DISPOSABLE BAND FOR A COMPRESSION DEVICE
Apparatus and methods for cyclically compressing the limb of a patient to improve blood flow in the limb. In one embodiment, a compression device includes a compressive section sized and shaped for extending around a portion of the limb for applying compressive pressure and a housing operatively connected to the compressive section. The housing includes first and second housing members movable relative to each other between contracted and expanded positions. A non-pneumatic mechanical actuator is provided in the housing for cyclically moving the first and second housing members from their contracted position to their expanded position.
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This invention relates generally to compression therapy, and more particularly to devices which enhance blood flow to avoid circulation problems, such as deep vein thrombosis (DVT).
Cyclical compression of a body part (e.g., leg) is beneficial to a person who has a blood circulation problem involving poor venous return to the heart. Many devices on the market and in the prior art provide compression by using one or more pneumatic bladders that encircle the leg or other limb(s). The bladders are inflated in a predetermined sequence and to a prescribed pressure at timed intervals. The device that controls the inflation typically employs an air pump or compressor and a number of valves that operate to direct the flow of air to the bladders. Conventional products use a bladder-filled sleeve wrapped around the limb and a tube that connects the bladder(s) to a controller device that resides separately from the patient such as on the footboard of a bed, on the floor, or on a night stand. If the patient must move, the device must be removed. In addition, while the device is on the patient, it is possible that tubes become entangled in the patient's limbs and/or become a nuisance or safety hazard to caregivers and visitors who may be close to the bed.
There is a need, therefore, for an improved compression device.SUMMARY OF THE INVENTION
In general, a compression device of this invention is used for cyclically compressing the limb of a patient to improve blood flow in the limb. The compression device comprises a compressive section sized and shaped for extending generally circumferentially around a portion of the limb for applying compressive pressure to the limb portion, and a housing operatively connected to the compressive section. The housing includes first and second housing members movable relative to each other between a contracted position in which the housing has a first dimension for relaxing pressure on the limb portion, and an expanded position in which the housing has a second dimension greater than the first dimension for compressing the limb portion. A non-pneumatic mechanical actuator is provided in the housing for cyclically moving the first and second housing members from their contracted position to their expanded position.
In another aspect, this invention is directed to a compression system which includes at least two of the compression devices described above and, in addition, a single integrated control system for controlling the operation of the at least two compressive devices.
In still another aspect, this invention is directed to a method of using a compression device to cyclically compress the limb of a patient to improve blood flow in the limb. The compression device comprises a compressive section sized and shaped for extending generally circumferentially around a portion of the limb for applying compressive pressure to the limb portion, and a housing operatively connected to the compressive section. The housing includes first and second housing members movable relative to each other between a contracted position in which the housing has a first dimension and an expanded position in which the housing has a second dimension greater than the first dimension. The method comprises the steps of first applying the compression device to a limb of a patient such that the compressive section extends circumferentially around a portion of the limb, and then cyclically activating a non-pneumatic mechanical actuator located inside the housing to move the housing members from their contracted position to their expanded position in a series of cycles to cyclically compress the limb.
In another aspect, this invention is directed to a method of using a compression system to cyclically compress portions of a limb of a patient to improve blood flow in the limb. The compression system comprises a compressive unit having zones corresponding to different portions of a limb, and at least two modules each comprising a housing including first and second housing members movable relative to each other between a contracted position in which the housing has a first dimension and an expanded position in which the housing has a second dimension greater than the first dimension. The method comprises the steps of applying the compressive unit to a limb such that the compressive unit extends circumferentially around the limb and the zones of the unit correspond with the limb portions to be cyclically compressed, and operatively connecting the modules to the compressive unit such that the modules are positioned in respective zones of the compressive unit. The housing members are then caused to move cyclically between their expanded and retracted positions for cyclically compressing the limb portions.
In another aspect, a compression device of this invention comprises a compressive section sized and shaped for extending generally circumferentially around a portion of the limb for applying compressive pressure to the limb portion, and a module operatively connected to the compressive section for cyclic expansion and contraction in generally radial directions with respect to the limb portion between a contracted condition in which the module has a first dimension for relaxing pressure on the limb portion, and an expanded condition in which the module has a second dimension greater than the first dimension for compressing the limb portion. The module comprises the combination of at least one pneumatic bladder and at least one non-pneumatic mechanical device. The at least one non-pneumatic mechanical device is operable to apply a force in a generally radial direction with respect to the limb portion for moving the module toward its expanded condition.
