DOCSLIB.ORG

Venous Ulcers October 1, 2020

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Venous Ulcers October 1, 2020 Leading the way. The Guide Wire NEWSLETTER • JULY 2020 VENOUS ULCERS weight of the blood presses distally, interstitial tissue spaces produces What is a venous ulcer? and the highest pressures generated a brawny, brownish pigmentation Venous ulcers are a consequence by this mechanism are expressed at often associated with venous of venous hypertension, usually the level of the ankle and foot. ulcers. This is due to haemosiderin caused by chronic deep or deposition caused by the breakdown “The second mechanism of venous 1 superficial venous insufficiency1. of the red blood cells , and is hypertension is dynamic. The predominantly seen in the medial Until recently, it was believed that anatomic angulation of superficial lower third of the calf. Pigmentation venous ulceration was primarily to deep perforating veins and their may be followed by an itching, due to deep venous insufficiency contained valves normally prevent weeping dermatitis, in turn, possibly following valve failure, (either compartmental pressure from being progressing to ulceration2. Ulceration primary valvular failure, or as a transmitted to subcutaneous tissue may be either spontaneous, or as a consequence of deep venous and skin. Failure of this mechanism result of minor trauma. Although the thrombosis causing damage to the allows intra-compartmental pathophysiology of the ulceration venous valve), or as a result of failure forces to be transmitted directly to is not clear, it appears to be related unsupported subcutaneous veins of the calf muscle pump. However, to an inflammatory reaction in the and dermal capillaries. There, the recent studies have suggested that tissue, fibrin cuffing and eventual effective vessels elongate, dilate 3 up to 57% of venous ulcers are due lipodermatosclerosis . and lose their valve competence. to superficial venous reflux alone, Thus, venous hypertension is both Risk Factors with the deep veins demonstrating hydrostatic and hydrodynamic2.” normal venous competence 1. • Previous deep venous Subcutaneous tissue and skin are the thrombosis and subsequent That said, it is important to note ultimate targets for chronic venous post thrombotic syndrome that some ulcers which may appear insufficiency2. The underlying cause • Superficial venous venous in origin can possibly be of ulceration is still unclear, but it incompetence (either caused by other conditions such is thought to involve changes in primary, or secondary as a as rheumatoid arthritis or skin the microcirculation of the skin consequence of the above). disorders1. and subcutaneous tissues. Venous • Obesity Pathophysiology hypertension causes an increase in • Immobility venular and capillary pressure, in • Arthritic conditions (result Lower limb venous hypertension is turn, leading to local oedema and in reduced movement of a result of one of two sources. The reduced reabsorption of proteins the ankle joint, which may first is reflux of gravitational origin, and fluid from the interstitial tissue lead to failure of the calf also known as hydrostatic pressure. spaces. Leakage of red blood cells muscle pump)1. When venous valves fail to coapt, the across the capillary wall and into the 2424 VHC Newsletter Jun2020.indd 1 8/7/20 1:42 pm Role of Ultrasound Ultrasound is a useful tool to rule out deep venous pathology which may affect the successfulness of varicose vein treatment3, and can be used for the assessment of patients with primary or secondary varicose veins, or the investigation of patients with skin changes and extensive venous ulceration1. Early detection and recognition of the pre-ulcerative leg are important factors which influence the effectiveness of treatment and the duration an ulcer may be active for. Clinical Appearance Venous ulceration presents on the ulcers are usually painless. the aforementioned haemosiderin CEAP classification table as - deposition) and is frequently Ulcers may be large and shallow, • C5 - skin changes with healed ulcer associated with local skin irritation with a red base sometimes covered • C6 - skin changes with active ulcer4 or iotching1. Ultimately, ankle by yellowing tissue (See Figure Two). ulceration in the gaiter zone (located Exudate fluid can vary in its degree6. Venous ulcers usually vary in size in the lower calf and ankle)3 occurs. and can be reasonably shallow. Venous ulcers usually demonstrate In this region, the ambulatory In some cases ulcers may be uneven borders, and the surrounding superficial venous pressures are circumferential, involving a large skin may be tight, shiny, warm and the highest, leading to oedema, area of the lower calf. discoloured5 (See Image One). pigmentation, and ulceration. Often, they become infected with Before