Lower limb ulceration is a common, debilitating and costly condition that accounts for over one third of chronic wounds in the UK. The most common underlying causes of leg and foot ulceration are venous insufficiency, arterial insufficiency, lymphoedema and diabetic neuropathy. More than half of leg ulcers do not have a recorded diagnosis and are unlikely to receive appropriate care. Poor care can cost up to ten times as much as appropriate care. The Legs Matter campaign aims to change this situation through a public health campaign supported by a website: http://legsmatter.org. The website provides clearly written, easily accessible information for patients, the public and generalist healthcare professionals along with signposts to reputable sources of information. In this way, the campaign aims to raise awareness that leg and foot conditions can be improved with the right care.
The second in this four-part series exploring leg ulcer management and understanding compression therapy examines the role of assessment as the basis for optimal clinical practice. The authors explore how the findings of thorough assessment can influence treatment choice. Adopting an holistic, person-centred approach to assessment, which includes taking an ankle brachial pressure index (ABPI) reading and involves the patient in decision-making will help nurses to make effective clinical decisions and plan care in partnership with patients. This article discusses a three-stage assessment and clinical decision-making process, which involves looking at the whole person, assessing the leg and the wound. The next article in the series will examine compression hosiery and adjustable wraps for the management of the lower limb.
Many of you may have experienced heavy, aching, tired legs when returning home from work. We tend to put this down to a long day and to some extent we are right. However, over time, these symptoms could be a clinical manifestation of a condition known as chronic venous hypertension...
The number of people with venous and/or lymphatic disorders who require long-term management of their condition with compression garments in a community setting is growing. Here, Professor Jackie Stephen-Haynes, professor and consultant nurse in Tissue Viability, Birmingham City University and Worcestershire Health and Care NHS Trust, outlines the problems that some patients and clinicians encounter as a result of delayed and/or inaccurate dispensing of garments, and asks if this is a problem that affects you in your practice.
Lower limb cellulitis is a common acute medical condition that results in a large number of hospital admissions (Clinical Resource Efficiency Support Team [CREST], 2005). It is a growing and costly problem. The NHS spends between £172–£254 million a year on inpatient treatment of people with lower leg cellulitis (Curtis, 2011). The clinical presentation of cellulitis is similar to other conditions and diagnostic errors are common and may prolong hospital stay (Nazarko, 2012). Community nurses are involved in caring for people at risk of cellulitis and are often responsible for referring on suspected cases and then continuing treatment upon discharge. It is essential that community nurses are aware of the evidence base for diagnosis, differential diagnosis, treatment and management, as well as the long-term prevention of cellulitis. This paper discusses the evidence base for treatment and prevention of cellulitis and presents a case study.
Compression is the key to management of lymphoedema and multilayer bandaging has been considered the gold standard. This article looks at adjustable Velcro compression devices as an alternative to multilayer bandaging. The author finds that the devices enable patients to maintain the required pressure in between consultations with healthcare professionals. They also allow for changes in limb volume and can help with concordance, as well as cutting down on the time clinicians need to spend with patients as the devices promote self-management.
Venous leg ulcers make up a considerable part of the community nurse’s workload and the gold standard treatment is multilayered compression bandaging applied to cleansed and debrided lower limbs. The author of this piece looks at the background to leg ulcer development; as well as how to assess patients and the principles of prevention. This article also examines the KTwo® bandaging system (Urgo Medical), which has a built-in pressure indicator to ensure that application is both consistent and effective. The make-up of the twolayer system makes it as effective as four-layer systems without the associated bulk, which means that patients find it easier to wear.
