FAQ
Frequently Asked Questions
What is the geko™ device?
The geko™ device, utilising OnPulse™ neuromuscular electrostimulation technology, is clinically proven to enhance blood circulation in various in-hospital therapy areas, including the prevention of venous thrombosis (VTE) and the management of oedema.
What does the geko™ device do?
The geko™ device, utilising OnPulse™ neuromuscular electrostimulation technology, is clinically proven to enhance blood circulation in various in-hospital therapy areas, including the prevention of venous thrombosis (VTE) and the management of oedema.
How does the geko™ device work?
Who is using the geko™ device?
The geko™ device, typically used in a clinic or home care setting, is also employed in hospitals by front-line staff, including tissue viability nurses, vascular surgeons, wound care specialists, consultant surgeons, nursing staff, and physiotherapists.
Which locations on the body can I wear the geko™ device?
The geko™ device is intended for use only on the lower limbs. Secure the device to the leg so that the location marker (the line of arrows) is positioned directly over the centre of the fibula head. When correctly fitted, the longer tail should wrap around to the back of the leg, below and parallel to the crease of the knee.
This positioning ensures the negative electrode is placed over the common peroneal nerve, with the ‘plus’ button at the front of the leg and the ‘minus’ button at the rear. The device can also be applied in two alternative locations: just above or just below the crease of the knee, aligned with the lateral outer tendon.
How long do I have to wear the geko™ device for?
The healthcare professional prescribing the geko™ device will provide guidance on the wear protocol based on your condition. For example, to prevent venous thromboembolism, the device should be worn on both legs for 24 hours per day during the acute phase (the first 1 to 6 days).
Why does the geko™ T device have a limited run-time?
The lifespan of the geko™ device is controlled by a clock within the device’s software. Extensive testing has shown that by the expiry date, the battery still has sufficient capacity to operate reliably for 30 hours at the maximum setting. As the battery loses capacity, its voltage drops, and below a certain threshold, the device may not function reliably. To ensure effective VTE prophylaxis, the device must operate consistently. The 30-hour battery life allows for 24 hours of continuous operation, with a reserve to provide busy staff enough time to change the device and maintain uninterrupted 24-hour VTE prophylaxis.
What is considered the correct level of stimulation?
When activated, observe for a noticeable movement of the muscles in the lower leg and a visible outward and upward movement of the foot. It is not sufficient to see only a slight movement in the lower leg muscles alone; the movement in both the lower leg and foot should be clearly discernible.
Is the geko™ device painful to use?
No, there is no sensation of pain. You may feel the muscles in your lower leg contracting every second, which can take a few moments to get used to. After that, it’s common to forget you are even wearing the device.
How does the geko™ T3 device increase peripheral arterial blood flow?
The geko™ device increases venous return in the lower limbs, reducing venous pressure and thereby lowering peripheral capillary resistance. This enhances arterial blood flow, as demonstrated by direct measurements of the arterial system, increased cardiac ejection, and the reduction or abolition of diastolic flow reversal. These effects allow for the delivery of more oxygenated blood and nutrients throughout the lower limb. Additionally, the geko™ device increases skin tissue oxygen in the lower limb and foot, while also assisting in the removal of carbon dioxide and metabolic waste.
How does the geko™ W3 device increase peripheral arterial blood flow?
The geko™ device increases venous return in the lower limbs, reducing venous pressure and peripheral capillary resistance, which enhances arterial blood flow. This is demonstrated by direct measurements of the arterial system, increased cardiac ejection, and a reduction or abolition of diastolic flow reversal. These effects result in more oxygenated blood and nutrients being delivered to the entire lower limb. Increased blood circulation raises Transcutaneous Oxygen Tension (TCpO2), a key predictor of tissue viability and ischemic wound healing. Additionally, the geko™ device increases skin tissue oxygen in the lower limb and foot, aiding in the removal of toxins from the wound bed, as well as the removal of carbon dioxide and metabolic waste from the lower limb.
What is the comparison of blood flow rates between resting, walking using the geko™ device?
When measuring the effect of the geko™ device on increased blood flow, we use resting blood flow as the comparator. Tucker et al. (2010) compared the increase in volumetric blood flow between resting and with the geko™ device activated, finding that the geko™ increases blood flow by 100% in the superficial femoral vein. The superficial femoral vein, being the primary vein that drains the lower limb, is an ideal site for measuring overall blood flow in the lower limb.
Blood flow measurements are made using Doppler ultrasound, which requires the limb to remain stationary, making it impossible to measure blood flow during walking. However, it is known that the effectiveness of the calf muscle pump in circulating blood is roughly proportional to the degree of dorsiflexion. The dorsiflexion achieved by the geko™ device is equivalent to 60% of that achieved during walking.