ulceration occurs, venous The skin, after years of oedema, different types of bacteria and in hypertension typically presents is difficult to examine for venous these instances can be extremely clinically as chronic leg swelling incompetence (both clinically and painful1 and produce an odour5. and ankle pigmentation (in the form with ultrasonography) because of In the absence of infection, venous of reddish brown pigmentation- extensive fibrosis3. Clinical* Clinical Classifications with examples C0 - No clinical sign C1 - Small varicose veins C2 - Large varicose veins C3 - Edema C4 - Skin changes without ulceration C5 - Skin changes with healed ulceration C6 - Skin changes with active ulceration Etiology* EC - Congenital C - Telangiectasias or C - Varicose veins 1 reticular veins 2 EP - Primary ES - Secondary (usually due to prior DVT) Anatomy* AS - Superficial Image One - Venous Ulcer with obesity as co-factor. Image courtesy of Wound Source6. AD - Deep veins AP - Performing Pathophysiology* PR - Reflux C3 - Edema and corona C4 - Lipodermatosclerosis PO - Obstruction and eczema “Early application of compression should be performed to correct swelling and progressive scarring and to initiate the healing process by improving the venous microcirculation.” Kistner R. Specific Steps to Effective Management of Venous Ulceration, Supplement to Wounds June 2010. *Fronek HS, Bergan JJ, et al. The Fundamentals of C - Ulcer scar C - Active ulcer Phlebology: Venous Disease for Clinicians, 2004. pg 151. 5 6 Table One - CEAP Classification Table. Courtesy of CPD for General Practitioners (n.d)7. Image Two - Venous Ulcer. Image courtesy of Wound Source6. 2424 VHC Newsletter Jun2020.indd 2 8/7/20 1:42 pm Complications Take Home Message It is important to remember that Predisposing Factors some venous ulcers are associated • History of DVT with arterial disease and patients • Incompetent perforators with mixed venous and arterial ulceration can pose a challenging • Varicose Veins diagnostic problem for treating • Obesity physicians. Therefore routine Associated Changes to the Lower Limb measurement of the ABI in all • Firm “brawny” oedema patients with ulceration and risk factors for peripheral artery disease • Reddish brown discolouration may be recommended to exclude a • Evidence of healed ulcers significant arterial component1. • Dilated and tortuous varicose veins Treatment • Limb may be warm Ulcer Location Treatment of superficial venous incompetence, either through • Anterior to medial malleolus ablation (thermal or chemical) • Pretibial area or surgical options results in the • Generally lower 1/3 of leg majority of ulcers healing due to Ulcer Characteristics reduction of venous hypertension. • Uneven edges Venous ulcers that are caused by • Ruddy granulation tissue significant deep venous insufficiency • No necrotic tissue are not treated as above, as the underlying venous hypertension Pain will not be corrected. Instead, • Moderate to no pain compression bandaging which • Discomfort relieved by leg elevation reduces oedema and venous hypertension has proved to be an Surrounding Area effective method of healing ulcers. • Leaking oedema may result in maceration, pruritus and scale Different compression grades can Pulses used dependant on the clinical • Normal leg and foot pulses situation. An ABI of >0.9 is required for the application of four layer Compression Bandaging Guidelines compression dressings in order • Compression bandages over padding with/without tubular to prevent arterial compromise of stretch bandage over compression bandages 1 tissues under the bandaging . Table One- Indicators for the Assessment of Venous Leg Ulcers – Curtesy of Carville 20058. Reference List 1. Thrush A & Hartshorne T. Peripheral Vascular Ultrasound: How, why and when. 2nd Ed. Elsevier Churchill Livingstone. Philadelphia, Pennsylvania. 2005. pp170-2 2. Dean 3. Zwiebal WJ & Pellerito JS. Introduction to Vascular Ultrasonography. 5th Ed. Elsevier Saudners. Philadelphia, Pennsylvania. pp479-80 4. Myers K & Clough A. Making Sense of Vascular Ultrasound. Oxford University Press. New York City. New York. 2005. pp211 5. Sobel, M. Venous Ulcers- Self Care. Medline Plus. U.S National Library of Medicine. [Internet] 2018. [Cited 23rd April 2020]. Available: https://medlineplus.gov/ency/patientinstructions/000744.htm 6. Wound Source. Venous Insufficiency Ulcers. Kestral Health Information. [Internet] n.d. [Cited 23rd April 2020]. Available: https://www.woundsource.com/patientcondition/venous-insufficiency-ulcers 7. CPD for General Practitioners. Ulcer Assessment. Revalidation Support Unit (RSU). [Internet] n.d. [Cited 24th April 2020]. Available: https://gpcpd.heiw.wales/clinical/venous-leg-ulceration/ulcer-assessment/ 8. Coville K. Wound Care Manual. 5th Ed. Silver Chain Foundation. Osborne Park, Australia.
