Colonization refers to the presence of replicating bacteria without a host reaction or clinical signs of infection.45 Colonized venous ulcers generally should not be treated with antibiotics. Compression therapy is a standard treatment modality for initial and long-term treatment of venous ulcers in patients without concomitant arterial disease.1,28 Goals of compression therapy include reduced edema and pain, improved venous reflux, and enhanced healing.16 Compression therapy is useful for ulcer healing and prevention of recurrence. If you would like to change your settings or withdraw consent at any time, the link to do so is in our privacy policy accessible from our home page.. Less often, patients have arterial leg ulcer resulting from peripheral arterial occlusive disease, the most common cause of which is arteriosclerosis. A wide range of dressings are available, including hydrocolloids (e.g., Duoderm), foams, hydrogels, pastes, and simple nonadherent dressings.14,28 A meta-analysis of 42 randomized controlled trials (RCTs) with a total of more than 1,000 patients showed no significant difference among dressing types.29 Furthermore, the more expensive hydrocolloid dressings were not shown to have a healing benefit over the lower-cost simple nonadherent dressings. Guidelines suggest cleansing of the affected leg should be kept simple, using warm tap water or saline. . Venous stasis ulcers are often on the ankle or calf and are painful and red. Multicomponent compression systems comprised of various layers are more effective than single-component systems, and elastic systems are more effective than nonelastic systems.28, Important barriers to the use of compression therapy include wound drainage, pain, application or donning difficulty, physical impairment (weakness, obesity, decreased range of motion), and leg shape deformity (leading to compression material rolling down the leg or wrinkling). There are numerous online resources for lay education. Gently remove dry skin scales from the legs, particularly around the ulcer edges to allow new growth of epithelium. These measures facilitate venous return and help reduce edema. Venous ulcers (open sores) can occur when the veins in your legs do not push blood back up to your heart as well as they should. Other associated findings include telangiectasias, corona phlebectatica, atrophie blanche, lipodermatosclerosis, and inverted champagne-bottle deformity of the lower leg. 1, 28 Goals of compression therapy. Examine the clients and the caregivers comprehension of pressure ulcer development prevention. Medical-surgical nursing: Concepts for interprofessional collaborative care. This means they can't stop blood which should be headed upward to your heart from being pulled down by gravity. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP. Patients who are severely malnourished (serum albumin 2.5 mg/dl) are more likely to acquire an infection from a pressure ulcer. 2 In some studies, 50% of patients had venous ulcers that persisted for more than 9 months, and 20% had ulcers that did not Venous ulcers are the most common lower extremity wounds in the United States. St. Louis, MO: Elsevier. The patient will continue to be free of systemic or local infections as shown by the lack of profuse, foul-smelling wound exudate. Pentoxifylline. She takes the topics that the students are learning and expands on them to try to help with their understanding of the nursing process and help nursing students pass the NCLEX exams. 17 We can define pressure ulcers as localized areas of necrosis that tend to occur when soft tissue is compressed between two planes, one bony prominences of the patient and other external surface. Immobile clients will need to be repositioned frequently to reduce the chance of breakdown in the intact parts. History of superficial or deep venous thrombosis, pulmonary embolism, and ulcer recurrence should be ascertained with comorbid conditions. The primary risk factors for venous ulcer development are older age, obesity, previous leg injuries, deep venous thrombosis, and phlebitis. Encourage performing simple exercises and getting out of bed to sit on a chair. Treat venous stasis ulcers per order. Oral antibiotics are recommended to treat venous ulcers only in cases of suspected cellulitis. Factors that may lead to venous incompetence include immobility; ineffective pumping of the calf muscle; and venous valve dysfunction from trauma, congenital absence, venous thrombosis, or phlebitis.14 Subsequently, chronic venous stasis causes pooling of blood in the venous circulatory system triggering further capillary damage and activation of inflammatory process. Your care team may include doctors who specialize in blood vessel (vascular . Color duplex ultrasonography is recommended in patients with venous ulcers to assess for venous reflux and obstruction. A recent meta-analysis showed that elastic compression therapy is more effective than inelastic therapy.46 In addition, high compression has been proven more effective than low compression, and multilayer bandages are more effective than single layer.23,45,47 The disadvantage of multilayer compression bandages is that they require skilled application in the physician's office one or two times per week, depending on drainage. VLUs are the result of chronic venous insufficiency (CVI) in the legs. A yellow, fibrous tissue may cover the ulcer and have an irregular border. Effective treatments include topical silver sulfadiazine and oral antibiotics. Elastic compression bandages conform to the size and shape of the leg, accommodate to changes in leg circumference, provide sustained compression during rest and walking, have absorptive capacity, and require infrequent changes (about once a week).5 There is strong evidence for the use of multiple