(Tucker et al., J Angio Vol 19 No 1, Spring 2010).
Is the geko™ safe to use with implanted electronic medical devices (e.g. pacemakers)?
Historically, there have been reports of electrical stimulators, such as direct muscle stimulators and TENS machines, interfering with implanted electronic devices. However, we have not received any reports of unsafe interactions between the geko™ device and implanted electronic medical devices, such as pacemakers. The geko™ device complies with stringent international standards regarding interference with other medical devices. However, due to the many variables involved, including the type and location of the implanted device and its modes of operation, we cannot be 100% certain that no interaction will occur. Therefore, we advise caution when using the geko™ device on patients with implanted electronic medical devices.
Can I sleep with the geko™ device on?
There is no detrimental effect to sleeping while wearing the devices. However, if you find the devices disruptive, discuss this with your healthcare professional, who may advise you to either lower the settings or turn them off completely, if that aligns with your treatment plan.
Is the geko™ device waterproof?
The geko™ device must be kept clean and dry. Do not bathe or shower while wearing the device, as prolonged exposure to water will soften the hydrogel and may cause the device to lose adhesion. Immersion in water may also affect the electronics and prevent proper operation. If the device becomes wet, either from water or bodily fluids, there is no danger to the patient. The adhesive gel is water-based, so slight dampening of the gel will make it easier to remove the device from the leg once treatment is complete.
How many times can I use a single geko™ device?
Hospital Application
The geko™ is a single-use medical device, meaning it is designed for use on a single patient as part of a single course of treatment.
Wound Therapy
For wound therapy, the geko™ device should be used for a maximum of two days before being discarded. The device can be stored on the backing card between uses. Please refer to the Instructions for Use (IFU) for further details.
How does it differ from other electrical stimulation devices?
The geko™ device is unique in that it delivers neuromuscular electrostimulation via the common peroneal nerve to activate the calf and foot muscle pumps of the lower leg, unlike other electrostimulation devices that stimulate the muscles directly and may be less well tolerated.
What differentiates geko™ device from a TENS device?
TENS (Transcutaneous Electrical Nerve Stimulation) uses electrical impulses to reduce pain signals transmitted to the spinal cord and brain. The exact mechanism of action remains unclear, and there is insufficient high-quality clinical data to confirm its effectiveness. In contrast, the geko™ device is a neuromuscular electrical stimulator (NMES), designed to stimulate motor neurons rather than sensory neurons that transmit pain signals, as TENS devices do. The geko™ device delivers short electrical pulses to the common peroneal nerve, causing brief contractions of the muscles in the calf and foot. This activates the muscle pump of the lower leg, helping to return blood to the heart and increasing both arterial and venous blood flow in the lower leg, effectively mimicking the act of walking.
Other electrical stimulators that also activate the calf and foot muscle pumps rely on direct stimulation of the muscles. These devices typically use a train of pulses (at 30 Hz or higher) to create sustained muscle contractions lasting several seconds. Such devices, often referred to as Electrical Muscle Stimulators (EMS), can be uncomfortable due to the strength of the contractions and are frequently used for muscle strengthening.
In essence, TENS devices stimulate sensory neurons, while NMES devices target motor neurons. While there may be some overlap in their effects, stimulating motor neurons is essential for effectively activating the calf muscle pumps. TENS devices generally operate at high frequencies to engage either the pain gate mechanism or the endogenous opioid system. TENS units can be adapted to stimulate motor neurons, but they cannot deliver the painless 1 Hz stimulation that the geko™ device provides. Typically, TENS units operate at around 100 Hz (high-frequency TENS) or 10 Hz (low-frequency TENS).
What is the difference between NMES and TENS?
NMES differs from transcutaneous or percutaneous electrical nerve stimulation (TENS), in that NMES stimulation is directed to the motor nerves and TENS is directed to the sensory nerves.
What type of electrical stimulation pulse is used by the geko™ device?
The geko™ device delivers a constant current, square wave, asymmetrical, charge-balanced pulse. The term “constant current” refers to the device’s ability to maintain a consistent output during the duration of the pulse. The device’s voltage adjusts according to the patient’s electrical resistance to ensure the required current output is achieved.
The stimulation pulse is described as a square wave, meaning the current rapidly rises to the desired value, remains constant for the duration of the pulse, and then quickly drops back to zero. This creates a rectangular or square shape when viewed on an oscilloscope, hence the name “square wave.”
Following the primary stimulation pulse, there is a return pulse of lower intensity but longer duration, with opposite polarity (asymmetrical) to ensure the total electrical charge is zero (charge-balanced). This charge-balancing feature helps prevent electrochemical changes in the skin.
