Journal of Community Nursing

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JCN Supplement 2016 7
desired sub-bandage pressure to the
lower limb from 20 to 50mmHg.
A pilot study to test juxtacures with
16 patients was carried out in Wiltshire
and after four weeks the average
saving for wound dressings and
compression therapy was £60.88 per
patient per week. The total number
of nursing visits also reduced by an
average of 87 minutes per patient per
week (Wicks, 2015). Following this,
juxtacures was considered for every
patient with a venous leg ulcer and 56
patients had their treatment converted
from compression bandaging to the
adjustable compression system.
During the first week of the
‘conversion programme’, a quality-
of-life questionnaire was given to
18 patients and this was repeated at
week four. The results indicated that
the perception of pain was reduced
in 70% of patients, sleep pattern
improved in 62%, and overall, 80%
of patients stated that this change
in treatment improved their quality
of life. They cited being able to wear
normal footwear, better balance, and
improved gait and stability leading
to greater mobility. Being able to get
socks and trousers on was also seen
as an advantage, with one patient
saying that he could get dressed and
have lunch with his friends for the first
time in two years. The option to check
and adjust pressure by the patient also
increased self-care, which improved
feelings of being in control’.
In the six months following this
conversion programme, the healing
rate, as a percentage of the number of
patients on the caseload with a venous
leg ulcer within the community
nursing teams, increased from 19 to
39%, and the length of time to healing
reduced from an average of 22 to 18
weeks. Fourteen of the 56 patients,
who had a chronic long-term leg ulcer
for 12 months or more, despite being
in compression bandaging, healed
within six months.
The following should be
considered when introducing
juxtacures:
 Patient choice (some patients
are used to having compression
bandaging and may not wish
to change)
 juxtacures will last for six months,
thus, if an ulcer is relatively small
and likely to heal quickly, it may
be appropriate to use alternative
methods of compression (e.g.
compression bandages, leg
ulcer kits)
 juxtacures is simple to use and
training can be given to carers, or
patients may wish to self-manage
after the initial fit and follow-up
 The product can be
laundered easily
 A recent randomised controlled
trial (RCT) found that adjustable
Velcro compression systems
were effective for patients with
venous oedema (Mosti et al,
2015), however juxtafit ™ is
more suitable, being designed
specifically to manage oedema/
lymphoedema.
With regard to the financial
impact of using juxtacures, the cost of
the bandage and dressing regimens
for six patients was scrutinised for six
months before the conversion to
juxtacures and there was a total cost
of £4,323.28 for wound dressings
and compression bandaging. This
reduced to £1,928.16 for the six
months following, i.e. a total saving
of £2,395.12 for six patients. This
included juxtacures and the primary
and secondary dressings used. The
significant reduction in exudate
volume in these patients also
led to fewer dressings and
dressing changes.
CONCLUSION
Various compression systems are
now available for the treatment of
venous leg ulcers, each having their
own advantages and disadvantages,
however, the choice for each patient
should be an individual one.
Many general practice nurses
(GPNs) are overstretched, with
challenging workloads. Thus,
innovations that can save nursing
time and money and improve patient
quality of life, to the extent that some
people take an active self-care role with
treatment, are a welcome progression
in the treatment of venous leg ulcers.
Whole system changes or
developments bring challenges
and change takes time to become
embedded in workforces, but effective,
consistent and safe choices for patients
with venous leg ulcers are now
readily available.
To cite this article: Wicks G (2016) Innovative
compression therapy systems can improve
practice. J General Practice Nurs 2(3): 26–7
REFERENCES
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Lay-Flurrie K (2005) Assessment and good
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Mears J, Moffatt C (2002) Bandaging
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Moffatt C (2004) Four-layer bandaging: from
concept to practice. Part 1: The development of
the four-layer system. World Wide Wounds.
Available online:
Mosti G, Cavezzi A, Partsch H, et al (2015)
Adjustable velcro compression devices
are more effective than inelastic bandages
in reducing venous edema in the initial
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Wicks G (2015) An alternative to
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Wounds International (2013) Principles of
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guide to treatment and prevention of
venous leg ulcers . Available online: www.
woundsinternational.com
FIGURE 1.
juxtacures in situ.
JCN