In another aspect, this invention is directed to a disposable band for use in a compression therapy to improve blood flow in the limb of a patient. The band comprises
a band member adapted to extend circumferentially around a portion of the limb. The band member has opposite ends. A fastening device is provided on the band member for releasable attachment of opposite ends of the band member to secure the band member around the limb portion. A pocket on the band member is sized and shaped for receiving a module cyclically movable between a contracted condition in which the module has a first dimension for relaxing pressure on the limb portion and an expanded position in which the module has a second dimension greater than the first dimension for compressing the limb portion. The module is removable from the pocket whereby on termination of the compression therapy the band can be disposed and the module re-used with a different disposable band.
Other objects and features will be in part apparent and in part pointed out hereinafter.
Corresponding parts are indicated by corresponding reference numbers throughout the several views of the drawing.DETAILED DESCRIPTION
Referring now to
In one embodiment (see
In the illustrated embodiment (
A force-distributing device (generally designated 45) is interposed between the housing 9 and the limb 3 for distributing compressive forces applied by the device 1 more evenly across the limb. As shown in
In some embodiments, the compression device may be used without a force-distributing device (e.g., device 45). In these embodiments, the pocket 39 is preferably of a smaller size.
As illustrated in
The second housing member 17 comprises a cover member (also designated 17) having a substantially planar top wall 77 generally parallel to the bottom wall 61 of the base member 15, opposite side walls 81 curving down from the top wall, and opposite end walls 83 extending down from the top wall. The top, side and end walls of the cover member 17 may have other shapes.
The base and cover housing members 15, 17 are fabricated from a suitable material, such as a flexible plastic or a rigid plastic having an outer coating of a more resilient material (e.g., an over-molded spongy or rubbery material). The parts may be molded as one-piece parts having a relatively thin-wall construction to reduce expense and weight.
The base and cover members 15, 17 of the housing are adapted to be moved by the actuator 21 from their stated contracted position to their stated expanded position. In a contracted position, the cover member 17 is spaced relatively close to the base member 15 and, in one embodiment, the bottom rim 87 of the cover member mates with the top rim 89 of the base member. In its contracted position (
The arrangement shown in
It will be understood that the actuator 21 described above is only exemplary and that other actuators can be used for effecting relative movement between the housing members without departing from the scope of this invention. Preferably, the actuator is non-pneumatic so that the compression device is entirely self-contained, i.e., all components for effecting cyclic compression are contained in a single garment which can be applied and removed as a unit from the patient. It is also preferred that the actuator be operable to rapidly expand and contract the housing 9 in an energy efficient manner.
The compression device 1 further comprises a control system, generally designated 201 (see
In one embodiment, this indicating device 227 senses a characteristic indicative of the actual pressure applied to the limb. By way of example, the device 227 may comprise a suitable circuit for monitoring the amount of current and/or voltage to the electric motor 125, which amount is proportional to the actual pressure applied to the limb. Alternatively, the pressure-indicating device may comprise one or more pressure sensors for sensing the pressure in one or more chambers in the cushion 49 (if a sealed bladder-like cushion is used), the sensed pressure being proportional to the actual pressure applied to the limb. In still another embodiment, the pressure-indicating device 227 may comprise one or more strain gauges on the band 27, the tension in the band being indicative of the actual pressure on the limb. Other devices for indicating the pressure applied to the limb may be used.
Preferably, the control system 201 also includes a visual indicator 231 for indicating the operational status of the compression device 1. Although various types of visual indicators are contemplated,
Referring again to
Those skilled in the art are familiar with executing software 237a and/or firmware 237b by CPU 237 to perform a number of operations, including but not limited to: controlling the operation of motor 125, including its output shaft 127; communicating with pressure sensing devices 227; controlling charge indicator 225 and/or visual indicator 231; communicating with charge indicator 225; operating actuator 21; and sensing the voltage or current to the motor 125 to indicate a relaxed state of the device 1. As known in the art, a processor such as CPU 237 may further execute computer-implemented instructions in the form of software 237a and/or firmware 237b to control voltage or speed of motor 125 to rotate its output shaft 127 for increasing the throw of the cams 121, thereby increasing D2 to increase the pressure during a compression therapy regimen. Once activated, CPU 237 determines the treatment regimen and begins treating, as described above, by rotating motor 125, which in turns adjusts the throw of the cams 121 for the correct pressure at the device based on its position on the limb (e.g., higher pressure may be desired on the ankle compared to the thigh).
