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).
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.
If left untreated, leg ulcers can descend into a cycle of tissue breakdown and healing, resulting in chronic venous leg ulcers, which are associated with considerable morbidity and impaired quality of life. Compression therapy is widely held up as the ‘gold standard’ for management of venous leg ulcers, and the provision of safe and effective compression is one of the vital skills of the community nurse. However, to provide this level of treatment it is essential that the bandage system used provides the correct amount of sub-bandage pressure, as too little will be ineffective; whereas too great a pressure may cause constriction and patient discomfort (Moffatt, 2005; Milic et al, 2010). This article highlights a study that investigated the efficacy of a two-layer bandaging system (HERO H-2®, H&R Healthcare), which was tested by a group of clinicians for its ability to provide optimum compression alongside ease of application and patient comfort.
This article provides an overview of lymphoedema and its management. It includes information on the definition of lymphoedema, anatomy (lymphatics), lymphoedema staging, complications and the psychosocial impact. This leads onto a discussion of the management methods that can be delivered by community staff and practice nurses who have received appropriate training. Involving patients and their family/carers in all aspects of the management plan can help them to cope with this lifelong condition and promote concordance with treatment.
This article outlines a survey that was undertaken in the community to find out how often patients with venous disease who are wearing compression hosiery have their ankle brachial pressure index (ABPI) monitored. It also asked clinical nurse specialists (CNSs) their opinion on the desired frequency of ABPI follow-up, and which patient groups they considered to be most at-risk. The survey findings highlight the lack of consensus and consistency in follow-up care. The majority of CNSs identified potential high-risk patient groups, the majority of which have their ABPI monitored every three months. However, there were inconsistencies in time interval for follow-up in patients with similar risk factors.
Winnie Furlong, Lead Clinical Nurse Specialist, Princess Alexandra Hospital and West Essex Leg Ulcer Service
Literature has shown that patients with leg ulcers can have a significantly poorer quality of life compared to those without leg ulcers. In addition, research has identified problematic relationships between patients with leg ulcers and practitioners, such as community nurses. The author contends that this mismatch needs to be addressed in order to improve patient quality of life through leg ulcer bandaging. He makes several recommendations for practice and highlights that community practitioners need to use innovative practice to help improve the quality of leg ulcer bandaging care they deliver. The overall aim of this article is to establish the extent of community practitioners’ understanding of the impact of leg ulcer bandaging on patient quality of life.
Edwin Tapiwa Chamanga, Tissue Viability Service Lead, Ipswich Hospital NHS Trust
In patients with venous and lymphovenous disease, skin changes to the lower limb(s) occur gradually, and become more serious over time if left untreated. The CHRonic Oedema Signs and Symptoms (CHROSS) Checker is a tool kit consisting of an assessment chart and key cards that have been developed to help clinicians easily identify the skin changes that occur as a result of underlying venous and lymphovenous disease, when carrying out holistic patient assessment. It also provides clear guidance on which compression products can be used to manage the disease type and severity of skin change. For clinicians unfamiliar with some or all of the signs and symptoms listed on the CHROSS Checker chart, the key cards contain further information in the form of a photograph, definition and cause of each sign and symptom listed. This article will describe the theory behind the development of the CHROSS Checker tools and explain how to use them in clinical practice.
Janice Bianchi, Independent Medical Education Specialist and Honorary Lecturer, Glasgow University
Andy Kerr & Sylvie Hampton discuss the use of the Clini Duo40 venous ulcer compression system in treatment and prevention of venous ulceration.
Andy Kerr RN, Dip HE is a Tissue Viability Consultant.
Sylvie Hampton MA, BSc (Hons), DpSN, RGN is a Tissue Viability Consultant. Wound Healing Centre, Eastbourne.