Frequently Asked Questions
What is the geko™ device?
The geko™ device, utilising OnPulse™ neuromuscular electrostimulation technology, is clinically proven to enhance blood circulation in various in-hospital therapy areas, including the prevention of venous thrombosis (VTE) and the management of oedema.
What does the geko™ device do?
The geko™ device, utilising OnPulse™ neuromuscular electrostimulation technology, is clinically proven to enhance blood circulation in various in-hospital therapy areas, including the prevention of venous thrombosis (VTE) and the management of oedema.
How does the geko™ device work?
Who is using the geko™ device?
The geko™ device, typically used in a clinic or home care setting, is also employed in hospitals by front-line staff, including tissue viability nurses, vascular surgeons, wound care specialists, consultant surgeons, nursing staff, and physiotherapists.
Which locations on the body can I wear the geko™ device?
The geko™ device is intended for use only on the lower limbs. Secure the device to the leg so that the location marker (the line of arrows) is positioned directly over the centre of the fibula head. When correctly fitted, the longer tail should wrap around to the back of the leg, below and parallel to the crease of the knee.
This positioning ensures the negative electrode is placed over the common peroneal nerve, with the ‘plus’ button at the front of the leg and the ‘minus’ button at the rear. The device can also be applied in two alternative locations: just above or just below the crease of the knee, aligned with the lateral outer tendon.
How long do I have to wear the geko™ device for?
The healthcare professional prescribing the geko™ device will provide guidance on the wear protocol based on your condition. For example, to prevent venous thromboembolism, the device should be worn on both legs for 24 hours per day during the acute phase (the first 1 to 6 days).
Why does the geko™ T device have a limited run-time?
The lifespan of the geko™ device is controlled by a clock within the device’s software. Extensive testing has shown that by the expiry date, the battery still has sufficient capacity to operate reliably for 30 hours at the maximum setting. As the battery loses capacity, its voltage drops, and below a certain threshold, the device may not function reliably. To ensure effective VTE prophylaxis, the device must operate consistently. The 30-hour battery life allows for 24 hours of continuous operation, with a reserve to provide busy staff enough time to change the device and maintain uninterrupted 24-hour VTE prophylaxis.
What is considered the correct level of stimulation?
When activated, observe for a noticeable movement of the muscles in the lower leg and a visible outward and upward movement of the foot. It is not sufficient to see only a slight movement in the lower leg muscles alone; the movement in both the lower leg and foot should be clearly discernible.
Is the geko™ device painful to use?
No, there is no sensation of pain. You may feel the muscles in your lower leg contracting every second, which can take a few moments to get used to. After that, it’s common to forget you are even wearing the device.
How does the geko™ T3 device increase peripheral arterial blood flow?
The geko™ device increases venous return in the lower limbs, reducing venous pressure and thereby lowering peripheral capillary resistance. This enhances arterial blood flow, as demonstrated by direct measurements of the arterial system, increased cardiac ejection, and the reduction or abolition of diastolic flow reversal. These effects allow for the delivery of more oxygenated blood and nutrients throughout the lower limb. Additionally, the geko™ device increases skin tissue oxygen in the lower limb and foot, while also assisting in the removal of carbon dioxide and metabolic waste.
How does the geko™ W3 device increase peripheral arterial blood flow?
The geko™ device increases venous return in the lower limbs, reducing venous pressure and peripheral capillary resistance, which enhances arterial blood flow. This is demonstrated by direct measurements of the arterial system, increased cardiac ejection, and a reduction or abolition of diastolic flow reversal. These effects result in more oxygenated blood and nutrients being delivered to the entire lower limb. Increased blood circulation raises Transcutaneous Oxygen Tension (TCpO2), a key predictor of tissue viability and ischemic wound healing. Additionally, the geko™ device increases skin tissue oxygen in the lower limb and foot, aiding in the removal of toxins from the wound bed, as well as the removal of carbon dioxide and metabolic waste from the lower limb.
What is the comparison of blood flow rates between resting, walking using the geko™ device?
When measuring the effect of the geko™ device on increased blood flow, we use resting blood flow as the comparator. Tucker et al. (2010) compared the increase in volumetric blood flow between resting and with the geko™ device activated, finding that the geko™ increases blood flow by 100% in the superficial femoral vein. The superficial femoral vein, being the primary vein that drains the lower limb, is an ideal site for measuring overall blood flow in the lower limb.
Blood flow measurements are made using Doppler ultrasound, which requires the limb to remain stationary, making it impossible to measure blood flow during walking. However, it is known that the effectiveness of the calf muscle pump in circulating blood is roughly proportional to the degree of dorsiflexion. The dorsiflexion achieved by the geko™ device is equivalent to 60% of that achieved during walking.