A typical use of the compression device 1 can be described as follows. Initially, the contracted housing 9 and force-distributing device 45 (if used) are inserted in the pocket 39 of the band 27. The band is then applied to a portion of a limb 3 to be treated, as illustrated for example in
During the compress stage, the electric motor 125 is energized to rotate the cam shafts 115 in a first direction, which causes the two housing members 15, 17 to move away from one another, thereby increasing the overall dimension of the housing from D1. As the housing 9 expands, the cover member 17 exerts a force in a direction away from the limb 3 to tension the band 27 and the base member 15 exerts a force in the opposite direction toward the leg. As a result of these forces (indicated at 251 in
After a predetermined compressive pressure is applied to the limb 3 for a duration of time (compress interval), the control system 201 operates the motor 125 to rotate the cam shafts 115 and cams 121 thereon in the opposite direction to contract the housing members 15, 17 and thus reduce the overall housing dimension from D2 back to D1 to relax the pressure on the limb. The relax pressure may range from zero to some pressure greater than zero but less than the compression pressure, as sensed by the current and/or voltage to the motor 125 or by some other suitable means. The relax pressure (if any) is maintained for a period of time (relax interval) sufficient to allow blood to return to the limb. The length of this time period may be fixed (e.g., sixty seconds) or it may vary depending on when a vascular refill condition is detected. In this regard, there is typically some increase in the circumferential size of the limb as blood returns to the compressed portion of the limb. This increase in size can be used to trigger the start of a new cycle. In one embodiment, the pressure sensing device of the control system 201 is used to detect the increase in limb size. For additional details regarding detection of a vascular refill condition, reference may be made to U.S. Pat. No. 6,231,532, assigned to Tyco Healthcare Group LP. This patent is incorporated herein by reference for all purposes not inconsistent with this disclosure.
The cycling continues as described above until the motor is de-energized automatically by the control system 201 or manually by actuating the power switch 205. After use, the housing 9 is removed from the pocket 39 of the band 27 for re-use with a fresh band.
During operation of the device 1, particularly during initial start-up, the compressive pressure applied by the device may need to be adjusted. The control system 201 can make any necessary adjustment by varying the “throw” of the cams 121 until the pressure sensing device of the control system 201 indicates that the desired compressive pressure is being applied. Thus, to increase the pressure, the control system 201 simply operates the motor 125 to rotate its output shaft 127 through a greater number of degrees to increase the throw of the cams 121 and thus increase dimension D2 of the housing 9. To decrease the compressive pressure, the control system 201 operates the motor 125 to rotate its output shaft 127 through a shorter segment of rotation, thereby decreasing the throw of the cams 121 to decrease dimension D2.
As illustrated in
In the example of
During the compress stage of an exemplary cycle, expansion of the ankle compression device 1A is started at time T1=0 seconds, for example, to apply the first compressive pressure; expansion of the calf compression device 1B is started at time T2=2.5 seconds, for example, to apply the second compressive pressure; and expansion of the thigh compression device 1C is started at time T3=5.5 seconds, for example, to apply the third compressive pressure. Each compression device continues to expand until the proper pressure is reached, as sensed by the sensing device incorporated into the control system 201 of the compression device. Further expansion of the compression device is then stopped. There may be some overlap of the times during which the compression devices expand, but in general the compression applied by the devices should occur in a progressive manner to move the blood in the limb in a direction toward the heart.
After the compress stage has ended (e.g., at a cycle time of T4=11 seconds), any further expansion of the compression devices 1A, 1B, 1C is stopped, and the devices are contracted simultaneously to relax or release the pressure on respective portions of the limb. The relax stage preferably continues for an interval of time sufficient to allow blood to return to the limb, as discussed above. A new cycle begins after the relax stage of the previous cycle has ended (e.g., at time T5=71 seconds). The cycles continue to repeat until the compression devices are shut off, which may occur automatically via the control system or by manual operation.
