Hrev_master Veins and Lymphatics 2018; volume 7:7625 [page 64] [Veins and Lymphatics 2018; 7:7625] Activities and effects of a qualification system for elastic compression stocking appliers of the Japanese Society of Phlebology Makoto Mo Department of Cardiovascular Surgery, Yokohama Minami Kyosai Hospital, Yokohama, Japan Abstract The Japanese Society of Phlebology established a qualification system for elastic stocking conductors to promote proper usage of elastic compression stocking (ECS) and bandages for the treatment and prevention of venous disease, and also treat- ment of lymphatic disease in 2002. One hundred fourteen half day hands-on semi- nars were held all over Japan with assis- tance of manufactures and distributors of ECS and bandages. The number of atten- dees, mainly nurses, was more than 11,000(!) and 2384 ESC conductors certifi- cates were issued after certain clinical expe- riences. ESC conductors are currently working in the outpatient clinics for treat- ment of venous and lymphatic edema and on inpatients wards for prevention VTE. ECS experts with good knowledge of ECS and diseases increase the compliance of ECS by meticulous consultation of the patients regarding compression therapy. Introduction Not many medical staff members have sufficient knowledge about compression stockings or bandages. Even if they know they do not have enough time to educate and consult patients regarding compression therapy. By increasing the number of med- ical professionals with knowledge of com- pression therapy we try to increase patients’ compliance. The educational program of the Japanese Society of Phlebology (JSP) to promote proper usage of elastic compres- sion stockings (ECS) and bandages for treatment and prevention of venous disease, and also treatment of lymphatic disease was established by Professor Masafumi Hirai in 2002. Then, a Japanese guideline for VTE prophylaxis was published in 2004, and revised in 2009. Reimbursement for preven- tion of pulmonary embolism prophylaxis was started in 2004. It is 305 points = approximately 30 Euro and is applied only for high-risk VTE in-hospital patients who were controlled under ECS, elastic bandag- es or IPC in accordance with the guideline. Perioperative pulmonary thromboembolism in Japan decreased to half after 2004, based on the results of perioperative pulmonary thromboembolism research by the Japanese Society of Anesthesiologists (JSA-PTE research), mainly after introduction of ECS, elastic bandage or IPC but not of anticoag- ulants.1 Management fee of secondary lym- phedema was also reimbursed in 2008. It is up to approximately 300 Euro per half year. A ESC conductor is qualified after attendance of ESC conductor seminar, i.e. half-day hands-on seminars, and documen- tation of 30 cases of clinical experience reports by JSP. ESC conductor seminars are half-day course with 100-300 attendees. Eight seminars per year are held all around Japan more than 140 times. The JSP pub- lished an official textbook for ESC conduc- tor seminar which covers venous anatomy, physiology, venous disease, prevention of deep vein thrombosis, pulmonary embolism, lymphedema, and includes theo- ry and practical usage of ESC/bandage.2 The lectures are based on the textbook. After the lecture, hands-on seminars of ECS & bandages with video viewing lasts about one and half hours. Several methods of application of ECS, elastic bandage and ECS donner are practiced with sub-bandage pressure measurement. Seminars are oper- ated under independent financial condi- tions. Class fee; approx. 50-80 Euro per attendee and exhibition fee from stocking company: 300-500 Euro per company are the main source of income. Currently, the number of attendees, mainly nurses, is more than 11000 and the number of qualified ECS conductors exceed 2384 by 2016. About 250 ECS conductors are qualified every year. ESC conductors are currently working in the outpatient clinic for treatment of venous and lymphedema and inpatients ward for prevention VTE. ECS conductors with good knowledge of ECS and diseases increase the compliance of ECS by meticu- lous consultation on compression therapy. Case Reports Case of increased compliance of com- pression therapy by meticulous consulta- tions by ECS conductor. Eighty years old female was presented with refractory venous leg ulcer (VLU) due to immobilization and knee/ hip arthroplas- ty (Figure 1). No DVT or varicose vein was detected. It was difficult for her to reach her leg because she could not bend over. Leg elevation was instructed. Compression ther- apy with pressure guide medium stretch bandage (30 mmHg) was started. Compression bandage was changed to pres- sure guide low stretch bandage (45 mmHg) because of no heeling of VLU. She started to complain of itching and finally rejected compression therapy. VLU worsened after three months (Figure 1). ECS conductor (outpatient nurse) consulted her meticulous- ly and found the reason of poor compliance of compression therapy and poor hygiene. She was living alone and depressed. A visit- ing nurse was introduced and her son living abroad was informed about his mother’s condition. Compression therapy was restarted with pressure guided cotton stretch bandage (30 mmHg) and the pressure was increased up to 45 mmHg. Compliance was kept well with help of visiting nurses and encouragement of her son. VLU was healed five months after presentation and she was kept on ECS (20 mmHg) without recur- rence (Figure 1). Conclusions ECS conductors with good knowledge of ECS and bandages and diseases help to increase the compliance regarding compres- sion therapy by meticulous consultation. Correspondence: Makoto Mo, Department of Cardiovascular Surgery, Yokohama Minami Kyosai Hospital, 1-21-1 Mutsuura higashi Kanazawa-ku, Yokohama 236-0037 Japan. Tel.: 81.45.782.2101. E-mail: mou-ths@umin.ac.jp Conference presentation: International Compression Club (ICC) Meeting, Paris, 2017. This work is licensed under a Creative Commons Attribution 4.0 License (by-nc 4.0). ©Copyright M. Mo, 2018 Licensee PAGEPress, Italy Veins and Lymphatics 2018; 7:7625 doi:10.4081/vl.2018.7625 Conference Presentation [Veins and Lymphatics 2018; 7:7625] [page 65] References 1. Kuroiwa M, Morimatsu H, Tsuzaki K, et al. Changes in the incidence, case fatality rate, and characteristics of symptomatic perioperative pulmonary thromboembolism in Japan: Results of the 2002-2011 Japanese Society of Anesthesiologists Perioperative Pulmonary Thromboembolism (JSA- PTE) Study. J Anesth 2015;29:433-41. 2. Iwai T, Hirai M ed. Elastic stocking conductor. Tokyo: Health Shuppann Co.;2010. Figure 1. Case reports.