Load more

Recommended publications
  • Association Between Hemorrhoids and Lower Extremity Chronic Venous Insufficiency
    Open Access Original Article DOI: 10.7759/cureus.4502 Association Between Hemorrhoids and Lower Extremity Chronic Venous Insufficiency Ugur Ekici 1 , Abdulcabbar Kartal 2 , Murat F. Ferhatoglu 2 1. General Surgery, Istanbul Gelişim University, Istanbul, TUR 2. General Surgery, Okan University Medical Faculty, Istanbul, TUR Corresponding author: Abdulcabbar Kartal, [email protected] Disclosures can be found in Additional Information at the end of the article Abstract Aim The aim of the present study was to evaluate the incidence of varicose veins among patients with hemorrhoidal disease and to compare its incidence reported in various community-based studies. Method The study group comprised of 100 patients who underwent surgery for symptomatic internal or external hemorrhoids; the control group consisted of 100 volunteers who received no prior therapy for hemorrhoidal disease and lacked any symptoms or findings suggestive of this condition. Subjects in both the groups were inquired with respect to their demographic data and risk factors. Both groups were asked to stand for two minutes before performing leg examinations while still in the standing position. The findings were recorded for both the groups. Varicose veins were classified according to the clinical appearance section of the Clinical, Etiologic, Anatomic, and Pathophysiologic (CEAP) classification that was developed by the 1994 American Venous Forum. Results There was no significant difference between the two groups with respect to age and body mass index (BMI). Significant relationships were identified between the groups with respect to the incidence of varicose veins and chronic constipation. The incidence of C1 and C2 varicose veins observed in the study group was higher than that observed in the control group.
    [Show full text]
  • Original Article
    Original Article Is chronic venous ulcer curable? A sample survey of a plastic surgeon V. Alamelu Department of Plastic, Reconstructive and Faciomaxillary Surgery, Madras Medical College and Govt General Hospital, Chennai - 600 003; Sri Jayam Hospital, West Tambaram, Chennai - 600 045; K.J. Hospital and Research Foundation, Poonamallee High Road, Chennai - 600 084, India Address for correspondence: Dr. V. Alamelu, 23, Ramakrishnan Street, West Tambaram, Chennai-600 045, India. E-mail: [email protected] ABSTRACT Introduction: Venous ulcers of lower limbs are often chronic and non-healing, many a time neglected by patients and their treating physicians as these ulcers mostly do not lead to amputation as in gangrenous arterial ulcer and also cost much to complete the course of treatment and prevention of recurrence. Materials and Methods: One hundred and twenty two lower limb venous ulcers came up for treatment between May 2006 and April 2009. Only twenty nine cases completed the treatment. The main tool of investigation was the non invasive Duplex scan venography. Biopsy of the ulcer was done for staging the disease. Patients’ choice of treatment was always conservative and as out-patient instead of hospitalisation and surgery, which required a lot of motivation by the treating unit. Results: Out of twenty nine cases, ten cases were treated conservatively and seven (24.13%) healed well. Remaining nineteen cases were given surgical modality in which fifteen cases (51.74%) were successful. Only seven cases (24.13%) failed to heal. Compression stockings were advised to control oedema, varices and pain. Foot care, regular exercises and follow-up were stressed effectively.
