Venous leg ulcer prevention and management protocolDiscover a system of products designed to follow best practices and improve outcomes

Make skin health second nature

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Setting you up for skin health successFrom hard-to-heal wounds and painful leg swelling to the increased risk of infection, caring for people with venous disease is more challenging today than ever before.

Our goal is to support you—and your growing list of obligations—with the right tools and best practices to manage this lifelong disease. Read on to learn how you can improve outcomes, help reduce clinical visits and change the numbers.

Venous disease by the numbers

Impact on patients

Impact on providers and payers

6 millionpeople with advanced venous disease1

Healing a VLU costs about

$10,5603

2 million people with VLUs each year in the U.S.2

VLUs that won’t heal can cause costs to triple to over

$33,0003

122 days healing time for a VLU3

Cost of treatment to heal an ulcer $86/day3

50% of VLUs last for 9 months or longer4

$15 billion annual cost of VLUs in the US6

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Discover a holistic approach to venous leg ulcersWe’ve done the work for you—identifying and developing the best-performing products to help improve skin health —from nutrient-rich supplements to a new kind of compression therapy. Our holistic approach combines best practice expertise, caregiver education and a unique system of products to help prevent skin breakdown, manage symptoms and promote wound closure.

Proper nutrition to help improve

clinical outcomes

Advanced skin care to help nourish, protect and provide botanical

based nutrition

Advanced wound care to help reduce the risk

of infection, and manage moisture and debris

in wounds

Compression therapy to help reduce swelling

and increase compliance

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An evidence-based system of products for venous diseaseNutritional supplements

Encourage proper nutrition to support skin health and wound healingPoor nutrition can delay wound healing. Individuals over 50 with chronic leg ulcers show low levels of zinc and vitamin C. They also lose significant amounts of protein in wound exudate.1 Nutrient-rich dietary supplements and increased protein intake may help with wound healing.2,3

Remedy Intensive Skin Therapy Hydraguard-D Silicone Barrier Cream Keep skin well-moisturized and protected from breakdown caused by the effects of excess exudate with 12.5% dimethicone.

Argiment AT Poor nutrition can delay wound healing. ArgiMent AT contains

protein, amino acids, vitamin C, minerals and a prebiotic to help break the cycle of malnutrition and poor wound healing.

Remedy Intensive Skin Therapy Calazime Skin Protectant Cream Use zinc oxide for even stronger barrier protection.

This soothing cream helps protect and treat the wet, open skin seen with venous dermatitis.

Active Critical Care With 21 grams of protein in each 1-ounce serving, along with arginine, zinc and vitamin C, this supplement helps support the nutritional needs of patients with acute and chronic wounds.

Advanced skin care

Nourish and protect at-risk skin to help manage complicationsGive patients and caregivers the products they need to help protect irritated skin.

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Opticell Gelling FIber Wound Dressing This chitosan-based dressing absorbs heavy drainage while maintaining intimate contact with the wound bed.*

IoPlex Iodophor Foam Wound Dressing Antibacterial iodine with controlled release technology which helps control infection within the wound dressing and manage biofilm based on in vitro testing.*

PluroGel Burn and Wound Dressing This concentrated surfactant gel softens and loosens debris for easy removal. Also proven to prevent biofilm formation in vitro.10

What is P-188?P-188 is a multi-block copolymer surfactant with an inverse thermosensitivity. • 100% water soluble • Rinses off gently with saline or cleansers, promoting patient comfort • Gels at body temperature, allowing for constant contact with wound debris • Less irritating to skin; compatible with other therapeutic agents

Advanced wound care

Help reduce infection and manage moisture within the wound dressingIf venous wounds develop, apply dressings that help manage and remove exudate. It’s also important to help reduce infection within the wound dressing.

In Vitro CDC Bioreactor Biofilm

0123456789

IoPlex

Log

Redu

ctio

n

Flui

d ab

sorb

ed (g

/100

cm2)

Hydrofera Blue Classic

S. aureus ATCC 6538

CDC Bioreactor: 24-Hour Treatment of 24-Hour Mature Biofilm*

P. aeruginosa ATCC 15442

Hydrofera Blue Ready

Aquacel Advantage Ag+

Mepilex Ag

*Data on file

30

25

20

15

10

5

0Aquacel Aquacel Extra Durafiber Opticell

Absorption value without compression

*Data on file

6 Medline

AccuWrap 2-Layer Compression Bandage System Thin and conformable first layer provides optimal comfort. Durable yet breathable second layer is a cohesive bandage with stretch indicators to help with correct application.

COMPRECARES Compression Garment Helps improve patient compliance because it’s easy for patients, caregivers and family members to remove and reapply at home. Unique ACCUTAB system helps make readjustment easy for precise levels of compression.

