Skin tears are a common type of tissue injury, which often go unrecognised and misdiagnosed. Furthermore, classification and documentation of skin is often poor, resulting in chronic wounds with associated adverse patient outcomes. The International Skin Tear Advisory Panel (ISTAP) recently updated the International Best Practice Guidelines and definition of a skin tear based on emerging evidence and expert discussion and consensus. This article presents a discussion of the epidemiology, risk factors and causes of skin tears. In addition, the most recent best practice recommendations for the prevention, assessment, and management of skin tears is summarised.
This article focuses on the work of a team of community nurses running a primary care drop-in centre. As well as a full range of clinic services, the team sees a lot of leg ulcer patients for compression bandaging. A common problem with traditional compression bandaging is the amount of time that community nurses have to spend on the procedure, as well as the dangers of maintaining pressure and bandage slippage between dressing appointments, which can result in discomfort for patients and even skin damage in some cases. This also has implications for patient concordance. This article looks at a review by the team of a new compression system (juxtacures®; medi UK), which offers measurable and adjustable compression and a greater involvement by patients in their own care, which in turn can minimise the time nurses need to spend on dressing changes.
When trying to prevent the recurrence of leg ulcers, many community nurses find it hard to get patients to concord with compression devices and techniques, particulary over the long term.
This article looks at a new adjustable Velcro compression device, juxtalite (part of the juxta® range; medi UK), which is designed to be simple to apply. It has built-in pressure system (BPSTM) that allows the nurse to accurately monitor the level of compression being applied to the limb, ensuring a therapeutic level of compression is maintained. Here, the author relates her own expreience of using the juxta system (in particular the juxalite version) through a series of case studies that show how the system aids patient concordance with treatment over an extended period of time.
Community nurses often work in isolation and are not always able to attend best practice updates in venous leg ulcer treatment. As a result, they do not always possess the up-to-date knowledge and skills to manage these patients. This project reached out to local ways of delivering compression therapy; in this case an adjustable Velcro compression device, juxtacures (juxtacures®; medi UK). The juxtacures range is designed to be simple to apply with a built-in pressure system that allows the nurse to accurately monitor the level of compression being applied to the limb. This ensures a therapeutic level of compression is maintained. The authors felt and skill level in compression bandaging. The aims of the project were to reduce the amount and duration of community nursing visits to patients with venous leg ulcers while ensuring that safe, visits to patients with lower limb problems, with some patients successfully discharged to self-manage their lower limbs.
In the community setting, leg ulcer management involves both care of the wound itself and the skin of the lower limb. Cleansing is vital to enure that infection does not develop in the wound itself and that the integrity of the periwound skin is maintained. Maintaining the skin’s barrier function is also vital, as, without this, fluid loss, inflammation, dryness and infection can develop. Wound exudate can also act as an irritant to healthy skin, particularly when permitted to accumulate under wound dressings. Keeping the skin clean and free of debris, alongside more frequent dressing changes can help in the treatment of irritated skin. This article highlights the use of an innovative cleansing product (UCS; medi UK), which is designed as a premoistened cloth that safely and effciently cleanses the wound of slough and debris, while rehydrating periwound skin.
Venous leg ulcers make up a considerable part of the community nurse’s workload and the gold standard treatment is multilayered compression bandaging applied to cleansed and debrided lower limbs. The author of this piece looks at the background to leg ulcer development; as well as how to assess patients and the principles of prevention. This article also examines the KTwo® bandaging system (Urgo Medical), which has a built-in pressure indicator to ensure that application is both consistent and effective. The make-up of the twolayer system makes it as effective as four-layer systems without the associated bulk, which means that patients find it easier to wear.
An optimal wound environment for promoting healing is dependent on maintaining moisture balance (i.e. an environment that is neither too wet, nor too dry). Practitioners need to understand what is normal and what is problematic exudate for wound healing, as well as the impact that wound fluid might be having on the patient’s quality of life. For example, if dressings chosen are unable to contain the volume being produced, this can lead to embarrassment and social isolation, as well as discomfort to the patient from wearing bulky dressings. Assessing and understanding the cause of excess exudate will help practitioners to develop goals with the patient and target treatments to achieve the best outcomes overall. This article examines what is meant by a moist wound healing environment and looks at one dressing range, Eclypse®, that has been found to contribute to moist wound healing and promote patient quality of life (Rafter et al, 2015).
In each issue of JCN we ask a clinical expert to take a look at a therapy area and examine some everyday problems that community nurses may experience. In this issue, we look at venous leg ulceration and associated oedema and ask the question...
What is the patient experience of healing in a hosiery kit?
Leg ulcers present a common clinical problem for community nurses. The need for assessment and maintenance can take up a lot of nursing time and issues such as pain, exudate and compression bandaging have a significant effect on the quality of life of patients. This article describes an evaluation of two new compression devices, one for people with venous insufficiency resulting in leg ulcers who need compression therapy (Juxta CURES; medi UK); another for those with leg ulcers, venous insufficiency and lymphoedema (Juxta-Fit; medi UK). This evaluation involved 16 patients and demonstrated the impact of quality of life and the potential for savings in a community nursing team, both financially and in terms of reduced nursing time.
The use of compression bandaging in venous leg ulcers has been acknowledged as ‘best practice’ for some time now, but these wounds remain a serious management problem in many patients with pain, excess exudate, limb swelling and poor mobility all affecting their quality of life. Wound care in general, and leg ulcer management specifically, are two of the most common reasons for referral to community nursing services and recent government policy aimed at managing more patients in primary care and in their own homes has also meant that nurses are now seeing more patients than ever before. All of this means that they need compression systems that are easy to apply and can deliver safe and consistent pressures to minimise risk and safeguard patients. This article presents the findings of a 40-patient multi-centre evaluation of a new inelastic compression bandage system (HERO H-2®; H&R Healthcare) designed to provide optimal compression levels, reduce odour and moisturise the skin. The evaluation demonstrated that the bandage system had a positive effect on a number of parameters including wound size, healing rates, patient comfort and mobility.
