Looking after your health. 3. Avoiding varicose veins.

This article is to summarise key concepts for the health of the midwife with particular focus on standing for prolonged periods. One of the resultant factors relating to standing postures is the slow but avoidable progression of varicose veins. There is a strong genetic bias to these veins, which can be distressing, but here we will highlight awareness and current research.

A thematic analysis of experiences of varicose veins and minimally invasive surgery under local anaesthesia.

AIMS AND OBJECTIVES: To gain insight into the experience of living with varicose veins and undergoing minimally invasive surgery under local anaesthesia in a private clinic. BACKGROUND: Minimally invasive surgery under local anaesthesia is replacing traditional surgical stripping for the treatment for varicose veins. Conscious surgery has previously been associated with elevated levels of anxiety and some associated pain. There is limited research exploring the experiences of patients undergoing varicose vein surgery under local anaesthesia. DESIGN: Qualitative semi-structured interviews with 20 patients who took part in a mixed methods study exploring the effects of distraction on intra-operative pain and anxiety. METHODS: Participants were interviewed eight weeks post surgery about their experiences before, during and after surgery. Interviews were analysed using thematic analysis. RESULTS: Four themes were captured (1) negative emotions associated with symptoms, (2) unpreparedness for the surgical process, (3) feeling cared for and (4) improvements in well-being. An overarching theme of relationships was identified. Overall, varicose veins had a detrimental impact on quality of life prior to surgery. Patients felt unprepared for their procedure and experienced the operation as anxiety provoking and uncomfortable. This was much helped by the support of nursing staff in the theatre. Post surgery, patients' quality of life was reported as improved. CONCLUSIONS: More emphasis needs to be placed on preparing patients for surgery under local anaesthesia. The role of the nurse is central to creating a caring, relaxed environment which could improve patient experience. RELEVANCE TO CLINICAL PRACTICE: Patients' experiences of varicose veins and their treatment both influence, and are influenced by relationships with others at all stages of the management process. Nurses play an important role in improving patient experience during surgery and care needs to be taken to ensure that patients understand and accept the processes of surgery and recovery.

[Setting up situated learning in vascular rehabilitation]. / Mise en place de situations apprenantes en rééducation vasculaire.

A pedagogical tool as well as a concept, situated learning describes the skills used in a situation in a given context, structuring the reflection, analysis and choice of nursing procedures, based on theoretical knowledge, know-how and interpersonal skills. A vascular rehabilitation team has chosen to formalise two situations from among the most common care procedures carried out in the department: the changing of complex dressings and ensuring the personal hygiene and comfort of a dependent patient with skin wounds.

Varicose veins: diagnosis and management.

Varicose veins affect up to one-third of the UK population. Many health professionals are therefore likely to come into contact with patients who have venous disease and need to understand how to assess, manage and treat this condition. This article discusses the updated guidelines from the National Institute for Health and Care Excellence on how health professionals can best treat patients who present with varicose veins.

Varicose vein surgery performed by a surgical care practitioner.

A surgical care practitioner (SCP) completed a structured training programme to perform all aspects of varicose vein surgery including sapheno-femoral disconnection and long saphenous vein stripping. Over a four-year period, she performed 152 groin procedures, closed 191 groin wounds and undertook phlebectomies on 91 legs with excellent results. A SCP can be used to improve theatre utilization and efficiency with no obvious drawbacks.

Management of dry skin conditions in older people.

This article examines the physiological changes that occur in the skin with advancing age that make it more prone to skin problems. Examples of common skin disorders that may affect older people are provided. Intrinsic factors such as a genetic tendency to eczema, and extrinsic factors such as the effects of sun damage and general poor health can both affect the skin of older people. The management of dry skin conditions in this age group is investigated and the value of emollient therapy, involving the use of bath emollients, soap substitutes and leave-on emollient lotions, creams or ointments, is discussed.

Conservative management of varicose veins.

Varicose veins occur in approximately 15-20 per cent of the UK population (Callam, 1994). Although there is no universally accepted definition of a varicose vein, Callam (1999) has described it as 'a superficial vein of the lower limb, which has permanently lost its valvular efficiency and, because of the resultant venous hypertension caused by the standing position, becomes dilated, tortuous and thickened'.