In use, the compressive unit 309 is applied to the limb and the modules 321 are operatively connected to the unit, as by placing the modules in respective pockets of the unit. The modules are then operated to compress respective portions of the limb in a sequential manner, i.e., in a direction toward the heart. This direction is important so as not to cause injury to the patient. After the treatment has ended, the modules 321 are removed from respective compressive sections of the unit 309. The unit 309 is then typically discarded. The modules can be re-used with a different unit 309 holding multiple modules, or with one or more bands each holding only one module. Because the modules 321 can be positioned at different locations with respect to a limb during re-use, it is desirable to have an integrated control system which senses the location of the modules with respect to the limb, and which coordinates the operation of the modules after they have been placed in position so that proper sequential and gradient compression of the limb is achieved. Preferably, the coordination of these modules should not interfere with the operation of other modules applied to a different limb of the same patient or with the operation of other modules on a limb or limbs or a different patient.
The integrated control system 401 also includes means for providing communication between the modules 321. For example, as shown in
It will be observed from the foregoing that the integrated control system 401 performs two functions. First, it senses the location of each module 321 with respect to the compression zone in which it is placed. Second, based on this sensed location, the system coordinates the operation of the modules 321 to achieve the desired sequential and gradient compression of the limb.
According to aspects of the invention, the integrated control system 401 cooperates with control system 201, such as shown in
In an alternative embodiment, one control system 201 functions as a master controller for controlling operation of all of the modules 321 connected thereto. In another alternative embodiment, the control system 201 associated with one module 321 is responsive to the control system associated with another module 321 as a function of the relative positions of the modules on the patient's limb 3. In yet another alternative embodiment, the integrated control system 401 comprises the control systems 201 associated with the compression devices 1 of modules 321 operating cooperatively.
The bladder 505 provides additional pressure and size adjustment when compressive treatment is provided to the patient. The bladder 505 is a sensing bladder for sensing a characteristic of compression therapy on a patient. The bladder 505 has a sensing device 521 in communication with the contents of the bladder for sensing, for example, the pressure of the contents of the bladder, and for outputting a signal indicative of that characteristic to the control system 201. Placing the sensor in-situ with the bladder medium provides for greater accuracy and control of the compression afforded during treatment. The bladder pressure directly impacts blood flow, in that, a lower pressure distributes less force from the mechanical device to the patient limbs, and likewise a higher pressure distributes a greater amount of the force from the mechanical device to the patient's limb. The ability to adjust the bladder pressure with precision allows the patient to tailor treatment to their comfort level. A patient wearing the device can adjust the nominal pressure, independent of computer instruction operating a therapy regime, as described below in the operation of the device. Other sensing devices for sensing other characteristics of the compression therapy are contemplated. For example, the sensor may be a sensor, in a thin layer composite, between the bladder and the leg for sensing a condition of the patient (e.g., temperature, pulse, blood flow, oxygen level).
The bladder has a pneumatic port 513 and a suitable valve mechanism (not shown) for inflation of the bladder by a pump 515. In
In use, one or more of the compression devices 501 are applied to the limb 3 to be treated, as described in the previous embodiments. A nominal pressure is maintained in the bladder(s) 505 to provide for therapy adjustment, to provide a static baseline pressure, and to distribute the compressive forces applied by the compression device 501 evenly about the surface of the leg or limb of a patient. The transducer 521 provides feedback to the controller (e.g., CPU 237 in
In operation, the compression device 501 cyclically compresses both the limb and the bladder(s) 505. This action is monitored by the transducer 521 which provides feedback to the controller to monitor and adjust the tension in band 27. Preferably, the aforementioned small nominal pressure is maintained in the bladder 505 during the relax stage of each compression cycle. This pressure is much less than in prior art systems, such as found in U.S. Pat. No. 4,253,449 (Arians et al.) owned by Tyco Healthcare Group LP.
