B6860852 Be13 42e7 A542 6e9181e829de
2018-04-05
: Pdf B6860852-Be13-42E7-A542-6E9181E829De b6860852-be13-42e7-a542-6e9181e829de 4 2018 pdf
Open the PDF directly: View PDF 
.
Page Count: 12
PREVENA™ THERAPY
IN ORTHOPEDICS
Surgical Site Infections (SSIs) affect
about 158,639 patients each year1
and cost the healthcare system
$3.3 billion per year1
COMPLICATIONS IN ORTHOPEDIC SURGERY:
Surgical Site Complications
7.7 TO 11.7 DAYS
Increased length of hospital stay due to SSIs
2
$31,141
Median readmission cost to treat
infected orthopedic trauma injuries5
18.8%
of unplanned 30-day readmission
following THA and TKA due to SSI3
$24,200
AND
Periprosthetic joint infection
average hospital costs after
TKA and THA, respectively4
$30,300
* Total knee arthroplasty = TKA; Total hip arthroplasty = THA
PREVENA™ Therapy
PREVENA™ Incision Management System is uniquely
designed to manage and protect surgical incisions by:
Helping to hold incision
edges together
Removing fluids and
infectious materials*
Acting as a
barrier to external
contamination
Delivering continuous
-125mmHg up to 7 days
Reducing edema
Decreasing lateral
tension of sutured/
stapled incisions†6
Designed to be flexible
PREVENA™ Incision Dressings are designed to allow for movement, enhancing
the post-operative rehabilitation process
*In a canister † In computer and bench models
PREVENA™ Therapy
Under -125mmHg of negative pressure, the Reticulated Open Cell Foam dressing
collapses to it’s geometric center. This brings the incision edges together, reduces
lateral tension, and also allows for improved fluid management.6-8
PREVENA™ Therapy utilizes Reticulated Open Cell Foam
technology and -125mmHg pressure
• Contours in PREVENA™ dressing allow for
even distribution of negative pressure
• Adhesive film creates a barrier to external
contaminants
• Designed to conform to articulating joints
to allow movement
• Skin interface layer contains 0.019% ionic
silver, which reduces bacterial colonization
in the fabric
• Multiple sizes and configurations
• PREVENA™ 125 Therapy Unit and
PREVENA™ Dressings are shower friendly*
*See PREVENA™ Therapy Patient and Clinician Guides for additional details
Passive Therapy
Direction of fluid
Appositional force
PREVENA™ Therapy
Clinical & Economic Evidence
• This prospective multicenter RCT investigated the
use of negative pressure wound therapy over closed
incisions (ciNPT) to prevent wound dehiscence and
infection after high-risk lower extremity fractures.
• There were a total of 23 infections in the Control group
(standard postoperative dressings) and 14 in the ciNPT
group, which represented a significant difference in
favor of ciNPT (p = 0.049).
• The relative risk of developing an infection was 1.9
times higher in control patients than in patients treated
with ciNPT (95% confidence interval, 1.03-3.55).
• A conservative hypothetical cost model applied to
the clinical results of this study shows potential cost
savings during the inpatient stay per patient of $3,128
with the use of ciNPT.
18.9%
5%
10%
15%
9.9%
14/141 23/122
20%
0% ciNPT Control
p = 0.049
INFECTION RATE
16.5%
5%
10%
15%
20%
8.6%
0% ciNPT Control
p = 0.044
DEHISCENCE RATE AFTER DISCHARGE
12/141 20/122
† Model assumes that patients could only have 1 infection and 1 dehiscence
§ Stannard JP, Volgas DA, McGwin G III, et al. Incisional negative pressure wound therapy after high-risk lower extremity fractures. J Orthop Trauma. 2012:26(1):37-42.
‡ Thakore RV, et al. Surgical site infection in orthopedic trauma: A case-control study evaluating risk factors and cost. Journal of Clinical Orthopaedics and Trauma. 2015;(6):220-226. The median
cost for treatment for patients with SSIs was $31,141.
◊ Weighted national estimates from HCUP National (Nationwide) Inpatient Sample (NIS), 2014, Agency for Healthcare Research and Quality (AHRQ), based on data collected by individual States
and provided to AHRQ by the States.
