be left in place for effective hydration.

For highly exuding wounds when the top liner is removed for better absorption, the wound should be checked frequently as the absorption process may be rapid and the wound may become drier than expected.

One of the real benefits of ActiFormCool® is, should the dressing harden it can easily be rehydrated to turn it back to a soft gel that is easily removed without causing trauma.

What is the best way to remove the dressing?

The dressing can be removed in one piece if the gel has not yet formed.

If the gel has formed it can be scooped up, or it can be washed off gently with water or soaked off when washing the legs as is normal practice for leg ulcer management.

Can the dressing be cut?

The dressing can be used on intact skin with no adverse effect, and this is demonstrated in the case study on skin improvement using ActiFormCool®.

For large areas of irritated skin it is recommended that several sheets of ActiFormCool® are placed side by side to cover the whole area. It can also be cut to fit small wounds e.g. necrotic or sloughy tissue to make it more cost effective.

Can ActiFormCool® be used on diabetic wounds?

ActiFormCool® can be used safely on diabetic wounds. However if the toe is black and necrotic, and there is evidence of irreversible arterial disease it is advisable to allow the digit to dessicate. If in doubt refer to the specialist vascular team as healing will be unlikely without adequate perfusion and the risk of infection is greater.

If there are large amounts of frank blood in the wound can I use an alginate as a haemostat with ActiFormCool®?

Combining dressings should always be justified by sound rationale. In this case ActiFormCool® can be used to provide pain relief and a haemostatic product can be used to control bleeding within the wound. When two absorptive products are used more frequent monitoring is advised to prevent undue drying out of the wound.

Can ActiFormCool® be used with maggots?

If the treatment regime requires the use of maggots and pain relief or exudate management, it is safe to use a product that does not contain the preservative Propylene Glycol e.g. ActiFormCool® which contains Polyethylene.

Can dopplers be performed through ActiFormCool®?

No. Special Doppler gel is recommended for accurate conductivity and readings. In this case the dressing can simple be lifted away from the skin and the Doppler gel applied prior to the procedure as normal.

Can ActiFormCool® be used on radiotherapy burns?

ActiFormCool® provides excellent relief for irritated, sore skin post radiotherapy treatment, but because of the high water content it should not be used whilst treatment is in progress. Most topical products affect the delivery of radiotherapy waves, and is is recommended that skin is clean and dry before treatments.

Flivasorb

What is a Superabsorbent Polymer (SAP)?

Superabsorbent polymers (SAP) are polymers that can absorb several times their own weight in liquid (e.g. 20 times as much fluid).

Chemically, a SAP is a long-chain polymer consisting of a polyacrylate (typically sodium polyacrylate). When a liquid comes into contact with a SAP it will attach to these polymer chains and form a complex network structure, resulting in visible swelling and gelling.

How long may Flivasorb be left on the wound?

Like any other wound dressing, Flivasorb has to be changed when its absorption capacity has been reached. In a clinical environment the usual dressing change intervals for Flivasorb are 2-3 days on heavily exuding wounds. In some cases the dressing may need more frequent changes.

Can Flivasorb be used in combination with antiseptic wound cleansing solution?

Yes

Can Flivasorb be used with ointments?

Ideally no, as the ointment may interfere with the absorption capacity of Flivasorb.

Can Flivasorb be used on infected wounds?

Flivasorb will retain some pathogens in the dressing but it will not kill them and is primarily designed for exudate management. It should never be used as the only treatment for critically colonized or infected wounds.

Can Flivasorb cause skin maceration?

Maceration can occur with any wound dressing when it has been left on for too long, i.e dressing is soaked through and can no longer absorb more exudate. Flivasorb’s superabsorbent polymers lock the fluid into the dressing away from the wound and surrounding skin, which helps prevent maceration.

Can Flivasorb be used under compression?

Yes, Flivasorb is suitable for use under compression; with its low rewet, the fluid stays locked in the dressing. Compression does not force exudate onto the wound, surrounding skin or clothing. However, as in any other wound dressing, the maximum absorption capacity will be reduced under compression.

Does Flivasorb require a secondary dressing?

To secure Flivasorb use an appropriate dressing ie ActiWrap or ActiFast, or consider using Flivasorb adhesive.

Flivasorb adhesive has the tried and tested benefits of Flivasorb, combined with the convenience and comfort of a skin-friendly elastic, adhesive membrane.

What sizes of Flivasorb are available?

Flivasorb adhesive

Sterile, individually sealed.

Suprasorb X

What is Surprasorb X made from?

4% Cellulose

96% water

0.085% chlorhexidine gluconate (preservative)

What does HydroBalance mean?

Suprasorb X can release moisture into the wound or absorb exudate from the wound, or both at the same time. This makes dressing selection easier.

Which wounds should I use Suprasorb X on?

Non-infected wounds if they are

e.g

Can Subrasorb X be used under compression bandages?

Yes, but a secondary dressing is required over the dressing prior to application of compression.

The dressing has dried out what shall I do?