elastic layers vs. single layers to increase ulcer healing.30, Inelastic. Preamble. Venous ulcers commonly occur in the gaiter area of the lower leg. such as venous ulcers and lymphoedema, concomitant bacterial and fungal colonisation or infection may be present. Suspected osteomyelitis warrants an evaluation for arterial disease and consideration of intravenous antibiotics to treat the underlying infection. Debridement may be sharp (e.g., using curette or scissors), enzymatic, mechanical, biologic (i.e., using larvae), or autolytic. Skin grafting should be considered as primary therapy only for large venous ulcers (larger than 25 cm2 [3.9 in2]), in which healing is unlikely without grafting. Nursing Times [online issue]; 115: 6, 24-28. It has been estimated that active VU have They typically occur around the medial malleolus, tend to be shallow and moist, and may be malodorous (especially when poorly cared for) or painful. The nursing management of patients with venous leg ulcers Recommendations 30 10.0 Drug treatments 10.4 There is no evidence that aspirin increases the healing of venous leg ulcers. However, in a recent meta-analysis of six small studies, oral zinc had no beneficial effect in the treatment of venous ulcers.34, Bacterial colonization and superimposed bacterial infections are common in venous ulcers and contribute to poor wound healing. This causes blood to collect and pool in the vein, leading to swelling in the lower leg. This prevents overdistention and quickly empties the superficial and tibial veins, which reduces tissue swelling and boosts venous return. Further evaluation with biopsy or referral to a subspecialist is warranted if ulcer healing stalls or the ulcer has an atypical appearance. See permissionsforcopyrightquestions and/or permission requests. Granulation tissue and fibrin are typically present in the ulcer base. Nursing Diagnosis: Risk for Infection related to poor circulation and oxygen delivery and ischemia secondary to venous pressure ulcers. Slough with granulation tissue comprises the base of the wound, with moderate to heavy exudate. It can related to the age as well as the body surface of the . Nursing Diagnosis: Impaired Peripheral Tissue Perfusion related to deficient knowledge of risk factors secondary to venous stasis ulcers as evidenced by edema, decreased peripheral pulses, capillary refill time > 3 seconds, and altered skin characteristics. Make careful to perform range-of-motion exercises if the client is bedridden. Venous ulcers are believed to account for approximately 70% to 90% of chronic leg ulcers. Buy on Amazon, Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2020). However, there are few high-quality studies that directly evaluate the effect of debridement versus no debridement or the superiority of one type of debridement on the rate of venous ulcer healing.3640 In addition, most wounds with significant necrotic tissue should be evaluated for arterial insufficiency because purely venous ulcers rarely need much debridement. The disease has shown a worldwide rising incidence as the worlds population ages. As an Amazon Associate I earn from qualifying purchases. Unless the client is immunocompromised or diabetic, a fever is defined as a temperature above 100.4 degrees F (38 degrees C), which indicates the presence of an illness. Risk Factors Trauma Thrombosis Inflammation Embolism Treatment options for venous ulcers include conservative management, mechanical treatment, medications, and surgical options (Table 2).1,2,7,10,19,2244 In general, the goals of treatment are to reduce edema, improve ulcer healing, and prevent recurrence. Color duplex ultrasonography is recommended to assess for deep and superficial venous reflux and obstruction. Teach the caretaker how to properly care for the afflicted regions of the wounds if the patient is to be discharged. In a small study, patients receiving simvastatin (Zocor), 40 mg once daily, had a higher rate of ulcer healing than matched patients given placebo.42, Phlebotonics. Evidence-based treatment options for venous ulcers include leg elevation, compression therapy, dressings, pentoxifylline, and aspirin therapy. These actions are intended to improve overall muscle tone and strength, as well as boost venous return from the lower extremities and decrease venous stasis. Leg ulcer may be of a mixed arteriovenous origin. These are most common in your legs and feet as you age and happen because the valves in your leg veins can't do their job properly. Intermittent Pneumatic Compression. There is no evidence that collagenase is superior to sharp debridement.23 Larval therapy using maggots is an effective method of debridement with added potential for disinfection, stimulation of healing, and biofilm inhibition and eradication.24,25 Potential barriers to larval debridement include patient acceptability and pain.26,27 Autolytic debridement uses moisture-retentive dressings and may be used in addition to other forms of debridement. An example of data being processed may be a unique identifier stored in a cookie. For patients who have difficulty donning the stockings, use of layered (additive) compression stockings; stockings with a Velcro or zippered closure; or donning aids, such as a donning butler (Figure 4), may be helpful.33, Intermittent Pneumatic Compression. 1 The incidence of venous ulceration increases with age, and women are three times more likely than men to develop venous leg ulcers. Human skin grafting may be used for patients with large or refractory venous ulcers. Inelastic compression wraps, most commonly zinc oxideimpregnated Unna boots, provide high compression only during ambulation and muscle contraction. Aspirin. On physical examination, venous ulcers are generally irregular, shallow, and located over bony prominences.