Just before the compress stage of each cycle begins, the pneumatic port 513 of the bladder 505 is closed by a suitable valve mechanism (not shown) or other means to capture the small nominal pressure in the bladder. As the base and cover members 15, 17 of the housing 9 expand, the tension in the band 27 and the pressure in the bladder 505 increase proportionally. The pressure transducer 521 monitors this change in pressure and the peak pressure value is fed into a feedback algorithm executed in one of the software and/or firmware modules 237a, 237b of
In the case of an edematous patient, the level of swelling in a limb or limbs can change over time. An advantage of this compression device 501 is that the pressure in the bladder(s) 505, as sensed by the pressure transducer 521, can be adjusted to reduce or increase the volume contained within the compressive band 27 in a manner which is inversely proportional to the amount of edema change. For example, if the compression device 501 is set to apply a predetermined compressive pressure of 45 mmHg during the compress interval, but the pressure transducer 521 senses a bladder pressure of 50 mmHg due to increased edema, the control system 201 will automatically reduce the pressure in the bladder(s) 505 to compensate for the increased swelling. As a result, blood flow to the swollen limb is not unduly restricted.
The compression device 501 using one or more bladders 505 is also capable of measuring vascular refill time (VRT). VRT measurement is an air plethysmographic technique that determines when the veins of a limb have substantially completely refilled with blood after the compression stage of a compression cycle. See, for example, the VRT measurement described in U.S. Pat. No. 6,231,532 to Watson et al., the entire content of which is incorporated by reference herein. This VRT technique is used to minimize the amount of time that blood remains stagnant in the veins.
In general, a VRT measurement is made during the relax stage of the compression cycle in which the compressive device 501 first reaches its compressive pressure set point. Thereafter, measurements are taken at selected intervals (e.g., every 30 minutes). The measurement process it initiated at T=Tstart when the sensed pressure in the bladder decreases to a predetermined level (e.g., 5-7 mmHg), indicating the end of the compress stage and the start of the relax stage of the cycle. As blood returns to the limb 3, the limb expands and causes the pressure in the bladder(s) 505 to increase. This pressure increase is sensed over time by the transducer 521. In one example, the bladder pressure is sampled at one-second intervals and the pressure is monitored by using a moving or “rolling” 10-second window of time in which the oldest sample value is dropped from the window and a new sample value is added every second. When the difference between the first and last sample values in the window decreases to a predetermined value (e.g., about 0.3 mmHg), indicating that the refill curve has reached its plateau and that refill is substantially complete, the measurement process is terminated at T=Tend. The vascular refill time is then determined (Tend minus Tstart) and, if necessary, an appropriate adjustment to the relax interval of the compression cycle is then made.
For example, in one embodiment the “default” relax interval is 60 seconds. If the measured VRT is greater than 60 seconds, then the relax interval remains at 60 seconds. If the measured VRT is between 20 and 60 seconds, the relax interval is re-set to the measured VRT. If the measured VRT is less than 20 seconds, then the relax interval is re-set to a minimum time of 20 seconds, for example. The minimum relax interval (e.g., 20 seconds) should be sufficient to insure that the limb has substantially refilled with blood before initiation of the compress stage of the next cycle. The minimum relax interval may also be established by adding a predetermined safety factor (e.g., 5 seconds) to the measured VRT.
Under certain circumstances, the VRT measurement may be disregarded. For example, such circumstances might include a situation where the standard deviation of the pressure values in the sample window exceed a predetermined maximum standard deviation, indicating that the VRT measurement is erroneous; or a situation where the sensed pressure in the bladder(s) 505 falls below a predetermined minimum value (e.g., 2 mmHg) during the measurement process, indicating a possible leak in the system; or a situation where the sensed pressure in the bladder(s) 505 exceeds a predetermined value (e.g., 20 mmHg) during the measurement process. In such situations the VRT measurement is disregarded, and the relax interval of the prior cycle continues to be used.
As explained in regard to the first embodiment, more than one compression device 501 can be used to sequentially compress different portions of the same limb (e.g., one leg) or different limbs (e.g., two legs). If more than one device 501 is used, the VRT is determined separately for each limb portion being compressed. Preferably, the longest of the measured vascular refill times is then used as the new relax interval for all of the compression devices. The VRT measurements for the compression devices are made (i.e., started and stopped) independent of one another. Preferably, however, any adjustment to the relax interval of the compression devices is not made until after the VRT measurements have been completed for all devices.
