CLINICAL FOCUS DOCUMENT

User feedback on theFlowtron® ACS900 pumpand Tri Pulse garment range

Authors: Jonathan Busby, MSc, BSc (Hons) RN, Global Senior Clinical Manager; Kristina Holst, MDSc,Senior Clinical Trial Manager; Kristina Hansson, BSc, Senior Clinical Affairs Manager

Introduction & clinical context
Venous Thromboembolism (VTE), (a blood clot in the legor lung) is a largely preventable condition associated witha high rate of mortality and morbidity if left untreated. VTE
formation although complex consists of three primary risk
factors collectively referred to as Virchow’s Triad, namely:
Venous Stasis, Hypercoagulation and Vessel injury(Figure 1)1.

Executive summary
118 users of the Flowtron ACS900 and Tri Pulse
system participated in this survey that included users
at 32 hospitals in Australia, France, UK and USA.
The survey gained user feed back and demonstrated
the clinical application of the Flowtron ACS900 andTri Pulse garment range.
The majority of users who took part provided
positive feedback e.g.:• 97.5% of the users responded that they experiencepatients in general to comply with Flowtron
ACS900 and Tri Pulse therapy• 98.3% of the users thought that the Tri Pulse
garment design allows for good anatomical fit tothe patients’ limbs• 99.2% of the users thought that the Flowtron
ACS900 pump is easy to use in general

Figure 1: Virchow’s Triad1

Patients admitted to hospital (medical or surgical), areparticularly at risk of VTE and the problem continues after
discharge2. Without adequate prophylaxis the incidence ofVTE is high3. There are approximately 10 million VTE cases
reported worldwide each year4 and these are associated withhigh economic and humanitarian cost5. VTE is considered themost common preventable form of hospital death6.

The use of IPC in VTE prevention is a very well-established,generic, intervention with few side effects. It is indicated foruse across a wide range of patients including those for whom
anticoagulation is contraindicated. Many configurations of
IPC devices are available to clinicians, with different garment
types, compression profiles and cycle times. Whilst there has
been considerable debate over many years about the relative
merits of these, clinical studies have consistently shown nosignificant difference in VTE outcome, even where there aresmall differences in type of garment, compression profile, andcycle time1,9,10,11,12. This can often make the clinical decision
making process problematic and hence the need for user
feedback and evaluation data is important.

In clinical practice, routine systematic patient risk assessment
has become an inherent aspect of effective VTE prevention
programmes.
Prevention strategies commonly incorporate the use ofpharmacological prophylaxis and mechanical methods
including intermittent pneumatic compression (IPC). Thesecan be used as stand-alone therapies, or for the highest risk
patients, a combination of methods may be used concurrently
to enhance benefit7.

This paper reports the results of a user survey conductedwith end users in order to gain post market feedback on
the use and clinical application of the Flowtron ACS900
pump and Tri Pulse sequential compression garment range
manufactured by Arjo.

IPC devices involve the use of inflatable garments
wrapped around either the foot, calf or thigh of the patient,intermittently inflated by an electrically operated pump. This
intermittent inflation and deflation enhances venous return.
Venous stasis is prevented and the action of the inflationand deflation stimulates the release of chemical substancesin the blood, that both inhibit clot formation and promotefibrinolysis8. IPC addresses two of the principle causes of DVT
formation: Venous stasis and Hypercoagulation.

The Flowtron ACS900 & Tri Pulse
garment range
The Flowtron ACS900 system offers both uniform andsequential compression therapy modes in one easy-to-use
pump (Figure 2) and is designed to be used in conjunction
with an extensive range of garment types and sizes, ensuring
effective and comfortable therapy for all patients.

Figure 2: Flowtron ACS900 & Tri Pulse Garment Range
2

Arjo’s patented SmartSense garment detection technology
automatically sets the correct pressure and compression cycle
depending on the type of garment connected to the tubeset,
without the need for any additional user intervention. Thesystem allows for a combination of different garment types tobe used simultaneously.

Number of hospitals by country
1576

The Tri Pulse garment range provides a graduated sequential
intermittent compression profile, designed for optimal
anatomical fit and enhanced patient comfort. The range
consists of calf and calf-and-thigh garments available in avariety of sizes including a bariatric version.

AustraliaFranceUK4USAFigure 3

Study description

User information and demographics

The objective of this user survey was to collect user data on
Tri Pulse and Flowtron ACS900 by interviewing caregivers(=users) in the USA, United Kingdom (UK), Australia andFrance. The purpose was to understand user perception of Tri
Pulse and Flowtron ACS900, and how it is used in the clinicalenvironment.

The majority of the responding users were nurses (63 %).
The remaining 37% were mainly caregivers, clinical educatorsand healthcare assistants. Most users worked in surgicalwards (48%), intensive care (21%), acute stroke wards (5%),
medical wards (7%) or general wards (6%).
The most common responsibilities with Flowtron ACS900
and Tri Pulse system were• To set up equipment; e.g., connecting garments to thepump (36%)• Various logistics; e.g., maintaining correct working
conditions (32%)• Monitoring therapy (31%)• 1% responded “other”, e.g., ordering, trainingUser data from caregivers was collected in the following areas:• Patient compliance• Patient comfort• Ease of use• Safety
Users were contacted by Arjo representatives and faceto-face interviews were performed in the UK, Australiaand France. In the US, users were contacted by an Arjo
representative who sent a link to the questionnaire that wascompleted online. All data was collected in Google Forms. No
personal data on caregivers and no patient data was collected.
For any questions related to the patient, e.g. on patient
comfort, only user’s perceptions were collected.

