Decision-making on the use of compression hosiery and compression bandaging: a systematic review.

This systematic literature review was carried out by a final-year nursing student in response to clinical experience, and to understand the rationale and evidence around managing venous ulcers. In the student's clinical experience, the two most commonly used treatment methods were forms of compression hosiery and compression bandaging. The CINAHL, Science Direct, Cochrane Library, Internurse and MEDLINE databases were searched for literature published over the period 2003-2023. From the resulting five papers, five key themes were identified: types of compression systems used and the rationale for decision-making; clinical effectiveness; the impact on patient experience and quality of life; pain levels following application of compression systems; and cost effectiveness. Conclusion: Management and prevention of venous ulceration is complex. The decisions should be made in partnership with the patient and will be influenced by context. Overall, compression hosiery was identified as the more favourable system.

Consistency of wound care in Leg Clubs.

Mr B had lost his wife of 65 years and was distraught, but he tried to move on with life. However, while playing football he injured his leg, which then developed into a venous ulcer that was to last for many years. Unfortunately, his care was inconsistent, and the wound was not progressing. He found the local Leg Club and decided to self-refer. He not only went on to achieve wound closure rapidly, but he found a social atmosphere in the club, made friends and learned how to prevent the wound from recurring. He felt that consistency of care was the reason for the rapid progress.

Managing venous leg ulceration: variance and variety.

Frameworks of care have been developed to enhance and standardise care for those with venous leg ulcers. Community nurses are faced with an array of frameworks and guidance documents on which to base their care. This article outlines and discusses variations in the information provided within the body of evidence relating to the care of venous leg ulcers. It is based on the findings of ongoing study for a PhD thesis.

Nurse-led patient education for persons suffering from a venous leg ulcer in outpatient's clinics and homecare settings: A scoping review.

AIM OF THIS STUDY: To provide an overview of the available nurse-led individualized educational interventions, for persons with Venous Leg Ulcer (VLUs) in an outpatient or homecare settings. MATERIALS AND METHODS: For this scoping review, a search was performed between December 2019 and January 2020. To identify sources of evidence a systematic search was conducted in PubMed, CINAHL, Embase, PsychINFO, Web of Science and LiSSa as well as in clinical trial registers to identify sources of evidence. All types of evidence associated with a nurse led-intervention were included. RESULTS: Fifteen sources of evidence met the inclusion criteria. Educational sessions varied in modality, content and duration. Education sessions were face to face and supported by written materiel. The content focused on compression therapy and exercises. The duration and numbers of sessions varied. The most reported health related outcomes was wound healing. CONCLUSION: This scoping review provides a broad overview of the available evidence and ongoing research for individualized nurse-led education persons with VLUs. Variability in the literature was found, which suggests that more intervention studies are needed to test and evaluate efficacy of nurse-led patient education.

Why nurses in primary care need to be research active: the case of venous leg ulceration.

Venous leg ulceration (VLU) is predominantly managed in primary care by district nurses, however much of the research takes place in secondary care. This study aimed to identify to what extent nurses are involved in publishing VLU research and to ascertain how much VLU research is conducted in primary care. Three searches of literature published between 2015 and 2020 were undertaken, reviewing VLU publications on interventions, quality of life and qualitative research. Some 37% of intervention studies had one or more nurse authors, compared with 65% of quality of life studies and 86% of qualitative research publications. Of papers that providing details of recruitment, 39% of intervention and quality of life studies included primary care as a recruitment setting. Qualitative studies were more likely to recruit from primary as well as secondary care (50%). Nurses are involved in leading VLU research but are more likely to publish quality of life and qualitative research than intervention studies. The majority of nurse authors in this field are based in academic institutions. A minority of studies utilise primary care as a recruitment setting for VLU research. More must be done to enable VLU research in community settings and to promote the involvement of clinical nurses in research.

An audience survey of practice relating to pain in the management of chronic venous leg ulcers.

Venous leg ulcers (VLU) respond well to compression, yet many ulcers remain unhealed after 1 year. Practitioners could be reluctant to apply compression to patients with significant ulcer pain. This study aimed to capture the views of practitioners on compression therapy for patients with painful VLU. A survey was conducted at a UK meeting in 2019 using handheld voting pads to capture the anonymous responses to four questions to which a mean of 90 practitioners responded. Nearly 40% of practitioners treat six or more patients a day with painful lower-limb ulcers. Some 80% felt confident in managing patients with painful ulcers; yet, most practitioners suggested they would refer onward for pain management. Some 40% would omit or reduce compression therapy as a pain management strategy. This survey supports the need for technological solutions that reduce VLU pain so that patients receive effective compression therapy.

Randomised controlled trials as part of clinical care: A seven-step routinisation framework proposal.