φ KCI estimate based on price of PREVENA™ PEEL & PLACE™ Dressing System and Control therapy (gauze) changed once a day at $18 a week
The economic model based on the clinical assessment on ortho trauma patients uses select study data to provide an illustration of estimates of costs for use of ciNPT or standard postoperative
dressings (Control). This model is an illustration and not a guarantee of actual individual costs, savings, outcomes or results. The hospital is advised to use this model as an illustration only to
assist in an overall assessment of products and pricing.
Economic Model
High Risk Lower Extremity Fractures
- Hypothetical Economic Model ciNPT (n=130) Control (n=119)
Number of Infections† 14 23
Number of Dehiscence† 12 20
Total Infection Cost (Incremental cost of infection = $31,141 per patient)‡ $435,974 $716,243
Total Dehiscence Cost (Incremental cost of dehiscence = $12,407 per patient)◊ $148,884 $248,140
Per Patient Infection Cost (Total Infection Cost / n) $3,354 $6,019
Per Patient Dehiscence Cost (Total Dehiscence Cost / n) $1,145 $2,085
Per Patient Cost of Therapyφ$495 $18
Total Cost Per Patient $4,994 $8,122
Closed incision negative pressure therapy decreased the incidence of SSI
and dehiscence after lower extremity fractures in this prospective RCT §
$8,122
$4,994
$3,128
ciNPT Control
COST SAVINGS PER PATIENT
Potential cost savings
per patient
Clinical & Economic Evidence
• This study evaluated the efficacy of PREVENA™ Therapy
compared to a sterile antimicrobial dressing (AMD)
AQUACEL™ Ag on wound complications, surgical site
infections (SSIs), and reoperations after hip and knee
revision surgery over a 34-month period.
• PREVENA™ Therapy was used selectively in higher-risk
patients with multiple risk factors for SSIs over the
last 15 months of the study period.
• A hypothetical cost model applied to the clinical results
of this study shows potential cost savings per patient
of $1,499 with the use of PREVENA™ Therapy.
• Patients treated with PREVENA™ Therapy developed
fewer overall wound complications (6.7% vs 26.9%,
p = 0.024) and fewer total SSIs (3.3% vs 18.5%, p =
0.045) than patients treated with AQUACEL™ Ag.
• There were trends toward a lower rate of superficial
wound dehiscence (6.7% vs 19.4%, p = 0.163), fewer
deep periprosthetic joint infections (0.0% vs 9.3%,
p = 0.118), and fewer reoperations (3.3% vs 13.0%,
p = 0.191) among patients treated with PREVENA™
Therapy.
‡ de Lissovoy G, Fraeman K, Hutchins V, Murphy D, Song D, Vaughn BB. Surgical site infection: incidence and impact on hospital utilization and treatment costs. Am J Infect Control. 2009
Jun;37(5):387-97
◊KCI estimate based on price of Incisional NPWT plus three days of inpatient NPT, and Control therapy changed once a day, at $18 a week.
◊KCI estimate based on price of PREVENA™ PEEL & PLACE™ Dressing System and AQUACEL Ag price is an estimate; individual prices may vary
The hypothetical economic model uses select study data to provide an illustration of estimates of costs for use of PREVENA™ Therapy or AQUACEL™ Ag. This model is an illustration and not a
guarantee of actual individual costs, savings, outcomes or results. The hospital is advised to use this model as an illustration only to assist in an overall assessment of products and pricing.
† Cooper HJ, Bas MA. Closed-Incision Negative-Pressure Therapy Versus Antimicrobial Dressings After Revision Hip and Knee Surgery: A Comparative Study. J Arthroplasty
2016;31:1047-1052.
* Although the authors reported use of ciNPT for a mean of 9.2 days (ranging from 6 to 14 days), this mean time of application is outside the
recommendations for Optimum Use as stated in the PREVENA™ Incision Management System Clinician Guide Instructions for Use: “The PREVENA™
Incision Management System is to be continuously applied for a minimum of two days up to a maximum of seven days.” Use for greater than 7 days is
not recommended or promoted by KCI.