    [Show full text]
  • Chronic Venous Ulcers: a Comparative Effectiveness Review of Treatment Modalities Comparative Effectiveness Review Number 127
    Comparative Effectiveness Review Number 127 Chronic Venous Ulcers: A Comparative Effectiveness Review of Treatment Modalities Comparative Effectiveness Review Number 127 Chronic Venous Ulcers: A Comparative Effectiveness Review of Treatment Modalities Prepared for: Agency for Healthcare Research and Quality U.S. Department of Health and Human Services 540 Gaither Road Rockville, MD 20850 www.ahrq.gov Contract No. 290-2007-10061-I Prepared by: Johns Hopkins University Evidence-based Practice Center Baltimore, MD Investigators Jonathan Zenilman, M.D. M. Frances Valle, D.N.P., M.S. Mahmoud B. Malas, M.D., M.H.S. Nisa Maruthur, M.D., M.H.S. Umair Qazi, M.P.H. Yong Suh, M.B.A., M.Sc. Lisa M. Wilson, Sc.M. Elisabeth B. Haberl, B.A. Eric B. Bass, M.D., M.P.H. Gerald Lazarus, M.D. AHRQ Publication No. 13(14)-EHC121-EF December 2013 Erratum January 2014 This report is based on research conducted by the Johns Hopkins University Evidence-based Practice Center (EPC) under contract to the Agency for Healthcare Research and Quality (AHRQ), Rockville, MD (Contract No. 290-2007-10061-I). The findings and conclusions in this document are those of the author(s), who are responsible for its contents; the findings and conclusions do not necessarily represent the views of AHRQ. Therefore, no statement in this report should be construed as an official position of AHRQ or of the U.S. Department of Health and Human Services. The information in this report is intended to help health care decisionmakers—patients and clinicians, health system leaders, and policymakers, among others—make well-informed decisions and thereby improve the quality of health care services.
    [Show full text]
  • Micronised Purified Flavonoid Fraction a Review of Its Use in Chronic Venous Insufficiency, Venous Ulcers and Haemorrhoids
    Drugs 2003; 63 (1): 71-100 ADIS DRUG EVALUATION 0012-6667/03/0001-0071/$33.00/0 © Adis International Limited. All rights reserved. Micronised Purified Flavonoid Fraction A Review of its Use in Chronic Venous Insufficiency, Venous Ulcers and Haemorrhoids Katherine A. Lyseng-Williamson and Caroline M. Perry Adis International Limited, Auckland, New Zealand Various sections of the manuscript reviewed by: C. Allegra, Servizio di Angiologia, Ospedale San Giovanni, Rome, Italy; J. Bergan, Vein Institute of La Jolla, La Jolla, California, USA; E. Bouskela, Laboratório de Pesquisas em Microcirculação, Universidade do Estado do Rio De Janeiro, Rio De Janeiro, Brazil; D.L. Clement, Department of Cardiology, University Hospital, Ghent, Belgium; P.D. Coleridge Smith, Department of Surgery, University College London Medical School, The Middlesex Hospital, London, England; P. Godeberge, Unité de Proctologie Médico-Chirurgicale, Institut Mutaliste Montsouris, Paris, France; Y.-H. Ho, School of Medicine, James Cook University, Townsville, Queensland, Australia; A. Jawien, Department of Surgery, Ludwik Rydygier University Medical School, Bydgoszcz, Poland; M.C. Misra, General Surgery Department, Mafraq Hospital, Abu Dhabi, United Arab Emirates; A.-A. Ramelet, Place Benjamin-Constant, Lausanne, Switzerland; G.W. Schmid-Schönbein, Institute of Biomedical Engineering, University of California, San Diego, California, USA; F. Zuccarelli, Département Angiologie et Phlébologie, Hôpital Saint Michel, Paris, France. Data Selection Sources: Medical literature published in any language since 1980 on micronised purified flavonoid fraction, identified using Medline and EMBASE, supplemented by AdisBase (a proprietary database of Adis International). Additional references were identified from the reference lists of published articles. Bibliographical information, including contributory unpublished data, was also requested from the company developing the drug.
    [Show full text]
  • Lower Extremity Ulcers: Venous, Arterial, Or Diabetic?
