Venous Wounds Flashcards
More valves in the veins are found where?
Distal extremities
Why are their more wounds distally than proximally?
Fighting harder against gravity in the distal limb
Muscular help for blood flow more proximally
What are the causes of venous insufficiency?
Reflux/Retrograde blood flow
Obstruction
Inadequate venous pump
What are the risk factors for venous insufficiency?
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
What are some characteristics of Venous wounds?
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
What is the clinical incidence of venous insufficiency ulcers?
80-90% of all ulcers
What are some characteristics of venous insufficiency ulcers?
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
What are some characteristics of venous insufficiency ulcers as far as LOCATION?
Lower 1/3 of leg (gaitor area)
What are some characteristics of venous insufficiency ulcers as far as PAIN?
Heavy, achy feeling
Pain with infection or vasculitis
What are some characteristics of venous insufficiency ulcers as far as SKIN?
Hemosiderin staining
Atrophie blanche (white)
Lipodermatosclerosis (fat scarring)
What are some characteristics of venous insufficiency ulcers as far as WOUND APPEARANCE?
Red or pink, poor granulation quality
Yellow slough
Bark-like texture
What are some characteristics of venous insufficiency ulcers as far as EXUDATE?
Minimal to copious serous drainage
Thick and odorous if infected
What do venous wounds look like?
Uneven edges
Shallow
Fibrotic or granular wound base
- Granulation tissue not typical texture
Little if any eschar (too moist)
“Weepy” serous drainage
Pitting edema scaling
Graded based on the amount of time it takes to get the indentations to recede
Typical should be 1-4 seconds
What is required of the clinician to make a correct diagnosis?
Thorough medical history
Vascular screening (ABI)
Wound assessment
Ankle ROM and strength
Gait assessment
What tests are used to identify venous insufficiency?
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)
What are the characteristics of the Brodie-Trendelenburg test?
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)
How do you try to prevent venous wounds?
Compression (Long-term)
LE elevation
Exercise to activate venous pump
Avoid prolonged sitting or standing
Avoid crossing legs
What do you do for venous stasis?
WOUND MANAGEMENT GOAL: Decrease edema and promote normal perfusion in the tissues
TECHNIQUE: Apply compression
OPTIONS: UNNA, Profore (Multiple Layer Compression Dressing)
What are UNNA boots?
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
What are the ADVANTAGES of UNNA boots?
Protection against trauma
“Minimal interference” with daily activities
What are the DISADVANTAGES of UNNA boots?
Long periods of pressure
Not suitable for wounds with large amounts of exudate
What are maintenance tips for people using UNNA boots?
Change every 3-7 days
2-4 layer wrap
What are the classes of compression hose and what are the characteristics of each class?
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!!!
What are the evidence-based standard care for venous wounds?
Antibiotics if indicated
Debridement
Absorbent wound dressings for exudate
Compression
Exercise
- Activates venous pump
- Increase ankle ROM
- Gait training to emphasize heel/toe sequence
