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High Resolution Ultrasound High Resolution Ultrasound

Detection, Prevention and Management of Detection, Prevention and Management of Pressure UlcersPressure Ulcers

LONGPORT, INC / High-Resolution Ultrasound / LONGPORT, INC / High-Resolution Ultrasound / LONGPORT, INC / High-Resolution Ultrasound / LONGPORT, INC / High-Resolution Ultrasound / LONGPORT, INC

EPISCAN I-200EPISCAN I-200


10% of 10% of of patients in acute and extended of patients in acute and extended stay facilities in the western world develop stay facilities in the western world develop pressure ulcers. pressure ulcers.

Annual cost ~$7billionAnnual cost ~$7billion

IncidenceIncidence


• Ultrasound Biomicroscopy Ultrasound Biomicroscopy

• Non-invasive visualization of skin and Non-invasive visualization of skin and underlying two centimeters of soft tissue underlying two centimeters of soft tissue

High Frequency UltrasoundHigh Frequency Ultrasound


Reflections from probe membrane

Coupling gel

Stratum corneum of epidermis

Living strata of epidermis

Reflections from acoustic interfaces(e.g. between collagen & hydrated ground substance) in papillary layer of dermis

Reflections from acoustic interfaces in reticular layer of dermis

Hypodermis (panniculus adiposus)

Reflections from collagen & ground substance interfaces within fibrous supports of adipose tissue

Normal SkinNormal Skin


The Episcan I-200 utilizes high frequency broadband The Episcan I-200 utilizes high frequency broadband (single pulse) ultrasound and digital technology to image (single pulse) ultrasound and digital technology to image the skin and underlying soft tissue to very high the skin and underlying soft tissue to very high resolution. resolution.

Captured images can be stored on hard disk, backed up Captured images can be stored on hard disk, backed up on an integrated CD writer and electronically transferred on an integrated CD writer and electronically transferred for remote archiving or interpretation. Digital for remote archiving or interpretation. Digital photographs can be integrated into the patient record.photographs can be integrated into the patient record.

The TechnologyThe Technology


AdvantagesAdvantages

• Objective Assessment forObjective Assessment for Early and reliable detection of developing pressure ulcersEarly and reliable detection of developing pressure ulcers Improved monitoring of existing woundsImproved monitoring of existing wounds Risk-based and cost-effective treatmentsRisk-based and cost-effective treatments

• Objective Documentation forObjective Documentation for Advanced record keepingAdvanced record keeping Improved staff awarenessImproved staff awareness Reduce exposure to litigation and sanctions Reduce exposure to litigation and sanctions

Episcan I-200 Episcan I-200 Ultrasound ScannerUltrasound Scanner


• Early and reliable detection of developing Early and reliable detection of developing pressure ulcers pressure ulcers

Image tissue changes that precede Image tissue changes that precede visible changes regardless of skin visible changes regardless of skin pigmentationpigmentation

Episcan I-200 Episcan I-200 Ultrasound ScannerUltrasound Scanner


PathogenesisPathogenesis

“ “Pressure ulcers appear to begin in the subcutaneous Pressure ulcers appear to begin in the subcutaneous tissue between the skin and bone as pockets of tissue between the skin and bone as pockets of edema, indicated ultrasonically by pockets of weak edema, indicated ultrasonically by pockets of weak reflections and progress by direct extension into reflections and progress by direct extension into dermal tissue”dermal tissue”

Paul Quintavalle, DPMPaul Quintavalle, DPMDirectorDirectorVirtua Wound Care Center Virtua Wound Care Center


Pre-Pressure Ulcers were induced in healthy volunteers by weighting the Pre-Pressure Ulcers were induced in healthy volunteers by weighting the heels for 1 hour. heels for 1 hour.

Edema was found to begin in the subcutaneous tissueEdema was found to begin in the subcutaneous tissue

45 Minutes after pressure was removed.

Induced Pre-Pressure UlcerInduced Pre-Pressure Ulcer

Normal heel prior to pressure

Note the edema in the Sub-Q tissue


Phase One Pre-Pressure UlcerPhase One Pre-Pressure Ulcer

Intact EpidermisNormal Dermis

Pockets of subcutaneous inflammation


Phase Two Pre-Pressure UlcerPhase Two Pre-Pressure Ulcer

Intact Epidermis

Strips of dermal damage

Increased subcutaneous damage


Phase Three Pre-Pressure UlcerPhase Three Pre-Pressure Ulcer

Intact Epidermis

Strips of dermal damage

Increased subcutaneous damage


Superficial Edema

Friction

Differentiate pressure ulcer from friction or incontinence related Differentiate pressure ulcer from friction or incontinence related breakdownbreakdown

Deep Edema

Pressure

Epidermis

Dermis

Episcan I-200 Ultrasound ScannerEpiscan I-200 Ultrasound Scanner



Improved monitoring of existing woundsImproved monitoring of existing wounds

“ “ Up until now, nurses have been limited to a two-Up until now, nurses have been limited to a two-dimensional picture and the presence of exudate for dimensional picture and the presence of exudate for assessing a wound. With this scanner we can see if assessing a wound. With this scanner we can see if healing has taken place in deeper tissue and not just on healing has taken place in deeper tissue and not just on the surface. This device takes the guess work out of the surface. This device takes the guess work out of wound treatment.”wound treatment.”