    Lower Extremity Ulcers: Venous, Arterial, or Diabetic? Determining the answer to this question is crucial to avoid administering treatment that only makes a serious condition worse. After pointing out where to look for the keys in the history and physical, the authors review how the etiology of an ulcer should influence the therapeutic approach. By Ani Aydin, MD, Srikala Shenbagamurthi, MD, and Harold Brem, MD hen a patient presents to the duration, progression, prior treatments, and clinical emergency department with a course of the ulcer can suggest its etiology. Pos- lower extremity cutaneous ul- sible considerations to rule out include diabetes; cer, many etiologies must be hypertension; hyperlipidemia; coronary artery dis- Wconsidered. These include venous and arterial dis- ease; alcohol and tobacco use; thyroid, pulmonary, ease, diabetes mellitus, connective tissue disorders, renal, neurologic and rheumatic diseases; peripheral rheumatoid arthritis, vasculitis, and malignancies. vascular disease; deep vein thrombosis; and specifi- One goal of the initial assessment is to determine cally cutaneous factors including cellulitis, trauma, whether the ulcer is chronic (defined as taking a and recent surgery. The patient should be asked significant amount of time to heal, failing to heal, about lower extremity pain, paresthesia, anesthesia, or recurring), as such ulcers are associated with sig- and claudication. nificant morbidity.1,2 Physical examination, too, may suggest the etiol- Most prominent in the differential diagno- ogy of an ulcer. Wound characteristics that should sis should be venous reflux, arterial insufficiency, be noted include size, location, margins, presence of pressure ulcer, and ulcer granulation tissue, necrosis, weeping, odor, and pain. >>FAST TRACK<< secondary to diabetic neu- Pulses must be palpated in the distal extremities.
    [Show full text]
  • Venous Leg Ulcers and Lymphedema
    Wound Home Skills Kit: Venous Leg Ulcers and Lymphedema AMERICAN COLLEGE OF SURGEONS DIVISION OF EDUCATION Blended Surgical Education and Training for Life® SAMPLE Welcome You are an important member of your health care team. This wound home skills kit provides information and skill instruction for the care of venous leg ulcers and lymphedema. The American College of Surgeons Wound Management Home Skills Program was developed by members of your health care team: surgeons, nurses, wound care specialists, and patients. It will help you learn and practice the skills you need to take care of slow healing venous ulcers or Lymphedema, watch for improvements, and how to prevent other ulcers. Your Venous Leg Ulcer ............ 3–6 Treatment ....................... 7–10 Wound Care ....................11–22 Lymphedema Ulcers ............ .25–26 Resources ..................... 29–38 Watch the accompanying skills videos included online at facs.org/woundcare Your Venous Leg Ulcer Venous Leg Ulcers Risk Factors for Venous Ulcers.... 4 Signs of a Venous Ulcer .......... 4 What to Do if You Develop a Venous Leg Ulcer .............. 5 Tests and Exams ................ 5 SAMPLE Venous Leg Ulcers A venous leg ulcer is an open wound between the knee and the ankle caused by problems with blood flow in the veins.1 Blood is carried down to the legs by arteries and back to the heart from the legs by veins. Veins have valves that keep the blood from backing up. When the vein valves don’t open and close correctly or the muscles are weak, blood backs up in the veins and causes swelling (edema) in the lower legs.
    [Show full text]
  • Chronic Leg Ulcers: the Impact of Venous Disease
    View metadata, citation and similar papers at core.ac.uk brought to you by CORE provided by Elsevier - Publisher Connector INVITED COMMENT Chronic leg ulcers: The impact of venous disease David Bergqvist, MD, PhD, Christina Lindholm, RN, PhD, and Olle Nelzén, MD, PhD, Uppsala, Sweden Chronic leg ulceration of various causes has been PREVALENCE OF LEG ULCERS a health care problem throughout history. The prob- Differences in leg ulcer prevalence between vari- lematic consequences of the disease and the difficul- ous studies may have several causes, such as the use ties in the promotion of healing conditions once cre- of overall or point prevalence, the inclusion or exclu- ated the need for a special saint for chronic leg ulcers, sion of foot ulcers, the age and sex distribution in St Peregrinus. At one of the oldest hospitals in the patient series, and the methodology of identify- Sweden, patients with leg ulcers comprised a large ing patients. With a combination of questionnaires proportion of all in-hospital patients during the years to the health care system (eg, wards, outpatient clin- 1767 to 1771.1 Both internal (laxatives) and external ics, nurses) and questionnaires to randomly selected (turpentine, honey) treatment options were used, individuals within the population and a thorough and, after a couple of months, at least some of the investigation of the random samples of responders, it ulcers healed. Bandaging therapy was mentioned would seem as if an optimal estimate is obtained. We already in the Old Testament of the Bible (Isaiah have been especially interested in an investigation of 1:6).
