Journal of Community Nursing - page 49

JCN
2013,Vol 27, No 4
49
WOUND CARE
By recognising early changes,
disease progression can be prevented or slowed...
...with a little bit of detective work.
CHROSS Checker
Figure 9.
The CHROSS Checker tool kit is available on request from Activa Healthcare.
Prevention
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
Spider veins
Mild varicose veins
Ankle flare
Mild hyperkeratosis
YES
Moderate varicose veins
Hyperpigmentation
Venous dermatitis
Varicose eczema
NO
Activa
®
British Standard hosiery
Class 2 (18–24mmHg)
or
Class 3 (25–35mmHg)
Atrophie blanche
Induration
Severe varicose veins
Moderate hyperkeratosis
Healed ulcer*
YES
ActiLymph
®
European class hosiery

Class 2 (23–32mmHg)
or
Class 3 (34–46mmHg)
Recurring ulcer/open ulcer*/**
Cellulitis***
Chronic oedema
YES
ActiLymph
®
European class hosiery
Class 3 (23–32mmHg)
or
Class 3 (34–46mmHg)
Made to Measure
Lymphorrhoea (wet legs)
Severe hyperkeratosis
Skin folds
Papillomatosis
Lymphangiomata
Lipodermatosclerosis
(acute or chronic)
NO
Activa
®
British Standard hosiery
Class 3 (25–35mmHg)
or
Class 3 (25–35mmHg)
Made to Measure
Figure 8.
The three steps to using the CHROSS Checker chart to get a hosiery recommendation for a patient with ankle flare and no oedema.
Activa
®
British Standard hosiery
Mild:
Class 1 (14–17mmHg)
or
Moderate:
Class 2 (18–24mmHg)
ActiLymph
®
European class hosiery
✝✝
Mild:
Class 1 (18–21mmHg)
or
Moderate:
Class 2 (23–32mmHg)
and colours available to help with
patient concordance (Bianchi and
Timmons, 2008).
If oedema is diagnosed, European
Class hosiery garments can be used
to prevent recurrence or deterioration,
once limb volume has been reduced
using bandaging.The action of
European Class garments is more likely
to encourage lymphatic movement
and reabsorption of the lymph in the
vessels and contain oedema, due to
their having greater stiffness that comes
from the yarns and the knitting process
used during manufacture (Bianchi and
Timmons, 2008). Patients with limbs
that are severely swollen may not fit
into standard hoisery sizes and will
require made to measure garments.
These are usually constructed using
thicker and firmer material that helps
to effectively contain the limb.
For all patients with venous or
lymphovenous disease, compression
should be used as part of an overall
treatment plan which, depending on
the underlying medical condition and
skin changes present, may consist of
medical management, skin and wound
care, exercise, manual lymphatic
drainage (MLD) and patient education.
CONCLUSION
The CHROSS Checker tool kit (
Figure
9
) provides a quick and easy way to
evaluate skin changes as part of holistic
ati nt a sessment, and provides
clear guidance on the selection of
compression products to delay disease
progression in patients with venous
and lymphovenous dysfunction.
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