Courtney H. Lyder, NDCourtney H. Lyder, NDProfessor, University of VAProfessor, University of VA



• Improved monitoring of existing woundsImproved monitoring of existing wounds

• Reveals sinus tracks, wound undermining, and Reveals sinus tracks, wound undermining, and edemaedema


Wound UnderminingWound Undermining

Undermining

Epidermis

Dermis

Wound


Sinus TractSinus Tract

Epidermis

Sinus track

Dermis

Wound


Measuring Treatment EffectivenessMeasuring Treatment Effectiveness

Epidermis Fluid

Dermis

left heel (day 1) left heel (day 7)

Same heels compared a few days after heel care program implemented. Notice a dramatic reduction of fluid between epidermis and dermis


Episcan I-200Episcan I-200 Ultrasound Scanner Ultrasound Scanner

Implement treatment based on these Implement treatment based on these objective findings!objective findings!

““Facilities’ caregivers now can target the Facilities’ caregivers now can target the intervention much more precisely based on the intervention much more precisely based on the interpretation of the scans.”interpretation of the scans.”

John Hertig, CEOJohn Hertig, CEOAdvanced Clinical ServicesAdvanced Clinical Services

Referenced from “Nursing Homes” magazine May 2004Referenced from “Nursing Homes” magazine May 2004


Control Resource UtilizationControl Resource Utilization

Risk-based and cost-effective treatmentsRisk-based and cost-effective treatments

““Thank you for the opportunity to become involved with your Thank you for the opportunity to become involved with your High Frequency Ultrasound Technology for soft tissue High Frequency Ultrasound Technology for soft tissue evaluation; we have found numerous benefits since we evaluation; we have found numerous benefits since we purchased your scanner…allows us to maintain a minimum purchased your scanner…allows us to maintain a minimum number of protocols thereby reducing the variety of wound number of protocols thereby reducing the variety of wound management products and associated costs.”management products and associated costs.”

Administrator,Administrator,Little Flower ManorLittle Flower ManorWilkes Barre, PAWilkes Barre, PA


Implement wound care strategies best suited for Implement wound care strategies best suited for wound characteristics……wound characteristics……

Patient specificPatient specific

Wound specificWound specific

Risk-based and cost-effective treatmentsRisk-based and cost-effective treatments

Resource control utilizationResource control utilization



Reduce exposure to litigation and sanctionsReduce exposure to litigation and sanctions

“ “Pressure ulcers are the #1 litigated wound Pressure ulcers are the #1 litigated wound problem in nursing homes and long term problem in nursing homes and long term care.”care.”

Courtney H. Lyder, NDCourtney H. Lyder, ND

Professor, University of VA Professor, University of VA


Reduce Exposure to Litigation Reduce Exposure to Litigation and Sanctionsand Sanctions

• Advanced record keepingAdvanced record keeping

• Comprehensive electronic recordComprehensive electronic record

• Integrate patient and wound assessment Integrate patient and wound assessment datadata

• Integrate treatment protocols and ultrasound Integrate treatment protocols and ultrasound imagesimages


High Resolution Ultrasound for High Resolution Ultrasound for Management of Pressure UlcersManagement of Pressure Ulcers

• Detection of pressure ulcers before clinical signs Detection of pressure ulcers before clinical signs are apparentare apparent

• Documentation of the existence of pressure ulcers Documentation of the existence of pressure ulcers on admissionon admission

• Targeting treatments to specific anatomical areasTargeting treatments to specific anatomical areas• Distinguishing between pressure ulcers and Distinguishing between pressure ulcers and

friction ulcersfriction ulcers• Measuring treatment effectivenessMeasuring treatment effectiveness• Increasing awareness and complianceIncreasing awareness and compliance



Conclusion:Conclusion:

• The Episcan I-200 is a valuable tool for The Episcan I-200 is a valuable tool for pressure ulcer detection and assessmentpressure ulcer detection and assessment

• Can aid in the reduction of the incidence of Can aid in the reduction of the incidence of pressure ulcerspressure ulcers

• Can aid in the treatment of pressure ulcersCan aid in the treatment of pressure ulcers

• Can aid in the reduction of liabilityCan aid in the reduction of liability


Further Information

For further information on this system and its applications and global sales enquiries please contact:

PPM Consult Ltd

Business web site: PPMconsult.com Medical web site: A1med.net

E-mail: [email protected]

longport, inc / high-resolution ultrasound / longport, inc / high-resolution ultrasound / longport,...

Documents

ultrasound scanner slide

technology slide

incidence slide

acoustic interfaces

management of pressure

sanctions episcan

digital technology

annual cost