CLOT for several years has worked with the BSH to put on a session at their annual scientific meeting which is next held in Glasgow from the 1st to the 3rd April 2019. The BSH are very keen to expand membership among nurses and allied health professional and for this reason from 2019 will offer free membership to all staff up to and including band 7 staff. Further information is available at https://b-s-h.org.uk/membership/ and CLOT would encourage all our members to take advantage of this offer.
The use of the gekoTM device and the activation of the foot and calf pumps for prevention of venous thromboembolism in patients with acute stroke
Current UK practice for DVT prophylaxis, in acute stroke, is based upon data from the CLOTS 3 study and routinely comprises of IPC or a prophylactic-dose of Low Molecular Weight Heparin (LMWH), when the bleed risk is reduced. However, regardless of the merits of these interventions, a large number of patients remain contraindicated to these therapies leaving them exposed to developing DVT (Deep Vein thrombosis) or PE (Pulmonary Embolism).
The Royal Stoke University Hospital, UHNM NHS Trust have conducted a clinical audit to assess patient compliance to a new neuromuscular electrostimulation device called the geko™ device, to evaluate its VTE prophylaxis capability in patients admitted for either ischemic or haemorrhagic stroke. Patients unsuitable for VTE drug prophylaxis or contraindicated to IPC were prescribed the geko™ device.
The audit included 455 patients. In total 6/455 (1.3%) patients developed symptomatic VTE (3 DVTs and 3 PEs) within 90 days. Of these, 4 patients (1.6%) were prescribed IPC, 1 patient (1.3%) was prescribed the gekoTM device as a secondary intervention and 1 patient (1.5%) patient was prescribed anticoagulation. There was no DVT or PE in patients treated with the gekoTM device as the primary VTE prophylaxis.
Jodie Williams, Clinical Nurse Specialist at the Royal Stoke University Hospital, UHNM NHS Trust says, “The audit has proven the geko™ device as well tolerated and its introduction has marked a significant change in our VTE nursing practice on the acute stroke ward. The device is easy to fit and patients are much easier to mobilize. We now routinely check that patients are fitted with either the geko™ device or intermittent pneumatic compression (IPC) on our wards rounds. These checks provide confidence that all at-risk acute stroke patients are compliant with one of the available mechanical VTE interventions at all times”.
Dr Indira Natarajan, Consultant Stroke Physician and Clinical Director of Neurosciences at the Royal Stoke University Hospital, UHNM NHS Trust comments, “The geko™ device is a new paradigm in antithrombotic therapy for acute stroke. The clinical audit has revealed that we are aligned to the CLOTS 3 study which reports as many as 36% of patients are contraindicated or become intolerant to IPC. It is to this unmet need cohort that we now routinely fit the geko™ device, and this has ensured that all acute stroke patients can now receive VTE prophylaxis, where previously no prophylaxis was given”.
The geko™ is a battery powered, disposable, neuromuscular electrostimulation device designed to increase blood flow in the deep veins of the leg. The geko™ gently stimulates the common peroneal nerve activating the calf and foot muscle pumps increasing venous, arterial and microcirculatory blood flow. The blood flow increase is equal to 60% of walking, without a patient having to move or exert energy.
About Firstkind and Sky Medical Technology Ltd
Sky Medical Technology, the parent of Firstkind Ltd, is a highly innovative UK based medical devices company that has developed a ground-breaking neuromuscular electrostimulation technology platform, OnPulse®. The company develops a range of products tailored to the needs of different medical application areas selling both direct and through strategic partnerships or distributors in each major clinical area. Clinical areas of interest include oedema control, DVT prevention, wound healing and elite sport recovery. The goal in each clinical area is to improve clinical outcomes and patient care whilst saving health system resources.
For more information visit: http://www.gekodevices.com
About North Midlands NHS Trust
The stroke service is jointly provided by University Hospitals of North Midlands NHS Trust and the Staffordshire and Stoke on Trent Partnership Trust. They have a combined acute stroke unit (hyper-acute beds and acute beds) and a specialist stroke rehabilitation unit at Haywood Hospital.
For more information visit: http://www.uhnm.nhs.uk/OurServices/pages/Stroke.aspx
+44 (0)1494 572044
Sky Medical Technology Limited
Peregrine Business Park
A recently published study looked at the effect of the mandatory VTE risk assessment that has been in place in England since 2010. This shows a significant reduction both in total HAT events but also when expressed as a percentage of total annual admissions. In addition the number of events associated with inadequate prevention has also significantly reduced over the same period. The most recent data however suggests there has been a plateauing of number of VTE events associated with hospital stay acknowledging not all VTE events can be prevented.
The link is available at http://openheart.bmj.com/content/4/2/e000653
Current UK practice for DVT prophylaxis in acute stroke patients is based upon data from the CLOTS 3 study and usually comprises of Intermittent Pneumatic Compression (IPC) or a prophylactic-dose of Low Molecular Weight Heparin (LMWH) when the bleed risk is reduced1. However, regardless of these interventions, a small group of patients remain contraindicated to these therapies leaving them exposed to developing a DVT or PE.
Firstkind Ltd, a UK based medical devices company, is working with an NHS Trust to introduce the innovative geko™ device into the acute stroke pathway, when patients are unsuitable for drug prophylaxis and/or contraindicated to IPC.
The geko™ is a battery powered, disposable, neuromuscular electrostimulation device designed to increase blood flow in the deep veins of the leg2. The geko™ gently stimulates the common peroneal nerve activating the calf and foot muscle pumps increasing venous, arterial and microcirculatory blood flow. The blood flow increase is equal to 60%3 of walking without a patient having to move or exert energy.
Patient compliance and the geko™ anti-stasis capability is being assessed through a prospective audit of clinical practice, covering patients who have been admitted for either ischemic or haemorrhagic stroke4. Patients unsuitable for VTE drug prophylaxis or contraindicated to IPC are being given the geko™ device.
Interim analysis highlights that the majority of high risk immobile acute stroke patients who could not tolerate IPC are able to tolerate the geko™. These patients would have not been treated as effectively otherwise, with the potential that geko™ will reduce the risk of morbidity and mortality in stroke patients. For more information on the geko™ device, click here: http://www.gekodevices.com/en-uk/
- NICE guidelines (CG92). Published date January 2010, update June 2015.
- Nicolaides, M Griffin, Measurement of blood flow in the deep veins of the lower limb using the geko™ neuromuscular electro-stimulation device. Journal of International Angiology August 2016-04.
- Tucker A, Maass A, Bain D, Chen LH, Azzam M, Dawson H, et al. Augmentation of venous, arterial and microvascular blood supply in the leg by isometric neuromuscular stimulation via the peroneal nerve. The International journal of angiology: official publication of the International College of Angiology, Inc. 2010 Spring; 19(1): e31-7.
- Stoke, prospective data on file, prospective April 2017, Firstkind.
Following on from our recent conference we have booked the same venue, Crowne Plaza Central Manchester for next year on the 12th October 2018. We will look at feedback and any suggestions or comments and have more detail next year. The CLOT Committee