Single-blind trial addressing the differential effects of two reflexology techniques versus rest, on ankle and foot oedema in late pregnancy.

This single-blind randomised controlled trial explored the differential effects of two different foot reflexology techniques with a period of rest on oedema-relieving effects and symptom relief in healthy pregnant women with foot oedema. Fifty-five women in the third trimester were randomly assigned to one of the three groups: a period of rest, 'relaxing' reflexology techniques or a specific 'lymphatic' reflexology technique for 15 min with pre- and post-therapy ankle and foot circumference measurements and participant questionnaire. There was no statistically significant difference in the circumference measurements between the three groups; however, the lymphatic technique reflexology group mean circumference measurements were all decreased. A significant reduction in the women's symptom mean measurements in all groups (p<0.0001) was apparent. A 'perceived wellbeing' score revealed the lymphatic technique group (p<0.0001) significantly increased their wellbeing the most, followed closely by relaxing techniques (p<0.001) and then the control rest group (p<0.03). Lymphatic reflexology techniques, relaxing reflexology techniques and a period of rest had a non-significant oedema-relieving effect. From the women's viewpoint, lymphatic reflexology was the preferred therapy with significant increase in symptom relief.

Treating varicose veins with transilluminated powered phlebectomy.

In the past, patients endured hours of surgery, many incisions, and multiple scars to manually remove painful, unsightly, swollen varicose veins. Patients now have a new treatment option. Endoscopic resection and ablation of superficial varicosities is possible using a powered vein resector, irrigated illuminator, and tumescent anesthesia. This article describes this new technique, called transilluminated powered phlebectomy, and explains how the procedure reduces the number of incisions and provides direct visualization of the veins as they are resected.

[Clinical evaluation of a hydro-cellular dressing for the treatment of venous leg ulcers]. / Evaluación clínica de un apósito hidrocelular en el tratamiento de úlceras venosas de pierna.

INTRODUCTION: Varicose ulcers (UV) are a serious health problem which produce tremendous pain for those who suffer from them; furthermore, they consume a large amount of health care system resources. Hydro-cellular dressings provide a moist environment cure option as a local treatment of varicose ulcers. MATERIALS AND METHODS: With the purpose of evaluating the use of an Allevyn non-adhesive hydro-cellular dressing under real clinical conditions, an open, observational multi-centric study was carried out. The study group was composed of outpatient care patients or patients hospitalized due to having varicose vein ulcers or having a mixed etiology with an ankle/arm index less than or equal to 0.8. MAIN RESULTS: 24 patients were initially part of this study; two of these abandoned this study group without a justified reason. Of the 22 who finished this study, 16 or 72.7% were women while 6 or 27.3% were men. The mean age in the women patients was 73.07 +/- 9.31 (DS), while among the men patients, the mean age was 67.23 +/- 18.17 (DS). 17 or 77.3% of the ulcers studied were varicose, 1 or 4.5% had a mixed etiology, 1 or 4.5% was due to amputation, and in three cases, the kind of ulcer was not specified. 22 patients finished this study with their lesions healed or in the process of healing; 2 abandoned this study without justification. The patient study group passed from an average initial sore area (IC 95%) or 9.41 or 19.42 cm2 to a final average sore area (IC 95%) of 4.45 or 10.5 cm2 with a mean percent reduction of (IC 95%) 57.22 or 86.22%. In 7 cases or 31.8% of the patients, their lesions healed completely during the course of the study. Inside the group of patients whose lesion did not fully heal during this study, the average initial sore area (IC 95%) was 15.66 +/- 12.75 cm2, a mean of 8.6 or 22.2 cm2 and the medium equaled 9 cm2. The information regarding comfort, absorption quality, ease in application and removal, and its fine results in the presence of pain and in the creation of new lesions once the dressing has been removed as well as the absolute lack of adverse reactions indicates we have discovered an excellent therapeutic option.

Caput medusae: peristomal varices.

Peristomal varices are a manifestation of severe liver disease and portal hypertension. Unfortunately, they may bleed profusely, usually as a result of pressure from a hard faceplate on the appliance or denudation from leakage of stomal output. This article provides a case study, followed by a review of the causes, the medical management, and surgical management of this condition. Some implications for ET nurses are also given.