Venous Wounds

Question 1

More valves in the veins are found where?

Answer 1

Distal extremities

Question 2

Why are their more wounds distally than proximally?

Answer 2

Fighting harder against gravity in the distal limb

Muscular help for blood flow more proximally

Question 3

What are the causes of venous insufficiency?

Answer 3

Reflux/Retrograde blood flow

Obstruction

Inadequate venous pump

Question 4

What are the risk factors for venous insufficiency?

Answer 4

Varicose Veins

DVT

Previous vein surgery

Multiple pregnancies

CHF

CABG w/ saphenous vein harvesting

Hip, knee, or anke trauma

Ankle immobility

Prolonged standing

Family history

Age > 50

Obesity

Question 5

What are some characteristics of Venous wounds?

Answer 5

LOCATION: Lower 1/3 of leg (gaitor area)

TISSUE: Red or pink, bark texture, yellow slough, poor granulation

PAIN: generally not unless vasculitic

SKIN: Hemosiderous (dark brawny appearance), atrophie blanche

EXUDATE: varies, may have copious serous drainage

Question 6

What is the clinical incidence of venous insufficiency ulcers?

Answer 6

80-90% of all ulcers

Question 7

What are some characteristics of venous insufficiency ulcers?

Answer 7

Swelling in extremity when in dependent position

Pitting edema

Discomfort when in dependent position

Skin typically purple or brown, hue due to hemosiderin staining

Pulses normal, but they may be difficult to palpate due to swelling

Ulcers usually proximal to malleolus (usually medial) with irregular margins

Inverted champagne bottle-shaped LE

Question 8

What are some characteristics of venous insufficiency ulcers as far as LOCATION?

Answer 8

Lower 1/3 of leg (gaitor area)

Question 9

What are some characteristics of venous insufficiency ulcers as far as PAIN?

Answer 9

Heavy, achy feeling

Pain with infection or vasculitis

Question 10

What are some characteristics of venous insufficiency ulcers as far as SKIN?

Answer 10

Hemosiderin staining

Atrophie blanche (white)

Lipodermatosclerosis (fat scarring)

Question 11

What are some characteristics of venous insufficiency ulcers as far as WOUND APPEARANCE?

Answer 11

Red or pink, poor granulation quality

Yellow slough

Bark-like texture

Question 12

What are some characteristics of venous insufficiency ulcers as far as EXUDATE?

Answer 12

Minimal to copious serous drainage

Thick and odorous if infected

Question 13

What do venous wounds look like?

Answer 13

Uneven edges

Shallow

Fibrotic or granular wound base
- Granulation tissue not typical texture

Little if any eschar (too moist)

“Weepy” serous drainage

Question 14

Pitting edema scaling

Answer 14

Graded based on the amount of time it takes to get the indentations to recede

Typical should be 1-4 seconds

Question 15

What is required of the clinician to make a correct diagnosis?

Answer 15

Thorough medical history

Vascular screening (ABI)

Wound assessment

Ankle ROM and strength

Gait assessment

Question 16

What tests are used to identify venous insufficiency?

Answer 16

Doppler for incompetent valves

Duplex ultrasound for DVT

Trendelenburg test

Pitting edema

(Clinical Assessment Guide for DVT-clinical prediction guideline)

(Homan’s test for DVT)

(US and venograms can be used to test for DVTs which are common with venous insufficiency)

Question 17

What are the characteristics of the Brodie-Trendelenburg test?

Answer 17

Used to determine site of vascular incompetence in pt with varicose veins

Pt lies down and elevates leg

Using tourniquet, occlude the superficial vein in the upper thigh

Patient then stands

If tourniquet prevents veins from re-filling rapidly, site of incompetent valve must be above this level (sapheo-femoral junction. If veins re-fill, communication must be lower down)

Question 18

How do you try to prevent venous wounds?

Answer 18

Compression (Long-term)

LE elevation

Exercise to activate venous pump

Avoid prolonged sitting or standing

Avoid crossing legs

Question 19

What do you do for venous stasis?

Answer 19

WOUND MANAGEMENT GOAL: Decrease edema and promote normal perfusion in the tissues

TECHNIQUE: Apply compression

OPTIONS: UNNA, Profore (Multiple Layer Compression Dressing)

Question 20

What are UNNA boots?

Answer 20

Non-elastic bandages impregnated with mix of zinc oxide and calamine that provide higher amounts of compression during muscle contraction (walking) and smaller pressure at rest

Question 21

What are the ADVANTAGES of UNNA boots?

Answer 21

Protection against trauma

“Minimal interference” with daily activities

Question 22

What are the DISADVANTAGES of UNNA boots?

Answer 22

Long periods of pressure

Not suitable for wounds with large amounts of exudate

Question 23

What are maintenance tips for people using UNNA boots?

Answer 23

Change every 3-7 days

2-4 layer wrap

Question 24

What are the classes of compression hose and what are the characteristics of each class?

Answer 24

CLASS 1:

• 20 to 30 mm Hg pressure
• Used for venous disease with skin changes

CLASS 2:

• 30 to 40 mm Hg pressure
• Used for hx of ulceration or severe skin changes

CLASS 3:

• 40 to 50 mm Hg pressure
• Used for lymphedema, pts with re-ulcerate w/ class 2, pts who work standing (hair stylists)

CLASS 4:

• > 60 mm Hg pressure
• TED HOSE USED FOR DVT PROPHYLAXIS ARE NOT SUFFICIENT FOR TX OF CVI!!!

Question 25

What are the evidence-based standard care for venous wounds?

Answer 25

Antibiotics if indicated

Debridement

Absorbent wound dressings for exudate

Compression

Exercise

• Activates venous pump
• Increase ankle ROM
• Gait training to emphasize heel/toe sequence