60-day episode potential cost calculatorNational average cost of nursing visit $150

Compression therapy

Prevent further venous stasis, and reduce uncomfortable swellingCompression therapy is essential for venous disease management, and these advancedtechnologies make it easier to manage swelling and help improve patient compliance.

Current practice: Disposable compression wraps only

Average wrap changes per week 2

Average nursing visits in 60 days 16

Total costs of nursing visits in 60 days $2,400

New Practice: Two weeks of AccuWrap followed by COMPRECARES

Average wrap changes week 1 through 2 4

Average visits week 3 through 8 6

Avearage nursing visits in 60 days 10

Nursing visits week with Total costs of nursing visits in 60 days $1,500

Total nursing visit cost savings $900 % Savings 38%

Disclaimer: Nursing visit costs and average changes per week are averages and not representative of every facility in every state.

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Patient case study

Wound characteristics:• Large venous ulcer in the anterior lower leg• Wound measures 7 cm x 4 cm <0.1• Irregular shape

Recommended regimen:

Note: This case study is theoretical and does not represent an actual patient. Product choice and regimes are also meant only as recommendations. Clinicians should refer to the physician for guidance based on each patient’s individual needs.

Ingest 1 oz. Active Nutrition Critical Care per patients nutritional needs.

Day 1: Dress wound with Opticell and AccuWrap. Consider using OptiLock.

Day 7: Wound shows signs of infection, switch to dressing wound with IoPlex and AccuWrap. Follow facility protocol for infected wound.

Day 14: Wound is making progress toward healing and edema is controlled. Evaluate if IoPlex should be discontinued. Phase out Accuwrap and start wrapping the leg with COMPRECARES.

Apply Remedy Hydraguard-D to periwound skin at every dressing change.

Ask your Medline Skin Health Representative for our decision tree to treat venous ulcers in each individual patient. This tool guides you through how to use our system of products to manage this type of patient.

Mrs. Jones, age 72

She is ambulatory and lives in her own home. History of controlled heart failure.

Presents with: Open venous ulcer on the right leg, lipodermatosclerosis

• Wound has been debrided, and is free of necrotic tissue • Heavy serous drainage• Leg shows signs of edema

