Caring for patients in a community setting continues to offer challenges to nurses and therapists because of the complexities of patients’ intricate and complicated conditions. The demand on district nursing is increasing as more patients are being cared for in their own homes with no additional resources to support nurses. Management of lower leg wounds dominates the workload. Compression bandaging has historically been the treatment of choice to reduce oedema and heal venous leg ulcers. However, there are safe and reliable alternatives to assist community nurses in their practice. Getting compression therapy right first time achieves many positive aspects: it improves patient quality of life, reduces costs, and enhances staff morale and job satisfaction. This article explores some of the challenges nurses face, and offers solutions with the use of the juxta range from medi UK.
This article is the second in a two-part series on managing common lower limb problems encountered in primary care. The first article in the series (Brown, 2017) discussed the causes of oedema and its relation to underlying conditions, such as venous disease, lymphoedema and lipoedema. This article investigates skin care, the management of ‘wet legs’ and the different types of compression therapy available to non-specialist community nurses.
This two-part series will discuss common lower limb problems, including venous leg ulceration, oedema (including oedema associated with lymphovenous disease), lymphoedema and lipoedema. This article will focus on the causes of these conditions and discusses the signs and symptoms to enable community nurses to diagnose and differentiate between the types of lower limb problems. Part two of the series will focus on management strategies for simple, uncomplicated venous leg ulceration and oedema, which can be successfully managed with skin care and compression therapy, without specialist skills. It will also briefly outline the management of lymphorrhoea or ‘leaking legs’, which can be challenging for nurses. The aim of this series is to enable community nurses to choose the most effective treatment in terms of efficacy and patient acceptability.
District nursing teams are under increasing pressure to cope with demands on their time and the skills to meet the needs of their local community. The author’s local nursing team has been struggling to manage the clinical skill mix required to meet the complex needs of their patients with lower leg wounds who should be treated with compression therapy. The task of managing compression therapy was mainly undertaken by nurses, but it was proving extremely time-consuming — especially when patients needed leg washing and compression treatment for bilateral leg wounds. After successfully using a Velcro™ compression system, a six-month evaluation of juxta products for the leg ulcer pathway was proposed for one community nursing team. This project was undertaken with an initial cohort of 17 patients to evaluate if switching to this product could help to improve the use of the team’s skill mix and reduce costs on wound products from the formulary by improving wound healing rates.
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).
This article highlights the normal and abnormal physiology of fluid circulation in the lower limb with particular reference to venous and lymphatic flow. Consideration is given to the assessment and diagnosis of disease and its severity, particularly the impact on the patient including chronic oedema, ulceration, cellulitis and loss of mobility. Options for disease management and prevention such as compression bandaging and hosiery are also discussed, and the gaps between theory and practice are highlighted to provide community nurses with the most up-to-date information and practical solutions.
Jeanette Muldoon discusses the measurement of oedema as a diagnostic and monitoring tool, highlighting the need for practitioners to reassess within agreed timelines to ensure constant monitoring of treatment effectiveness or the need to refer.
Jeanette Muldoon, Head of Clinical Services, Activa Healthcare.
Article accepted for publication: August 2011