As an enhanced safety feature, the control system 201 of the compression system 501 may provide an audible and/or visual error alarm for one or more of the following error conditions: high pressure error, including a sensed pressure greater than a set maximum pressure; low pressure error, including a sensed pressure less than a set minimum pressure (e.g., also detecting the absence of bands or sleeves); system pressure error, including a pressure sensed during a compress stage and/or relax stage of a compression cycle outside of desired parameters; valve error; software error; pump error; vent and deflation error; battery error; and temperature error, including temperatures detected outside of specified environmental conditions. (The compression device 501 can be modified to include one or more temperature sensors to provide the latter feature.) An alarm system of the type described advantageously enhances the safety of the patient during vascular therapy. In the event of an alarm condition, it is contemplated that the visual indicator 231 or other means may flash error signals, sound a continuous alarm, or otherwise indicate an alarm situation. Further, the control system 201 may be responsive to an alarm condition to deflate the bladder(s) 505 and cease further operation of the compression device 501.
In one embodiment, the compressive section 607 comprises a band member 635 having opposite ends which are releasably connected by a suitable fastening device 637 (e.g., similar to 31 in the first embodiment) to form an annular band around the limb. The compressive section 607 may have other configurations.
The mechanical device 619 is non-pneumatic in the sense that it does not include pneumatic components requiring or involving the use of pressurized air or other gas. In the embodiment of
In operation, the pump 641 inflates the bladder(s) 615 which causes the module 621 to expand to compress the limb portion 609 to a predetermined pressure during a compress stage of the compression cycle. The pump 641 deflates the bladder(s) 615 to a predetermined pressure after an appropriate compress interval has ended. This causes the module 621 to contract for relieving the pressure on the limb during the relax stage of the compression cycle. As indicated at 624 in
In one embodiment, the compressive section 707 comprises a band member 735 having opposite ends which are releasably connected by a suitable fastening device 737 (e.g., similar to 31 in the first embodiment) to form an annular band around the limb. The compressive section 707 may have other configurations.
The bladder(s) 715 is positioned between the limb portion 709 and the mechanical device 719. The bladder(s) has a pneumatic port 725 for inflation and deflation of the bladder, as by a hand pump manually operated by the patient or caregiver.
The mechanical device 719 is non-pneumatic in the sense that it does not include pneumatic components requiring or involving the use of pressurized air or other gas. In the embodiment of
To operate the compression device 701, the bladder(s) 715 is inflated to a suitable pressure using the pneumatic port 725. The actuator 731 is then energized to move the base and cover members 727, 729 toward and away from one another to expand and contract the module 721 to conduct successive compression cycles on the limb portion 709. As indicated at 724 in
In at least some of the bladder embodiments described above, the cost of the compression device can be reduced to a point where the entire device can be discarded after a single use. A disposable device has several benefits. First, it is more hygienic for the patient population. Further, the cost of reprocessing the device or components of the device is eliminated. Also, due to the reduced size and weight of the various components, the device is more portable. The bladder embodiments described above are, for the most part, “self-contained”, meaning that all components of the compression apparatus and the control are located on the garment worn by the patient.
When introducing elements of the present invention or the preferred embodiments(s) thereof, the articles “a”, “an”, “the” and “said” are intended to mean that there are one or more of the elements. The terms “comprising”, “including” and “having” are intended to be inclusive and mean that there may be additional elements other than the listed elements.
In view of the above, it will be seen that the several objects of the invention are achieved and other advantageous results attained.
As various changes could be made in the above constructions and methods without departing from the scope of the invention, it is intended that all matter contained in the above description and shown in the accompanying drawings shall be interpreted as illustrative and not in a limiting sense.
1. A disposable band for use in a compression therapy to improve blood flow in the limb of a patient, the band comprising:
- a band member adapted to extend circumferentially around a portion of said limb, said band member having opposite ends;
- a fastening device on the band member for releasable attachment of said opposite ends to secure the band member around the limb portion; and
- a pocket on the band member sized and shaped for receiving a module cyclically movable between a contracted condition in which the module has a first dimension for relaxing pressure on said limb portion and an expanded position in which the module has a second dimension greater than said first dimension for compressing the limb portion, said module being removable from the pocket whereby on termination of said compression therapy the band can be disposed of and the module re-used with a different disposable band.
2. A disposable band as set forth in claim 1 wherein said pocket is defined by a layer of material secured to the band member on an interior side of the band member.
3. A disposable band as set forth in claim 1 wherein said pocket is sized and shaped for receiving said module and a force-distributing device positioned between said module and said limb portion when the band member is secured to the limb.
4. A disposable band as set forth in claim 1 further comprising a releasable closure for closing said pocket.
International Classification: A61F 5/00 (20060101);