A majority of the responders had worked for more than one
year with the Flowtron ACS900 and Tri Pulse system.

Patient compliance
A majority of the users responded that they experiencepatients in general to comply with Flowtron ACS900 and Tri
Pulse therapy (97.5%) (Figure 4) and that patients wear thegarments as prescribed by the doctor (88.8%). In addition,
79% of the users experienced that patients do not complain
about discomfort or any inconvenience during therapy andthat the system allows for patients’ rest and recovery (81%).

Facilities that had used Tri Pulse for at least six (6) monthswere included in the survey.
The interview consisted of open and multiple choice questions
on user information, patient compliance, fit and comfort of
the Tri Pulse garment, ease of use, safety and a summary.
Users were asked to add comments for each question. The
selectable ratings of the multiple choice-questions were:strongly disagree, disagree, agree and strongly agree.

”In my experience, patients generally comply
with Flowtron ACS900 and Tri Pulse therapy”
2.5%

W AgreeW Disagree

Results
A total of 118 users of the Flowtron ACS900 and Tri Pulse
system participated in the user survey that included users at
32 hospitals in Australia (6), France (15), UK (7) and USA (4)(Figure 3). The users were nurses, caregivers, clinicaleducators and healthcare assistants.

97.5%
n=116

Figure 4: Patient Compliance3Caregivers commented that if they explain the device andtreatment to patients, patients comply with therapy. Most
patients found the garments comfortable and wore them asprescribed.

”It is easy to use the Flowtron ACS900 pumpin general”
0.8%

W AgreeW Disagree

Fit and comfort of the Tri Pulse garment
Users were overall very positive about fit and comfort(Figure 5) and a majority of users considered the garment tobe comfortable for the patients (96.5%). Once the garment
is fitted onto the patient’s limb it doesn’t need to be adjusted(93.2%). A few users commented that they may need toadjust the garment if the patient moves a lot. Most users
thought that the Velcro® fastens appropriately and keeps theTri Pulse garment in place on the limb (96.6%) and that theTri Pulse garment design allows for good anatomical fit tothe patients’ limbs (98.3%).

99.2%
n=118
Figure 6Most users (99.1%) liked the placement of the tube/garment connector on the Tri Pulse garment and felt that
this could help in reducing the risk of pressure injuries whilst
wearing the garments. The tubeset being fixed to the pump toeliminate the risk of losing it was also valued by users.

”The Tri Pulse garment design allows for agood anatomical fit to the patients’ limbs”
1.7%

All users appreciated that one pump covers all VTE prevention
IPC therapy needs, as it facilitates ease of use and training.

W AgreeW Disagree

SafetyThe majority of users (94%) considered the safety features
to limit risk of operator error and to facilitate troubleshooting
when using the Flowtron ACS900 and Tri Pulse system.

98.3%
n=116

MiscellaneousFigure 5

Almost all users (97.5%) who took part in this survey
indicated that they would recommend the Flowtron ACS900
with Tri Pulse garments to other facilities and caregivers.

The majority of users were happy with the range of sizes on
the Tri Pulse garment.

Discussion and conclusion

Ease of use

A VTE represents a serious, potentially life-threatening
complication which is largely preventable. The use of IPC
provides one aspect of a prevention strategy that can beused either as a standalone therapy, or combined with othermethods of prophylaxis. It is a well-established therapy withmany configurations of IPC device available.

Most users found the Flowtron ACS900 and Tri Pulse easyto use.
99.2% of the users thought that the Flowtron ACS900
pump is easy to use in general (figure 6), easy to operate
and that it facilitates ease of use. The plug-and-play system
is considered to free up time to care for patients by mostusers (95%) as it reduces time spent on non-patient related
activities.

This survey has gained user feedback with end users ofthe device and demonstrated the clinical application of theFlowtron ACS900 and Tri Pulse garment range in the clinicalenvironment. The majority of users who took part provided
positive feedback in terms of patient compliance, ease of use
and safety of the Flowtron ACS900 device. In addition users
were very positive with regards to the overall fit and comfortof the Tri Pulse garment and with the range of garment sizes
available. Compliance with therapy was considered to be highin general which is an important aspect in VTE prevention
practices requiring the patient to adhere to prescribed
therapy.

Users reported that the Flowtron ACS900 pump was easy toclean.

4

References
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11. Westrich G, Specht LM, Sharrock NE et al. Venous haemodynamics after total
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12. Woodcock JP and Morris RJ. The effect of the Kendall SCD™ and Huntleigh
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At Arjo, we believe that empowering movement within healthcare environments is essential to quality care. Our products and solutions aredesigned to promote a safe and dignified experience through patient handling, medical beds, personal hygiene, disinfection, diagnostics, and theprevention of pressure injuries and venous thromboembolism. With over 6000 people worldwide and 60 years caring for patients and healthcareprofessionals, we are committed to driving healthier outcomes for people facing mobility challenges.
Arjo AB • Hans Michelsensgatan 10 • 211 20 Malmö • Sweden • +46 10 335 4500
www.arjo.com

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