7/31/2019 vlu-1233115624198541-3
1/26
Venous Leg UlcersAn Evidence-Based Approach
7/31/2019 vlu-1233115624198541-3
2/26
Researched and Compiled by
Valarie, Sandy, Leann, Ruth
7/31/2019 vlu-1233115624198541-3
3/26
Venous Leg Ulcers
What interventions work best?
7/31/2019 vlu-1233115624198541-3
4/26
7/31/2019 vlu-1233115624198541-3
5/26
A non-healing open wound Often near the ankle
With or without visible varicose veins
7/31/2019 vlu-1233115624198541-3
6/26
Signs and Symptoms
red, open, draining
non-healing painful
swollen leg
7/31/2019 vlu-1233115624198541-3
7/26
What Lies Beneath:
IncompetentPerforators
Perforators should
only allow inwardflow from super-
ficial to deep
Valve competence
in perforators iscritical to protecting
superficial tissues
from elevated deep
venous pressure
7/31/2019 vlu-1233115624198541-3
8/26
Maternal history of venous insufficiency
History of DVT, DM,
chronic heart failure or
recent edema
Obesity
Severe trauma to the leg
Vigorous exercise
Number of pregnancies
Risk Factors
7/31/2019 vlu-1233115624198541-3
9/26
Venous Insufficiency:
its in the circulation
edema varicose
veins
changes in
color, skin
ulceration
7/31/2019 vlu-1233115624198541-3
10/26
>80% of ulcers treated are venous
1-2% of the population affected
Venous Leg Ulcer Facts
Rarely occurs < 45
years of age
Average time to heal12-30 weeks
Annual burden: >$1B
7/31/2019 vlu-1233115624198541-3
11/26
Poor circulation
decreases delivery of
oxygen and nutrients,
prevents removal of
metabolic wasteproducts such as
carbon dioxide, and
ultimately delays
healing.
Blood Flow:
The key toWoundHealing
7/31/2019 vlu-1233115624198541-3
12/26
Interventions
Modify activity to promoteblood flow
Apply compression therapy
Provide local wound and
skin care
Treat and control infection,inflammation
Improve nutrition
7/31/2019 vlu-1233115624198541-3
13/26
First Step: Assess for PAD
(Peripheral Arterial Disease)
Check pedal pulses
before compression Use Doppler to
check ABPI >0.8
(ankle/brachial press. index) If ABI is
7/31/2019 vlu-1233115624198541-3
14/26
Keep the pressure on:
Unna Boot
A paste bandage with
zinc oxide, glycerin, etc. Applied without tension
distal to proximal to
below knee Primary dressing applied first
Boot dries to a semirigid cast
Changed 1-2x q week, depends on drainage
7/31/2019 vlu-1233115624198541-3
15/26
Pneumatic Compression Pump
Inflatable boot and pump
rhythmically fills with air
Long-term use for ptsnoncompliant with other
methods
For pts who have failedtreatment with other
compression devices
7/31/2019 vlu-1233115624198541-3
16/26
Lifelong: Compression Therapy
After healing of ulcer,fit for custom stockings
Remove and bathe eachevening, apply moisturizer
Each morning put on
to prevent edema Metal frame used to assist
Pt should purchase in pairs of
two, replace every 6 months
7/31/2019 vlu-1233115624198541-3
17/26
Advanced Cases:
Surgical Treatment
Subfascial endoscopic perforator
surgery (SEPS) Improves healing rates, and reoccurence
7/31/2019 vlu-1233115624198541-3
18/26
Advanced Cases:
Maggot Therapy
Maggots are currently one of the most
effective means of treating ulcers withMRSA
Specially bred fly larvae secrete enzymes to
break down dead tissue intoa liquid they will ingest
The FDA approved this
therapy in Jan, 2004.
http://www.youtube.com/watch?v=bAY7OKp6D7w7/31/2019 vlu-1233115624198541-3
19/26
Venous Leg Ulcers
Random Control Trials
Study 1-Review Question:
What are the effects of systemicantibiotics and topical antibioticsand antiseptic on healing?
22 RCTs included High bacterial colonization
Currently no strong evidence
7/31/2019 vlu-1233115624198541-3
20/26
Venous Leg Ulcers
Random Control Trials
Study 2Efficacy and safety of CHRONOSEAL cream
Evaluates if CHRONOSEAL
Is safe
Is tolerated
Reduces size The study is currently recruiting participants
Sponsors and collaborators: Tripep AB, Kringle Pharma,
Inc.
7/31/2019 vlu-1233115624198541-3
21/26
Venous Leg Ulcers
Random Control Trials
7/31/2019 vlu-1233115624198541-3
22/26
Best Nursing Practice
Identify and treat the cause
Obtain history
Perform physical
assessment
Determine cause
Implementappropriate therapy
7/31/2019 vlu-1233115624198541-3
23/26
Best Nursing Practice
Address Patient Concerns
Communicate
Establish realistic goals
Provide information Assess support system
7/31/2019 vlu-1233115624198541-3
24/26
Best Nursing Practice
Provide Wound Care & Support
Assess
Optimize healing environment
Consider additional therapies
Refer as needed Consider all factors that affect healing
Teach patient measures of prevention
7/31/2019 vlu-1233115624198541-3
25/26
7/31/2019 vlu-1233115624198541-3
26/26
REFERENCES
http://www.medscape.com
http://www.mayoclinic.org/vascularcenter
http://www.ncbi.nlm.nih.gov
http://veinforum.org
http://www.cawc.net/
http://www.VeinClinics.com
http://www.icvein.com/http://clinicaltrials.gov/identifier:nct00797706
Journal of Advanced Nursing, prepared by Joana Briggs
Institute, Cochrane Library; 2008
Top Related