Journal of Community Nursing - page 60

60 JCN
2013,Vol 27, No 4
WOUND CARE
C
ompression therapy is a
simple principle that, applied
correctly, can have important
beneficial effects. Compression can
either be applied by bandaging,
hosiery or hosiery kits and, if
used appropriately, can make a
fundamental contribution to the
long-term management of venous
leg ulceration, as well as having an
enormous effect on patients’ quality
of life (World Union of Wound
Healing Societies [WUWHS], 2008).
There are different compression
grades available, with German
RAL, French ASQUL and British
Standard being the recognised
independently tested compression
standards available in the UK. Higher
compression values are found to be
more effective in preventing ulcer
recurrence (Dowsett, 2011). However,
when patients are elderly and unable
to tolerate high compression, the
lower values of the British Standard
can be a useful resource.
Leg ulceration, of venous,
arterial and mixed aetiology, is a
significant problem in older people
The use of compression hosiery
in mixed aetiology ulceration and
palliative care
and, as this population grows
larger (Posnett and Franks, 2008),
it is vital that clinicians are familiar
with appropriate management
strategies. Similarly, oedema is a
common complication of many
conditions seen at the end of life,
where palliative compression may be
appropriate to help ease symptoms
(Dowsett, 2011).
This article looks at the causes
and symptoms of venous oedema
and ulceration, as well as highlighting
appropriate management strategies,
including an innovative type of
hosiery that provides graduated
compression in a patient-friendly
design, which can help clinicians
with long-term patient concordance
in elderly patients with existing co-
morbidities and end of life care.
VENOUS DISEASE
Chronic venous disease is a
common condition in elderly
people, which develops when
valves that normally allow blood
to travel back up to the heart from
the lower leg — simultaneously
preventing a back-flow of blood
into the lower limbs — become
weaker, usually through age. This
causes a build-up of fluid in the
lower limb, which if not managed
properly, can result in venous
stasis and venous hypertension
(Scottish Intercollegiate Guidelines
Network [SIGN], 2010). In turn, this
can result in subsequent venous
leg ulceration, as the blood flows
backwards and pools in the legs,
increasing pressure in the veins.
Initially, this can cause certain ‘mild’
problems, including (Eberhardt and
Raffeto, 2013):
Feelings of heaviness in the legs
Aching
Dilated or unsightly veins.
If left untreated, mild venous
disease can develop and the
patient can encounter more severe
problems, including (Eberhardt and
Raffeto, 2013):
Swelling
Colour changes in the skin
Dermatological symptoms, such
as varicose eczema and recurrent
skin infections
Chronic ulcers.
The UK has an expanding elderly population, which means that in
the future nurses and clinicians who work in community-based units,
such as nursing homes and hospices, will increasingly encounter
age-related conditions such as palliative oedema and mixed aetiology
ulceration. This article looks at duomed soft
®
, (medi UK, Hereford) a
new hosiery solution, which is not only easy to apply, making patient
self-care more likely, but also provides consistent mild compression in
a format that is more cosmetically acceptable to patients.
KEYWORDS:
Mixed aetiology ulceration
Palliative care
Compression hosiery
‘Compression is a simple
principle that, if applied
correctly, can have important
beneficial effects.’
Helen Butterfield, Leg Ulcer/Dermatology
Specialist Nurse, Oxford
Helen Butterfield
An understanding of leg
ulceration, oedema and how
compression therapy can help
patients is particularly important
in the community, where elderly
patients may be isolated, lack
support and find it difficult to access
healthcare services.
It is also crucial that community
clinicians understand the
psychosocial element of compression
therapy, where patients may find
it difficult to adhere to long-term
treatment due to the commitment
involved in bandaging regimens,
as well as cosmetic considerations
(Williams, 2010; Anderson, 2013).
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