    [Show full text]
  • Venous Insufficiency
    The Multi-Billion Dollar Vascular Disease No One Teaches, But Should!!! Venous Insufficiency Thomas E. Eidson, DO Certified Venous Disease Specialist Board Certified Family Medicine Disclosure of Conflict of Interest I do not have relevant financial relationships with any commercial interests 1 Bio • Certified Phlegologist (Vein Disease Specialist) – American Board of Venous and Lymphatic Medicine • Board Certified Family Medicine • Successfully performed over 6000 vein procedures since 2011 • Published in Vein Therapy News • Founder of Atlas Vein Care in Arlington, TX Questions for Thought 1. Which of these vascular diseases is most common in the United States? A – Peripheral Arterial Disease (PAD) B – Venous Insufficiency/Reflux Disease C – Coronary Artery Disease D – Stroke 2 Questions for Thought 2. Which of the following is a correct statement? A – Venous disease affects men more than women B – Venous disease affects women more than men C – Venous disease affects women and men the same D – I don’t know but I think I am going to find out very soon Questions for Thought 3. Which of these statements is FALSE? A – Venous reflux is a disease of old people B – Venous insufficiency is purely cosmetic and not a big deal C – Insurance does not cover treatment of venous reflux D – Varicose veins should be treated with vein stripping E – All of the above 3 Questions for Thought 4. According to most recent estimates, how many people in the US are afflicted with venous reflux disease? A – between 5 and 10 Million people B – between 10 and 20 million people C – between 40 to 50 million people D – 50+ million people E – I don’t know but I bet it’s a lot or you would not be up here talking about it Questions for Thought 5.Which of these symptoms CANNOT be associated with chronic venous insufficiency? A – leg pain, aching, and heaviness B – Night cramps and Restless Legs C – Lower extremity and ankle edema D – Skin darkening and texture changes E – All of the above can be caused by venous reflux 4 Questions for Thought 6.
    [Show full text]
  • Relationship Between Deep Venous Thrombosis and the Postthrombotic Syndrome
    REVIEW ARTICLE Relationship Between Deep Venous Thrombosis and the Postthrombotic Syndrome Susan R. Kahn, MD, MSc, FRCPC; Jeffrey S. Ginsberg, MD, FRCPC he postthrombotic syndrome (PTS) is a frequent complication of deep venous thrombo- sis (DVT). Clinically, PTS is characterized by chronic, persistent pain, swelling, and other signs in the affected limb. Rarely, ulcers may develop. Because of its prevalence, severity, and chronicity, PTS is burdensome and costly. Preventing DVT with the use of effective Tthromboprophylaxis in high-risk patients and settings and minimizing the risk of ipsilateral DVT re- currence are likely to reduce the risk of development of PTS. Daily use of compression stockings after DVT might reduce the incidence and severity of PTS, but consistent and convincing data about their effectiveness are not available. Future research should focus on standardizing diagnostic criteria for PTS, identifying patients at high risk for PTS, and rigorously evaluating the role of thrombolysis in preventing PTS and of compression stockings in preventing and treating PTS. In addition, novel thera- pies should be sought and evaluated. Arch Intern Med. 2004;164:17-26 The postthrombotic syndrome (PTS) is a CLINICAL PRESENTATION AND chronic condition that develops in 20% to PATHOPHYSIOLOGY OF PTS 50% of patients within 1 to 2 years of symptomatic deep venous thrombosis Patients with PTS complain of pain, (DVT). A severe form, which can include heaviness, swelling, cramps, itching, or venous ulcers, occurs in one quarter to one tingling in the affected limb. Typically, third of patients with PTS.1,2 Because of its symptoms are aggravated by standing or prevalence and chronicity, PTS is costly walking and improve with rest and to society and is a cause of substantial pa- recumbency.