(Tucker et al., J Angio Vol 19 No 1, Spring 2010).
Is the geko™ safe to use with implanted electronic medical devices (e.g. pacemakers)?
Historically, there have been reports of electrical stimulators, such as direct muscle stimulators and TENS machines, interfering with implanted electronic devices. However, we have not received any reports of unsafe interactions between the geko™ device and implanted electronic medical devices, such as pacemakers. The geko™ device complies with stringent international standards regarding interference with other medical devices. However, due to the many variables involved, including the type and location of the implanted device and its modes of operation, we cannot be 100% certain that no interaction will occur. Therefore, we advise caution when using the geko™ device on patients with implanted electronic medical devices.
Can I sleep with the geko™ device on?
There is no detrimental effect to sleeping while wearing the devices. However, if you find the devices disruptive, discuss this with your healthcare professional, who may advise you to either lower the settings or turn them off completely, if that aligns with your treatment plan.
Is the geko™ device waterproof?
The geko™ device must be kept clean and dry. Do not bathe or shower while wearing the device, as prolonged exposure to water will soften the hydrogel and may cause the device to lose adhesion. Immersion in water may also affect the electronics and prevent proper operation. If the device becomes wet, either from water or bodily fluids, there is no danger to the patient. The adhesive gel is water-based, so slight dampening of the gel will make it easier to remove the device from the leg once treatment is complete.
How many times can I use a single geko™ device?
Hospital Application
The geko™ is a single-use medical device, meaning it is designed for use on a single patient as part of a single course of treatment.
Wound Therapy
For wound therapy, the geko™ device should be used for a maximum of two days before being discarded. The device can be stored on the backing card between uses. Please refer to the Instructions for Use (IFU) for further details.
How does it differ from other electrical stimulation devices?
The geko™ device is unique in that it delivers neuromuscular electrostimulation via the common peroneal nerve to activate the calf and foot muscle pumps of the lower leg, unlike other electrostimulation devices that stimulate the muscles directly and may be less well tolerated.
What differentiates geko™ device from a TENS device?
TENS (Transcutaneous Electrical Nerve Stimulation) uses electrical impulses to reduce pain signals transmitted to the spinal cord and brain. The exact mechanism of action remains unclear, and there is insufficient high-quality clinical data to confirm its effectiveness. In contrast, the geko™ device is a neuromuscular electrical stimulator (NMES), designed to stimulate motor neurons rather than sensory neurons that transmit pain signals, as TENS devices do. The geko™ device delivers short electrical pulses to the common peroneal nerve, causing brief contractions of the muscles in the calf and foot. This activates the muscle pump of the lower leg, helping to return blood to the heart and increasing both arterial and venous blood flow in the lower leg, effectively mimicking the act of walking.
Other electrical stimulators that also activate the calf and foot muscle pumps rely on direct stimulation of the muscles. These devices typically use a train of pulses (at 30 Hz or higher) to create sustained muscle contractions lasting several seconds. Such devices, often referred to as Electrical Muscle Stimulators (EMS), can be uncomfortable due to the strength of the contractions and are frequently used for muscle strengthening.
In essence, TENS devices stimulate sensory neurons, while NMES devices target motor neurons. While there may be some overlap in their effects, stimulating motor neurons is essential for effectively activating the calf muscle pumps. TENS devices generally operate at high frequencies to engage either the pain gate mechanism or the endogenous opioid system. TENS units can be adapted to stimulate motor neurons, but they cannot deliver the painless 1 Hz stimulation that the geko™ device provides. Typically, TENS units operate at around 100 Hz (high-frequency TENS) or 10 Hz (low-frequency TENS).
What is the difference between NMES and TENS?
NMES differs from transcutaneous or percutaneous electrical nerve stimulation (TENS), in that NMES stimulation is directed to the motor nerves and TENS is directed to the sensory nerves.
What type of electrical stimulation pulse is used by the geko™ device?
The geko™ device delivers a constant current, square wave, asymmetrical, charge-balanced pulse. The term “constant current” refers to the device’s ability to maintain a consistent output during the duration of the pulse. The device’s voltage adjusts according to the patient’s electrical resistance to ensure the required current output is achieved.
The stimulation pulse is described as a square wave, meaning the current rapidly rises to the desired value, remains constant for the duration of the pulse, and then quickly drops back to zero. This creates a rectangular or square shape when viewed on an oscilloscope, hence the name “square wave.”
Following the primary stimulation pulse, there is a return pulse of lower intensity but longer duration, with opposite polarity (asymmetrical) to ensure the total electrical charge is zero (charge-balanced). This charge-balancing feature helps prevent electrochemical changes in the skin.