Economic Model
Hip (THA) and Knee (TKA) Surgery Revision
Hypothetical Economic Model PREVENA™ Therapy (n = 30) AQUACEL Ag (n = 108)
Number of Infections (a) 1 20
Percent of SSIs 3.3% 18.5%
Cost per SSI‡ (b) $15,129 $15,129
Cost of SSI Per Patient (a*b)/n) $504 $2,802
Cost of Therapy Per Patient◊ $830 $31
Total Cost Per Patient $1,334 $2,833
PREVENA™ Therapy decreased the incidence of SSI and wound
complications on hip and knee revision patients in this retrospective study*†
$2,833
$1,334
$1,499
PREVENA™ Dressing
COST SAVINGS PER PATIENT
AQUACEL® Ag
26.9%
5%
10%
15%
20%
6.7%
25%
30%
0%
PREVENA™ Dressing AQUACEL® Ag
p = 0.024
WOUND COMPLICATIONS
2/30 29/108
18.5%
5%
10%
15%
20%
3.3%
0%
PREVENA™ Dressing AQUACEL® Ag
p = 0.045
SSI INCIDENCE
1/30 20/108
Potential cost savings
per patient
General risk factors for SSI (adapted from [9-14])
Category Patient-related risk factors Procedure-related risk factors
Major risk factors • BMI ≥40kg/m2 or ≤18kg/m2
• Uncontrolled insulin dependent diabetes mellitus
• Renal dialysis
• Extended duration of surgery*
• Emergency surgery
• Hypothermia
Moderate risk factors • ASA Physical Status >II
• BMI 30–39.9kg/m2
• Diabetes mellitus
• Chronic obstructive pulmonary disease ≥GOLD class 2
• Renal insufficiency/chronic kidney disease
• Immunosuppression
• Steroids for a chronic condition
• Chemotherapy
• Pre-existing infection at a body site remote from operative site
• Serum albumin <2.5g/dl
• Smoking (current)
• Anaemia/blood transfusion
• High wound tension after
closure
• Dual antiplatelet treatment
• Suboptimal timing or
omission of prophylactic
antibiotics
• Tissue trauma/large area
of dissection/large area of
undermining
Minor risk factors • BMI 25–29.9kg/m2
• Extended pre-operative hospitalization or residency in a nursing home
• Peripheral vascular disease
• Congestive cardiac failure with left ventricular ejection fraction <30%
• Failure to obliterate dead
space
• Location of incision
• Previous surgery
• Surgical drains
*Defined as >T (hours) which is dependent on the type of surgical procedure, and is the 75th centile of duration of surgery for a particular procedure, e.g. coronary artery
bypass graft has a T of 5 hours and caesarean section has a T of 1 hour[81]
Example of additional risk factors for surgical site complications for by selected surgery type (adapted from[15-18])
Type of Surgery Additional risk factors
Abdominal • Perforated viscus
• Ostomy formation/closure
• Previous radiotherapy to surgical site
• Multiple incisions
Breast/plastic • Corony artery disease
• Bleeding risk
• Breast Reconstruction Risk Assessment (BRA)
score*
Cardiothoracic • Bilateral internal mammary artery harvesting
• Chest wall radiotherapy
• Left ventricular assist device (LVAD)
• Transplant
• Cardiopulmonary bypass time extended
• Delayed closure
Obstetric • Multiple (>3) caesarean sections
• Anticoagulants
• Operative blood loss >1.5l
• Pre-eclampsia
• Chorioamnionitis
Orthopedic • Implant/prosthesis
• Rheumatoid arthritis
• Nasal carriage of Staphylococcus aureus
Vascular • Groin incision
*The BRA Score calculates risk (as %) of a range of complications, e.g. SSI, seroma, dehiscence, flap loss, explantation and reoperation, based on factors including
reconstructive modality, BMI, age, ASA Physical Status class, bleeding disorder, history of percutaneous cardiac intervention or cardiac surgery (www.brascore.org)
** However, prematurity does not appear to be a risk factor for SSI or for a resulting mortality-related event[112]
WUWHS Clinical Guideline
Risk factors for surgical site complications are dependent on many
factors including both patient-related and surgical procedure factors.
The World Union of Wound Healing Societies (WUWHS)
consensus panel proposed the following clinical guideline for
the use of NPWT on closed surgical incisions*
Patient with closed surgical incision(s)
Does the patient have any major
patient-related risk factors for
surgical site infections?
Does the patient have two or more
moderate or low patient-related or
procedure-related risk factors for
surgical site complications?
Does the patient have combination
of two or more moderate/low risk
factors and surgery type risk factors
for surgical site complications?
