Use of specialist knowledge and experience to manage patients with mixed aetiology leg ulcers.

OBJECTIVE: To discuss the role of the clinical nurse specialist in managing patients with ulceration caused by mixed venous arterial disease. METHOD: A small scale retrospective audit study of eight mixed aetiology patients drawn from the caseload of leg ulcer patients within a specialist leg ulcer service in Ayrshire, Scotland was conducted by two specialist nurses with over 8 years' experience in specialist leg ulcer management. Patients were individually assessed using Doppler ultrasound and a rigorous set of validated risk factor criteria. Where Doppler ultrasound was considered to be unreliable, due to an inability to detect sounds, or where further diagnostic information was required in order to safely plan care, arterial duplex scanning was carried out by the cardiac department at Ayr Hospital. All patients were treated with a cohesive inelastic compression bandage system and closely observed by the specialist nurse. RESULTS: All eight patients with mixed aetiology leg ulcers were reported to experience complete ulcer healing within 6-30 weeks after first application of the inelastic bandage system. The regimen was well tolerated by all patients and no adverse events were recorded. CONCLUSION: With accurate assessment and treatment by a specialist team, patients with mixed venous arterial disease were safely and successfully managed where they may have remained unhealed. DECLARATION OF INTEREST: This was an independent retrospective audit study conducted by two clinical nurse specialists, with educational support by Activa Healthcare to assist in bringing it to print.