    [Show full text]
  • Assessment and Management of Venous Leg Ulcers
    June 2006 Learning Package Assessment and Management of Venous Leg Ulcers Based on the Registered Nurses’ Association of Ontario Best Practice Guideline: Assessment and Management of Venous Leg Ulcers Learning Package: Assessment and Management of Venous Leg Ulcers i Acknowledgement The Registered Nurses’ Association of Ontario (RNAO) and the Nursing Best Practice Guidelines Program would like to acknowledge the following individuals and organizations for their contributions to the development of this Learning Package: Assessment and Management of Venous Leg Ulcers. Saint Elizabeth Health Care, Markham, for their role in implementing and evaluating the guideline Assessment and Management of Venous Leg Ulcers through the RNAO pilot site implementation initiative, and for providing leadership in the development of this resource as part of their implementation plan. This educational resource has been adapted for web dissemination by the RNAO. The guideline development panel for Assessment and Management of Venous Leg Ulcers. This best practice guideline is a foundation document for the content of this educational resource, which has been developed to support the educational needs of nurses in the implementation of Assessment and Management of Venous Leg Ulcers. Disclaimer While every effort has been made to ensure the accuracy of the contents at their time of publication, neither the authors nor RNAO accept any liability, with respect to loss, damage, injury or expense arising from any such errors or omissions in the contents of this work.
    [Show full text]
  • Leg Ulcer Management
    PATIENT SAFETY TOOL BOX TALKS© EFFECTIVE CARE & SUPPORT TISSUE VIABILITY LEG ULCER ASSESSMENT & MANAGEMENT V1.0 1. Definition: A leg ulcer is a break in the skin of the lower leg which takes more than 4-6 weeks to heal (HSE, 2009) 2. Causes: - Venous Disease 70% - Arterial Disease 15-20% - Rheumatoid Arthritis (Less Common) - Vasculitis (Less Common) - Malignancy (Less Common) It is important to know the underlying cause of the ulcer as treatment varies according to the disease process: - Venous Ulceration- Chronic venous hypertension is the main underlying cause of venous leg ulceration - Arterial Ulceration- Caused by ischaemia, usually as a result of atherosclerosis. - Mixed Aetiology Ulcers- Mixed arterial and venous disease (approx 20% of patients with leg ulcers) 3. Assessment: should be carried out by a practitioner experienced and knowledgeable in leg ulcer care. A structured leg ulcer assessment form should be used and include details about: a. Patient: the general health of the patient, screening for diabetes, patient and family history of venous or arterial disease. b. Leg: signs of venous or arterial disease. c. Vascular assessment: measurement of the Ankle Brachial Pressure Index with a hand held doppler, together with the overall assessment is used to confirm or exclude the presence of arterial disease. d. Ulcer: site, dimensions, appearance of the wound bed, wound edge, level and type of exudate, the surrounding skin. Remember: Leg ulcers of any aetiology can be extremely painful. Patients with non-healing or atypical leg ulcer should be considered for biopsy to out rule malignancy. Bacteriology swabs should only be taken where there is clinical evidence of infection.
    [Show full text]
  • Venous Wounds – Continuing Clinical Challenges
    Venous Wounds – Continuing Clinical Challenges Up to 6 million people in the United States suffer from venous leg ulcers annually1 including at least 2.5 percent of the long term care population.2 In the UK, district nurses spend about 50 percent of their time treating leg ulcers.3 Venous Insufficiency Leads to Venous Wounds Patients are at risk for venous ulcers and venous dermatitis due to inflammation, hypoxia and edema caused by underlying venous hypertension (abnormally high venous pressure).4,5 Venous hypertension is caused by chronic venous insufficiency (CVI).4,5 CVI is the chronic inability to pump enough blood from the legs back to the heart. CVI is the result of one or more of these pathologies:6 • Obstruction of the veins (usually thrombosis, but also increased abdominal pressure from obesity, pregnancy, etc.) • Failure of the muscle pump related to inactivity, paralysis, decreased ankle range of motion or disease • Incompetent one-way valves in the veins Signs and symptoms associated with late stage Venous Hypertension or CVI include: • Venous leg ulcers:7,8 – painful in 90 percent of all cases – recurrent in up to 72 percent of all patients – at least 50 percent take more than a year to close, with about 34 percent taking more than 5 years • Lower leg dermatitis:7,8 – itching, with scratching, leading to ulcer formation – dry scaling or weeping crusts – brown staining (hemosiderin deposits) – thickened skin with scales – fibrotic skin that causes the lower 1/3 of the lower leg to be thin, giving the appearance of an inverted champagne bottle (lipodermatosclerosis) – hypersensitivity to allergens, such as products initially used to decrease itching and dryness or to treat ulcers and infection ® PolyMem The ideal venous wound management tool.™ Built right into each PolyMem dressing, these four capabilities are ready when you need them – without incurring extra costs or gathering additional supplies.
    [Show full text]