Apply ciNPT to the closed surgical
incision under aseptic conditions
and before the patient leaves the
operating room
Standard post-operative dressing
YES
NO
NO
NO
YES
YES
*Adapted from: 19, 20, 21
WUWHS Clinical Guideline
There are 70+ ciNPT journal publications using KCI™/Acelity™ products.
The following publications are specific to orthopedics
Citation Wound/Surgery
Type
Level of Clinical
Evidence*
Pauser J, Nordmeyer M, Biber R, et al. Incisional Negative Pressure Wound Therapy After Hemiarthroplasty for Femoral Neck
Fractures - Reduction of Wound Complications. International Wound Journal. 2014 Aug 14.
Hemiarthroplasty
for femoral neck
fractures
1b ●
Howell RD, Hadley S, Strauss E, et al. Blister Formation with Negative Pressure Dressings after Total Knee Replacement.
Current Orthopedic Practice. 2011 Mar;22(2):176-179. Knee arthroplasty 1b ■
Stannard JP, Volgas DA, Stewart R, et al. Negative Pressure Wound Therapy After Severe Open Fractures: A Prospective
Randomized Study. Journal of Orthopedic Trauma. 2009 Sep;23(8):552-7.
Lower extremity
fractures 1b ■
Stannard JP, Robinson JT, Anderson ER, et al. Negative Pressure Wound Therapy to Treat Hematomas and Surgical Incisions
Following High-Energy Trauma. Journal of Trauma. 2006 Jun;60(6):1301-6.
Lower extremity
fractures 1b ●
Stannard JP, Volgas DA, McGwin G 3rd, et al. Incisional Negative Pressure Wound Therapy After High-Risk Lower Extremity
Fractures. Journal of Orthopedic Trauma. 2012 Jan;26(1):37-42.
Lower extremity
fractures 1b ●
Pachowsky M, Gusinde J, Klein A, et al. Negative Pressure Wound Therapy to Prevent Seromas and Treat Surgical Incisions
After Total Hip Arthroplasty. International Orthopedics. 2012 Apr;36(4):719-22.
Total hip
arthroplasty 1b ●
Redfern RE, Cameron-Ruetz C, O’Drobinak SK, et al. Closed Incision Negative Pressure Therapy Effects on Postoperative
Infection and Surgical Site Complication After Total Hip and Knee Arthroplasty. The Journal of Arthroplasty. 2017. [Epub
ahead of print].
Hip and knee
arthroplasty 2●
Reddix RN Jr, Leng XI, Woodall J, et al. The Effect of Incisional Negative Pressure Therapy on Wound Complications After
Acetabular Fracture Surgery. Journal of Surgical Orthopedic Advances. 2010 Jun;19(2):91–7.
Hip arthroplasty 3▲
Cooper JH, Bas MA, et al. Closed-Incision Negative-Pressure Therapy Versus Antimicrobial Dressings After Revision Hip and
Knee Surgery: A Comparative Study. The Journal of Arthroplasty. 2015 Oct:1-6. Revision Knee & Hip 3 ●
H. John Cooper, Gilbert C. Roc, Marcel A. Bas, et al. Closed incision negative pressure therapy decreases complications after
periprosthetic fracture surgery around the hip and knee. Injury. 2017. [Epub ahead of print].
Hip and knee
arthroplasty
periprosthetic
fracture
3●
Hansen E, Durinka JB, Costanzo JA, et al. Negative Pressure Wound Therapy is Associated With Resolution of Incisional
Drainage in Most Wounds After Hip Arthroplasty. Clinical Orthopedics and Related Research. 2013 Oct;471(10):3230-6. Hip arthroplasty 4 ■
Reddix RN Jr, Tyler HK, Kulp B, et al. Incisional Vacuum-Assisted Wound Closure in Morbidly Obese Patients Undergoing
Acetabular Fracture Surgery. The American Journal of Orthopedics. 2009 Sep;38(9):32-5.
Acetebular fractures 4▲
Stannard JP, Atkins BZ, O’Malley D, et al. Use of Negative Pressure Therapy on Closed Surgical Incisions: A Case Series.
Ostomy Wound Management. 2009 Aug;55(8):58-66.
Lower extremity
fractures 4■
Gomoll AH, Lin A, Harris MB. et al. Incisional Vacuum-Assisted Closure Therapy. Journal of Orthopedic Trauma. 2006
Nov-Dec;20(10):705-9.
