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Venous Leg UlcersAn Evidence-Based Approach

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Researched and Compiled by

Valarie, Sandy, Leann, Ruth

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Venous Leg Ulcers

What interventions work best?

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A non-healing open wound Often near the ankle

With or without visible varicose veins

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Signs and Symptoms

red, open, draining

non-healing painful

swollen leg

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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

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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

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Venous Insufficiency:

its in the circulation

edema varicose

veins

changes in

color, skin

ulceration

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>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

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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

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Interventions

Modify activity to promoteblood flow

Apply compression therapy

Provide local wound and

skin care

Treat and control infection,inflammation

Improve nutrition

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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

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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

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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

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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

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Advanced Cases:

Surgical Treatment

Subfascial endoscopic perforator

surgery (SEPS) Improves healing rates, and reoccurence

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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=bAY7OKp6D7w

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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

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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.

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Venous Leg Ulcers

Random Control Trials

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Best Nursing Practice

Identify and treat the cause

Obtain history

Perform physical

assessment

Determine cause

Implementappropriate therapy

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Best Nursing Practice

Address Patient Concerns

Communicate

Establish realistic goals

Provide information Assess support system

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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

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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