venous insufficiency wounds Flashcards
Location of venous insufficiency wounds
above the malleoli in distal 1/3 of the lower leg
Medial more commonly than lateral
if outside this area may be mixed etiology or underlying etiology
surrounding skin of venous insufficiency wounds
hyperpigmentation- hemosiderin staining
Lipodermatosclerosis
scarring of the skin and fat (fibrin deposition)
Results in thickened hard immobile skin
Can cause champagne bottle leg
Wound characteristics for venous insufficiency
uneven edges, diffuse or rolled shallow wound bed
Highly exudated, primarily serous
Not painful
periwound characteristics of venous insufficiency
maceration is common
Diffuse edges
Irritation
compression
comfort, cosmesis, tolerance
frequency - change at home
can compress over most wound dressings
condition of skin
ambulation
congestive heart failure or renal failure?
LaPlaces law
compression= tension x # of layers x 4630/ limb girth circumference x bandage width
adjustments to compression amount
Increase or decreased tension
Increase or decrease number of by technique
Smaller girth = increased compression, progressively less compression moving up normal shaped conical LE
bandage width- small= higher compression
early signs of CBI without ulceration prophylaxis for high risk factors- indications for amount of pressure at the ankle
15 to 20 mmHg
20 to 30 mmHg amount of pressure at the ankle, indications for use
signs of CVI without ulceration
post sclerotherapy
Prophylaxis for high-risk factors
Post healing with inability to don/doff or tolerate higher compression
Mild lymphedema
30-40 mmHg ankle pressure indications
post ulceration
Pronounced varicose disease
Moderate lymphedema
Post traumatic edema
Burn scar management
40-60 mmHg indications
severe lymphedema
Severe CVI with Venous wounds and no arterial disease
60+ mmHg indications
severe lymphedema
Elephantiasis
Severe post-thrombotic disease
tube-like tubigrip
least compression
Inexpensive easy to apply remove reusable comfortable
Generally considered light compression can be doubled and stretches out out with repeated use
Conservative trial to determine compression tolerance
Variation in compression - typically 10 to 12 mmHg
long stretch
ACE wrap
always wants to return to its resting state
Provides high-pressure at rest and low pressure with activity
(low active pressure)
Goal is to move fluid into the deep venous system
indication -component of multi layer compression for CVI
Contraindication - ABI <0.8, vasculitis, lymphedema
short stretch bandages
Can be used for most patients with arterial insufficiency unless compression is contraindicated and ABI <0.5
great for mixed venous and arterial insufficiency ulcers
Provides a high-pressure with activity and low pressure at rest
great use in collaboration with ambulation program
Goal is to decrease filtration and increase reabsorption and transportation of lymphatic fluid
Short stretch bandages, indications, and contraindications
indications- lymphedema, lipidemia, CVI with arterial compromise (0.5-0.8), traumatic edema, post surgical swelling
Contraindications - ABI<0.5, insensate extremity, uncompensated, congested heart failure, untreated cellulitis
inelastic
oxide paste and gauze boots - unna boot
Applied with only enough tension to hold in place
no specific technique
2 to 3 layers over entire LE then a secondary wrap (coban)
Disadvantage is the inability to contract as extremity becomes smaller, thus providing less pressure and allowing the leg to telescope inside the bandage
multi layer
2 to 4 layers
Can be used to achieve high compression 40-60 mmHg
worn and compressing at work and rest
More expensive more time for application and a single use
Padding for prominences
Less Telescoping
Up to one week
Requires skilled application
stockings
Venus insufficiency or support of vein health
replace around six months , 2 pair, hand wash, air dry
Custom versus OTC
Can be worn during wound closure after edema is resolved
not 100% effective at prevention or maintenance
Prescribe the lowest effective level for maintenance comfort application heat
garments
farrow wrap-foot piece and series of Velcro bands that function similar to short stretch bandages, easier to don/doff vs compression stockings
circ-aid- custom non-elastic Velcro bands for VI and lymphedema
Exercise for patients with venous insufficiency ulcers
gastro stretches to optimize ankle range of motion and facilitate calf muscle pump
Ankle pumps circumduction ABC’s rocker board
Heel raises, seated and standing
Step over step 3 to 4 obstacle using hill strike in front to push off in back
exaggerated sequence during walking
Walking biking aquatics
patient education for venous insufficiency
compression
avoid extended standing or sitting, crossing legs
elevation higher than heart level
care and replacement of compression stockings
healthy lifestyle
goals of pt for venous insufficiency
prevention-vascular screening plan for long-term compression
Treatment
Relieve pressure and congestion, manage and resolve edema
Care for open wounds
Compression
Adjust to lifelong issue