Orthopaedic trauma 4●
Brem MH, Bail HJ, Biber R. Value of Incisional Negative Pressure Wound Therapy in Orthopedic Surgery. International
Wound Journal. 2014 Jun;11(Suppl 1):3-5. NA 5 ■
Berkowitz MJ. Use of a Negative Pressure Incisional Dressing After Surgical Treatment of Calcaneal Fractures. Techniques in
Foot and Ankle Surgery. 2013 Dec;12(4):172-174.
Calcaneal fractures 5■
Karlakki S, Brem M, Giannini S, et al. Negative Pressure Wound Therapy for Management of the Surgical Incision in
Orthopaedic Surgery: A Review of Evidence and Mechanisms for an Emerging Indication. Bone and Joint Research. 2013 Dec
1; 2(12):276-84.
NA 5 ■
Stannard JP, Gabriel A, Lehner B. Use of Negative Pressure Wound Therapy Over Clean, Closed Surgical Incisions.
International Wound Journal. 2012;9:32-39.
Orthopaedic trauma 5■
DeCarbo WT, Hyer CF. Negative-Pressure Wound Therapy Applied to High-Risk Surgical Incisions. Journal of Foot and Ankle
Surgery. 2010 May;49(3):299-300.
Orthopaedic trauma 5■
Published Studies
●Available on request. Contact your local Acelity sales representative.
▲Not available for distribution.
■Available through Acelity Medical Information: pubsmgt@acelity.com
*Level of Clinical Evidence Rating: Level 1: Evidence obtained from at least one properly designed randomized controlled trial. Level 1b: Systematic reviews (with homogeneity) of randomized
controlled trials. Level 2: Evidence obtained from well-designed controlled trials without randomization. Level 2b: Individual cohort study or low quality randomized controlled trials (e.g.,
<80% follow-up). Level 3: Evidence obtained from well-designed cohort or case-control analytic studies, preferably from more than one center or research group. Level 4: Case series (and
poor quality cohort and case-control studies). Level 5: Expert opinion without explicit critical appraisal, or based on physiology, bench research or “first principles.”
1. Zimlichman E, et al. Health Care-Associated Infections A Meta-analysis of Costs and Financial Impact on the US Health Care System. JAMA Intern Med.
2013;173(22):2039-46.
2. de Lissovoy G, Fraeman K, Hutchins V, Murphy D, Song D, Vaughn BB. Surgical site infection: incidence and impact on hospital utilization and treatment
costs. Am J Infect Control. 2009 Jun;37(5):387-97.
3. Merkow R, et al. Underlying reasons associate with hospital readmission following surgery in the US. JAMA 2015;313(5):483-95.
4. Kurtz SM,Lau E,Watson H,Schmier JK,Parvizi J. Economic burden of periprosthetic joint infection in the United States. J Arthroplasty.2012 Sep;27(8
Suppl):61-5.e1. doi: 10.1016/j.arth.2012.02.022. Epub 2012 May 2.
5. Thakore RV, et al. Surgical site infection in orthopedic trauma: A case-control study evaluating risk factors and cost. Journal of Clinical Orthopaedics and
Trauma. 2015;(6):220-226.
6. Wilkes RP, Kilpadi DV, Zhao Y, et al. Closed Incision Management With Negative Pressure Wound Therapy (CIM): Biomechanics. Surgical Innovation.
2012;19(1):67-75.
7. Kilpadi DV, Cunningham MR. Evaluation of Closed Incision Management with Negative Pressure Wound Therapy (CIM): Hematoma/Seroma and Involvement
of the Lymphatic System. Wound Repair and Regeneration. 2011;19:588-596.
8. Glaser DA, Farnsworth CL, Varley ES, et al. Negative pressure therapy for closed spine incisions: A pilot study. Wounds. 2012;24(11):308-316.
9. Reddy HV, Ujwala J, Swetha M, Ramya SB. Seroma: an interesting case report. Int J Reproduction Contraception Obs Gynecol. 2014; 3(1): 254-257.
