Journal of Community Nursing - page 44

44
JCN
2013,Vol 27, No 4
WOUND CARE
Figure 1.
Chronic Oedema Signs and Symptoms (CHROSS) Checker chart.
The CHROSS checker
It is important to check for the signs and symptoms of venous and lymphovenous disease, which are listed in the chart below,
as part of a full, holistic assessment.
1. The chart should be used as a prompt to check for skin and limb changes as part of holistic patient assessment.
2. The compression products recommended should be used as part of an overall management plan, which includes medical
management of underlying disease(s), skin and wound care, and patient education.
3. Vascular status must be determined before applying compression. If in doubt, do not use and refer for specialist advice.
4. If no ticks are recorded, the limb is healthy and no action is needed, other than a good skin care regimen.
5. Intensive bandaging to reduce limb volume may be required before hosiery can be effectively used.
6. For more information on the signs/symptoms listed below, including photos and description, refer to the accompanying key cards.
Patient name
Date:
Prevention
3
1
2
3
Tick the box below if the sign/
symptom is reported by, or present
on the limb of, the patient
Is oedema also present? Tick
yes or no (in the colour band
of the lowest tick in step 1)
Consider application of the
compression below, depending on
disease severity (mild, moderate or
severe) as part of management
Tired, aching, heavy legs
NO
Activa
®
British Standard hosiery
Mild:
Class 1 (14–17mmHg)
or
Moderate:
Class 2 (18–24mmHg)
Spider veins
Mild varicose veins
Ankle flare
Mild hyperkeratosis
YES
ActiLymph
®
European class hosiery
✝✝
Mild:
Class 1 (18–21mmHg)
or
Moderate
:
Class 2 (23–32mmHg)
Moderate varicose veins
Hyperpigmentation
Venous dermatitis
Varicose eczema
NO
Activa
®
British Standard hosiery
Moderate:
Class 2 (18–24mmHg)
or
Severe:
Class 3 (25–35mmHg)
or
Activa
®
Leg Ulcer Hosiery Kit
Atrophie blanche
Induration
Severe varicose veins
Moderate hyperkeratosis
Healed ulcer*/**
YES
ActiLymph
®
European class hosiery
✝✝
Moderate:
Class 2 (23–32mmHg)
or
Severe:
Class 3 (34–46mmHg)
or
ActiLymph
®
Hosiery Kit
Recurring ulcer/open ulcer*/**
Cellulitis***
Lipodermatosclerosis
(acute or chronic)
Activa
®
British Standard hosiery
Severe:
Class 3 (25–35mmHg)
Chronic oedema
ActiLymph
®
European class hosiery
✝✝
Moderate:
Class 2 (23–32mmHg)
or
Severe:
Class 3 (34–46mmHg)
or
ActiLymph
®
Hosiery Kit
Lymphorrhoea (wet legs)
Severe hyperkeratosis
Skin folds
Papillomatosis
Lymphangiomata
NO
YES
Intensive management
Early/medium
intervention
* Activa
®
Leg Ulcer Hosiery Kit (40mmHg)
**ActiLymph
®
Hosiery Kit
***Acute cellulitis should be treated before using compression
Once the correct class of hosiery has been selected for disease severity, If
limb measurements do not match stock sizes, use either Credalast
®
Velvet
Made to Measure hosiery
or ActiLymph
®
Made to Measure flat knit hosiery
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