Rehydrate with saline until soft enough to remove. This may take up to 30 minutes.

Can Suprasorb X be used on infected wounds?

No. However Suprasorb X PHMB combines the moist wound healing features of Suprasorb X with a clinically proven antimicrobial.

Suprasorb X PHMB

What is PHMB?

Polyhexamethylene biguanide or polyhexanide is a proven antimicrobial.

What micro-organisms has PHMB been successfully tried and tested on?

MRSA (methicillin- resistant staphylococcus aureus) and VRE (vancomycin –resistant enterococci), aerobic and anaerobic bacteria, fungi, moulds and yeasts.

For what period of time does PHMB ensure effective protection against microbial colonisation and multiplication?

Up to 7 days

Which wounds should I use SuprasorbX PHMB on?

Infected or critically colonized wounds if they are

e.g.:

What sizes does SuprasorbX PHMB come in?

It is available as a sheet or a rope in these sizes.

Debrisoft

What does Debrisoft® consist of?

The fibre composite material of Debrisoft® consists of 100% knitted monofilament (single) polyester fibres. The reverse side of the product is coated with a polyacrylate that contains no colophony or colophony derivatives, giving added stability and preventing shedding of fibres.

Does Debrisoft® contain latex or the softener DEHP (diethylhexylphthalate)?

No.

Does Debrisoft® contain any allergenic substances/ irritants / sensitizers?

No, Debrisoft® is hypoallergenic, i.e. it contains no substances known to have an allergenic potential.

Is Debrisoft® bleached?

No.

Is Debrisoft® inert?

Yes.

Is Debrisoft® Biodegradable?

No.

Can individual fibres come loose from the product?

Debrisoft® has been specifically designed in such a manner that no fibres can come loose from the composite material under ordinary circumstances. This is ensured firstly by the knitted reverse side, which retains the fibres. Secondly, the reverse side has a polyacrylate coating, which holds the fibres firmly in place. Furthermore, of course, Debrisoft® is subject to adequate quality assurance procedures.

What can Debrisoft® be used for?

Debrisoft® is intended for use in wound bed preparation. It is a rapid, highly effective and safe debridement method in the treatment of superficial wounds and the surrounding skin, e.g. in cases of:

Debrisoft® is gentle on intact tissue.

Debrisoft® may not be as effective on thick, hard eschar or thick, tenacious slough that is fixed. This may require softening first by autolytic debridement before the use of Debrisoft®.

What experience is there with the use of Debrisoft® in cases of hyperkeratosis?

Impressive results have been obtained with Debrisoft® even in the removal of hyperkeratosis.

Can Debrisoft® be used in wounds with very hard/tough coatings, e.g. severe necrosis?

Very good outcomes can be obtained with Debrisoft® even in cases of very hard/tough keratosis or necrosis when the wounds have previously been treated with autolytic debridement, e.g. softened by use of ActiFormCool or Suprasorb X / PHMB.

Is Debrisoft® indicated for deep wounds?

Due to its specific material structure, Debrisoft® is indicated only for superficial wounds. However, due to its long fibres, Debrisoft® will also conform perfectly to deeper wound beds. Moreover, by folding Debrisoft® in a specific manner, deeper wound areas can be reached by the fibres.

Does the use of Debrisoft® cause any damage to freshly formed, healthy cells?

No. The product is safe and particularly gentle on fresh granulation tissue and epithelial cells.

Why is effective debridement so important?

Only a clean wound can heal!

A clean wound bed is an essential prerequisite, not only for wound healing, but also for optimum effectiveness of many modern wound care products. In a chronic wound which is not clean, only limited new cell growth can occur. Therefore, effective debridement is the indispensable first step to wound treatment, which is the consensus of most experts in the field - as laid down in the ‘TIME’ principle recommended by the European Wound Management Association (EWMA).

How should Debrisoft® be held and used?

There is really no right or wrong way to hold Debrisoft®, provided the correct side is used - the soft, fluffy, fibre side.

However, from the clinical work so far, the best results have come from using the Debrisoft® flat, folded or corner by corner. In all cases very light strokes and/ or gentle, circular movements have been used over wounds and surrounding skin. (Too much pressure could cause flattening of the fibres)

Why is the mode of action of Debrisoft® so effective?

The flexible fibres can reach all the way into the wound bed, even in deeper areas.

Debris and exudate are actively loosened from the wound by the angled tops of the fibres. Skin flakes and keratoses are also efficiently removed from the surrounding skin. The loosened coatings and keratoses are removed and safely locked into the Debrisoft® fibre composite material.

The fascinating mechanism of Debrisoft® can be summarized in one sentence:

‘Coatings are actively loosened by the tops of the fibres, and subsequently removed and retained inside the fibre composite.’

What liquids can be used for moistening Debrisoft®?

Debrisoft® can be moistened with any standard wound rinsing solution or tap water, according to applicable local guidelines. The material used in Debrisoft® (polyester) is basically resistant to the ingredients of standard water-based wound solutions, such as: Saline, Prontosan C, Braunol, Betaisodona, Octenisept, or Lavasorb.