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References: 1. Eberhardt RT & Raffetto JD. Circulation. 2014;130(4):333-346. Available at: https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.113.006898. References: 1. Eberhardt RT & Raffetto JD. Circulation. 2014;130(4):333-346. Available at: https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.113.006898. Accessed October 26, 2020. 2. Agency for Healthcare Research and Quality. Chronic Venous Ulcers: A Comparative Effectiveness Review of Treatment Modalities. Accessed October 26, 2020. 2. Agency for Healthcare Research and Quality. Chronic Venous Ulcers: A Comparative Effectiveness Review of Treatment Modalities. September 4, 2012. Available at: https://effectivehealthcare.ahrq.gov/products/venous-ulcers-treatment/research-protocol. Accessed October 26, 2020. 3. Ma H, September 4, 2012. Available at: https://effectivehealthcare.ahrq.gov/products/venous-ulcers-treatment/research-protocol. Accessed October 26, 2020. 3. Ma H, O’Donnell TF, Rosen NA, Iafrati MD. The real cost of treating venous ulcers in a contemporary vascular practice. Journal of Vascular Surgery: Venous and Lymphatic O’Donnell TF, Rosen NA, Iafrati MD. The real cost of treating venous ulcers in a contemporary vascular practice. Journal of Vascular Surgery: Venous and Lymphatic Disorders. 2014;2(4):355-356. Available at: https://pubmed.ncbi.nlm.nih.gov/26993537. Accessed October 26, 2020. 4. Fishman TD. How to manage venous stasis Disorders. 2014;2(4):355-356. Available at: https://pubmed.ncbi.nlm.nih.gov/26993537. Accessed October 26, 2020. 4. Fishman TD. How to manage venous stasis ulcers. Podiatry Today. 2007;20(5):66-72. Available at: https://www.podiatrytoday.com/article/7071. Accessed October 26, 2020. 5. Marston WA, Carlin RE, ulcers. Podiatry Today. 2007;20(5):66-72. Available at: https://www.podiatrytoday.com/article/7071. Accessed October 26, 2020. 5. Marston WA, Carlin RE, Passman MA, Farber MA, Keagy BA. Healing rates and cost efficacy of outpatient compression treatment for leg ulcers associated with venous insufficiency. Passman MA, Farber MA, Keagy BA. Healing rates and cost efficacy of outpatient compression treatment for leg ulcers associated with venous insufficiency. Journal of Vascular Surgery. 1999;30(3):491-498. Available at: https://www.jvascsurg.org/article/S0741-5214(99)70076-5/fulltext. Accessed October 26, 2020. 6. Journal of Vascular Surgery. 1999;30(3):491-498. Available at: https://www.jvascsurg.org/article/S0741-5214(99)70076-5/fulltext. Accessed October 26, 2020. 6. Davies AH. The seriousness of chronic venous disease: A review of real-world evidence. Advances in Therapy. 2019; 36:S5-S12. Available at: https://link.springer.Davies AH. The seriousness of chronic venous disease: A review of real-world evidence. Advances in Therapy. 2019; 36:S5-S12. Available at: https://link.springer.com/article/10.1007/s12325-019-0881-7. Accessed October 26, 2020. 7. Wade C, Wolf SE, Salinas R, Jones JA, Rivera R, et al. Loss of protein, immunoglobulins, and com/article/10.1007/s12325-019-0881-7. Accessed October 26, 2020. 7. Wade C, Wolf SE, Salinas R, Jones JA, Rivera R, et al. Loss of protein, immunoglobulins, and electrolytes in exudates from negative pressure wound therapy. Nutrition in Clinical Practice. 2010;25(5):510-516. Available at: https://onlinelibrary.wiley.com/doi/electrolytes in exudates from negative pressure wound therapy. Nutrition in Clinical Practice. 2010;25(5):510-516. Available at: https://onlinelibrary.wiley.com/doi/abs/10.1177/0884533610379852. Accessed October 27, 2020. 8. Rojas AI, Phillips TJ. Patients with chronic leg ulcers show diminished levels of vitamins A and E, abs/10.1177/0884533610379852. Accessed October 27, 2020. 8. Rojas AI, Phillips TJ. Patients with chronic leg ulcers show diminished levels of vitamins A and E, carotenes, and zinc. Dermatologic Surgery 1999;25(8):601-604. Available at: https://journals.lww.com/dermatologicsurgery/Abstract/1999/08000/Patients_with_carotenes, and zinc. Dermatologic Surgery 1999;25(8):601-604. Available at: https://journals.lww.com/dermatologicsurgery/Abstract/1999/08000/Patients_with_Chronic_Leg_Ulcers_Show_Diminished.2.aspx. Accessed October 26, 2020. 9. Saghaleini, S., et al., Pressure Ulcer and Nutrition. Indian J Crit Care Med. 2018 Apr; Chronic_Leg_Ulcers_Show_Diminished.2.aspx. Accessed October 26, 2020. 9. Saghaleini, S., et al., Pressure Ulcer and Nutrition. Indian J Crit Care Med. 2018 Apr; 22(4): 283–289. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5930532/. Accessed October 26, 2020. 10. Yang Q, Larcose C, Porta AD, Della Porta AC, Schultz GS, 22(4): 283–289. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5930532/. Accessed October 26, 2020. 10. Yang Q, Larcose C, Porta AD, Della Porta AC, Schultz GS, Gibson DJ. A surfactant-based wound dressing can reduce bacterial biofilms in a porcine skin explant model. International Wound Journal. 2017;14(2):408-413Gibson DJ. A surfactant-based wound dressing can reduce bacterial biofilms in a porcine skin explant model. International Wound Journal. 2017;14(2):408-413

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Ordering informationActive Critical Care Item No. Description Pkg. ENT697 Berry Flavor, 30-oz. Bottle 30/cs

Argiment Item No. Description Pkg.

ENT220 Drink Mix Powder, Orange Crème Flavor, 42.75 g Packet 30/cs

IoPlex Iodophor Foam Wound Dressing Item No. Description Pkg. MSC5345EP 4 x 5" Pad 40/cs

OptiLock Non-Adhesive Super Absorbent Wound Dressing Item No. Description Pkg. MSC64610EP 6.5 x 10" 50/cs

Remedy Intensive Skin Therapy Silicone Barrier Cream Item No. Description Pkg. MSC092564 Silicone Barrier Cream, 4-oz. 12/cs

Remedy Intensive Skin Therapy Calazime Skin Protectant Cream Item No. Description Pkg. MSC092554 Calazime Skin Protectant Paste, 4-oz. 12/cs

Opticell Ag+ Gelling Fiber Wound Dressing Item No. Description Pkg. MSC9845EP 4 x 5" Wound Dressing 50/cs

PluroGel Burn and Wound Dressing Item No. Description Pkg. PGL020 0.7 oz. Tube 35/cs

AccuWrap 2-Layer Compression Bandage System Item No. Description Pkg. MSC7800 2-Layer Compression Bandage System 8/cs

MSC7802 Lite 2-Layer Compression Bandage System 8/cs

COMPRECARES Compression Garment Item No. Description Pkg.

MSC1402 Reusable Compression Garment Kit, M Regular 1 ea

Discover how we make skin health second natureSkin Health Solutions

Best practice expertiseObservations, insights and analysis

to inform recommendations tha thelp reduce care variation.

System of productsThe best-perforingprocucts pairedwith utilization recommendations

to drive best practices.

Caregiver educationTraining and education for every learning

style and skill level to help caregivers practice more effectively.

Consult your Medline Skin Health Representative to learn more.