10. Carlson MA. Acute wound failure. Surg Clin Nor Am. 1997; 77(3):607–36.
11. Son D, Harijan A. Overview of surgical scar prevention and management. J Korean Med Sci 2014; 29: 751-57.
12. Mangram AJ, Horan TC, Pearson ML, et al. Guidelines for prevention of surgical site infection, 1999. Inf Control Hosp Epidemiol. 1999; 20(4): 247-78.
13. Culver DH, Horan TC, Gaynes RP, et al. Surgical wound infection rates by wound class, operative procedure, and patient risk index. Am J Med 1991; 91 (suppl
3B): 152-157.
14. Jones ME, Hardy CJ, Ridgway JM. Head and neck keloid management: a retrospective early review on a new approach using surgical excision, platelet rich
plasma and in-office superficial photon X-ray radiation. Edorium J Otolaryngol 2015; 2: 14-19.
15. Kim HJ, Levin LF. The management of patients on dual antiplatelet therapy undergoing orthopaedic surgery. HSSJ. 2010; 6: 182-89.
16. Korol E, Johnston K, Waser N, et al. A systematic review of risk factors associated with surgical site infections among surgical patients. PLOS One
2013;8(12):e83743.
17. Tran TS, Jamulitrat S, Chonsuvivatwong V, Geater A. Risk factors for postcesarean surgical site infection. Obs Gynecol. 2000; 95(3): 367-71.
18. Inui T, Bandyk DF. Vascular surgical site infection: risk factors and preventive measures. Semin Vasc Surg. 2015; 28(3-4): 201-7.
19. Willy, C., Agarwal, A., Andersen, C. A., et al. (2017), Closed incision negative pressure therapy: international multidisciplinary consensus recommendations.
Int Wound J, 14: 385–398. doi:10.1111/iwj.12612
20. Stannard, J., Atkins, B., O’Malley, D., et al. (2009). Use of Negative Pressure Therapy on Closed Surgical Incisions: A Case Series. Ostomy/wound
management. 55. 58-66.
21. World Union of Wound Healing Societies (WUWHS) Consensus Document. Closed surgical incision management: understanding the role of NPWT. Wounds
International, 2016
References:
Ordering information
Item# Description Unit of Measure (UOM)
PRE1001US PREVENA™ PEEL & PLACE™ System Kit – 20cm Each
PRE1055US PREVENA™ PEEL & PLACE™ Dressing – 20cm Case of 5
PRE1101US PREVENA™ PEEL & PLACE™ System Kit – 13cm Each
PRE1155US PREVENA™ PEEL & PLACE™ Dressing – 13cm Case of 5
PRE3201US PREVENA PLUS™ PEEL & PLACE™ 35cm System Kit Each
PRE3255US PREVENA PEEL & PLACE™ 35cm Dressings Case of 5
PRE4001US PREVENA PLUS™ CUSTOMIZABLE™ System Kit Each
PRE4055US PREVENA PLUS™ CUSTOMIZABLE™ Dressing Case of 5
PRE1121US PREVENA DUO™ System with PEEL & PLACE™ 13cm/13cm Dressings Each
PRE3321US PREVENA PLUS DUO™ System with PEEL & PLACE™ 13cm/20cm Dressings Each
PRE3021US PREVENA PLUS DUO™ System with PEEL & PLACE™ 20cm/20cm Dressings Each
PRE4000US PREVENA PLUS™ 125 Therapy Unit Each
PRE1095 PREVENA™ 45ml Canister Case of 5
PRE4095 PREVENA PLUS™ 150ml Canister Case of 5
PRE9090 PREVENA™ Therapy V.A.C.® Connector Case of 10
Note: Ordering information is comprehensive. Confirm which products available at time of print.
NOTE: Specific indications, contraindications, warnings, precautions and safety information exist for PREVENA™ Therapy. Please
consult the applicable PREVENA™ System Clinician Guide instructions for use prior to application. Rx only.
Copyright 2018, KCI Licensing, Inc. All rights reserved. All trademarks designated herein are proprietary to KCI Licensing, Inc., its affiliates and/or licensors.
PRA-PM-US-00260 • LIT 29-A-354 (03/18)
PREVENA™ Therapy Resources
Please contact your local KCI Representative for more information.
Live Clinical Training & Product Support
(25,000 Professionals Trained Annually)
Free Product Evaluation Program
PREVENA™ Therapy Financial Protection
Clinical Services & Reimbursement Hotlines
24/7 Centralized, On Demand Clinical &
Technical Support