Debrisoft® must not be used in combination with strong acids or alkalis.

How much liquid should be used to moisten Debrisoft®?

Debrisoft® should be soaked with a standard wound rinsing solution (eg: saline or tap water; see Question 15 above) in such a manner that it is thoroughly moistened, but not dripping wet. For most applications 20-40ml of liquid will be sufficient. Do not wring Debrisoft®.

If a bucket of water is being used to wash limbs for leg ulcers and surrounding skin, Debrisoft® can be used to debride areas while the leg is in the bucket.

Is it OK to have emollients in bucket?

Yes, this will not affect Debrisoft®.

What action should be used to debride the wound and/or peri-wound skin with Debrisoft®?

The product can be used either in a gentle circular motion, or by wiping from top to bottom. The most important thing is to use only a slight amount of pressure.

The wound and the peri-wound skin should not be treated with the same piece of Debrisoft®.

Should you debride the wound first, then the peri-wound area with Debrisoft® or vice versa?

Usually debride wound first, then, using a second Debrisoft® , debride the surrounding tissue.

Can Debrisoft® be rinsed of wound debris and then re-used on other areas?

No

How long does it take to debride a wound with a single Debrisoft®

In most cases, the impressive results of a debridement procedure will be apparent after 2-4 minutes, depending on wound size.

(N. Mustafi, S. Bahr, Petra Hättig, M. Abel, Zeynep Babadagi-Hardt, M. Schmitz. Clinical efficacy of a monofilament fibres containing wound debridement product evaluated in a multicenter real life study. Lecture and poster. 15e Conférence Nationale des Plaies et Cicatrisations (CPC). Paris 16.-18. January 2011)

Do emollients affect the effectiveness of Debrisoft®?

If there is a large build-up of emollients on an area, it may be helpful to rinse them away before using Debrisoft® to prevent clogging of the fibres.

How often should Debrisoft® be used?

If necessary, Debrisoft® can be used each time the wound dressing is changed.

How long should Debrisoft® be used for?

Debrisoft® should be used until the wound is thoroughly clean and has progressed from the cleansing phase to the granulation phase

Can Debrisoft® be left on the wound?

No. Debrisoft® is a product for debridement only and is not a wound dressing.

Can Debrisoft® be re-used/re-sterilized?

No. Debrisoft® is intended for single use only. It must not be re-sterilized

Can Debrisoft® be cut to size as needed?

No, it cannot be cut to size, as this would disrupt the protective coating on the reverse side and fibres may come loose from the composite material.

How is Debrisoft® disposed of?

In normal clinical waste, or as you would dispose of wound dressings.

The user is advised to observe current national legislation, Standards and Guidelines regulating the disposal of medical refuse. Packaging materials must also be disposed of in compliance with applicable national requirements.

Do you need special training to use Debrisoft®?

No - Debrisoft® is particularly safe and easy to use, which means it can be used by specialist and non-specialist clinicians to perform a rapid effective debridement with high patient satisfaction.

Always read the instructions for use before using Debrisoft®.

Do patients feel pain after treatment with Debrisoft®?

After treatment with Debrisoft®, 97.4 % of all patients did not experience any pain or side effects.

(N. Mustafi, S. Bahr, Petra Hättig, M. Abel, Zeynep Babadagi-Hardt, M. Schmitz. Clinical efficacy of a monofilament fibres containing wound debridement product evaluated in a multicenter real life study. Lecture and poster. 15e Conférence Nationale des Plaies et Cicatrisations (CPC). Paris 16.-18. January 2011)

What are the precautions to the use of Debrisoft® ?

What size is Debrisoft® available in?

What is the cost of Debrisoft®?

Box of 5 pieces = £30.95

(£6.19 per piece)

What is the shelf life of Debrisoft®?

Stored appropriately, Debrisoft® has a shelf life of 5 years.

Does Debrisoft® have a CE mark?

Yes. Debrisoft® is a medical device in terms of Class Is, Rule 4 (Annex IX of the Council Directive 93/42/EEC concerning medical devices).

How is Debrisoft® sterilized?

The product is sterilized by use of steam, in compliance with DIN EN ISO 17665-1.

Related links & downloads

Related links

Check out our Leg Exercise Videos

Leg Exercise Videos

Improve your leg health by following the exercises in the video.

Save a copy

This information is not intended as a substitute for the advice of a health care professional. Consumers should rely on the judgement of a health care professional for specific conditions.
Activa is a Registered Trademark of Activa Healthcare Ltd. Lycra and Tactel Micro are Registered Trademarks of DuPont.
Registered in England No. 3631028 VAT No. 716473038

We'd love to hear any ideas or feedback you have about Activa   Yes      No   Please keep me up to date
Thanks for taking the time to share your thoughts with us

Your feedback has been submitted and you will receive a response very soon.

Enter your details below to receive our monthly e-newsletter featuring latest product news, e-learning resources, and other updates relevant to your work as a healthcare professional.
*All fields are required