Evidence translation in wound care relies on the need for evidence generation. Clinical practice may generate evidence only if evidence-generating research projects, such as randomised controlled trials (RCTs), became routinised in clinical settings. The aim of this study was to identify optimal trial-related practices to routinise trial-related activities in Melbourne-located wound clinics as reported by clinicians and researchers. We conducted a secondary analysis of the available data on how to routinise RCTs in clinical care, with a focus on enablers and suggestions provided by the participants during face-to-face and telephone interviews. Data were obtained from a qualitative observational study nested within a randomised, double-blinded, placebo-controlled trial on clinical effectiveness of aspirin as an adjunct to compression therapy in healing chronic venous leg ulcers (ASPiVLU). We developed a seven-step Routinisation of Trials in Clinical Care Framework. These steps include: (1) pre-trial clinical site assessment, (2) optimising pre-recruitment arrangements, (3) developing and updating trial-related skills, (4) embedding RCT recruitment as part of routine clinical care, (5) promoting teamwork and trial-related collaboration, (6) addressing trial-related financial issues, and (7) communicating trial results to clinicians.

Interface pressures with compression systems: relevance to clinical practice.

Interface pressures with compression depend on many factors relating to the science of measurement and intrinsic, patient-related factors, including limb size and tissue texture. While it is important for manufacturers of compression devices to measure pressures, it may not always be relevant to clinical practice where application methods and oedematous limbs may affect final pressures. Accurate performance of any compression system relies on the use of the right technology for the right condition and patient lifestyle. Correct application following training and in accordance with instructions for use may be adapted according to individual patient comfort and needs, including mobility, tissue texture and the stage of management. In order to provide treatment regimens that are safe, effective and well tolerated by patients, as well as being easy to apply and demonstrate sound economic practice, science needs to meet clinical practice. Patient reporting is an important for successful treatment, matching clinical effectiveness with patient acceptance during reassessment and monitoring.

ReadyWrap®: case studies in practice.

The cost that chronic wound care imposes on both patients and health services worldwide is well recognised. Most patients with venous leg ulcers require compression therapy over the long term, for both treatment as well as to prevent recurrence of these wounds. Caring for patients with chronic wounds makes up a large part of the workload for district and community nurses, and encouraging self-management among patients is a worthwhile effort to limit the costs and resources directed for this purpose. The present article describes the practical use of the ReadyWrap range of compression garments, which are available in various different styles, and aid patients, their families and carers in the self-management of venous leg ulcers. These products are designed with their long-term use in mind, and, as described in the case studies in this article, patients show good concordance to compression therapy involving ReadyWrap.

Embedding National Institute for Health and Care Excellence guidance into a leg ulcer pathway.

Research has shown that leg ulcers represent the largest category of wound type treated within the UK. Venous leg ulcers are often classified as chronic wounds with increased protease levels causing the wound to become suspended in the inflammatory stage, which leads to delayed healing. If treatment choices are not evidence-based and appropriate regimens are not instigated early on in the wound care journey, the cost to both the patient and the healthcare service is substantial. Recent guidance from the National Institute of Health and Care Excellence (NICE) recommends UrgoStart (Urgo Medical) for treating venous leg ulcers as an adjunct therapy to the gold standard of compression therapy. Correct treatment choices must be made by clinicians using up-to-date relevant wound care knowledge. Evidence-based treatment algorithms and pathways can assist with correct product and therapy placement, assisting decision-making to improve patient outcomes. The present article describes a patient-centred leg ulcer pathway that embeds NICE guidance.

Managing chronic, nonhealing wounds stalled in the inflammatory phase: a case series using a novel matrix therapy, CACIPLIQ20.

One of the biggest challenges faced by healthcare providers is the treatment of chronic, non-healing wounds. This paper reports for the first time in the UK the results of five case studies in which a novel regenerating matrix-based therapy, CACIPLIQ20, was used. CACIPLIQ20 is a heparan sulphate mimetic designed to replace the destroyed heparan sulphate in the extracellular matrix of wound cells. All five patients in this case series had chronic, non-healing ulcers that had not improved with conventional care. Treatment included two applications of CACIPLIQ20 per week, for a maximum of 12 weeks. Three of the five wounds healed completely, and the remaining two showed significant improvements in size and quality. The treatment was well tolerated by the patients and also led to a significant reduction in pain. Moreover, CACIPLIQ20 treatment was found to be highly cost-effective when compared to conventional care, with the potential to save healthcare systems significant resources. Further studies are needed to build a strong evidence base on the use of this product, but these preliminary findings are certainly promising.

Updated leg ulcer pathway: improving healing times and reducing costs.

Regardless of the amount of literature and evidence on leg ulcer management, there are still significant variations in treatment. Implementing a standardised leg ulcer pathway to ensure patients are appropriately and timely assessed could help reduce nursing time and overall costs, while improving healing outcomes and patients' quality of life. Such a pathway was introduced in Lincolnshire and Leicestershire, UK, to treat venous leg ulcers (VLUs). The results showed improved healing times, reduced costs and fewer nurse visits, among other findings.

[Evaluation of compression bandage application technique in patients with venous leg ulcers: A mixed methods observational study]. / Évaluation des techniques de pose des bandes de compression médicale chez les patients porteurs d'ulcères veineux : une étude observationnelle mixte.

Introduction: Treating venous leg ulcers involves replacing dressings and applying compression bandages (CB). The technique for applying these bandages set out in the best practice guidelines shows nurses how to achieve the required level of pressure. Considerable differences have been observed between these guidelines and the actual application of CB. Methodology: An observational study combining a quantitative and a qualitative component was conducted to analyze CB application and explore the elements taken into account by nurses when they perform this procedure. Results: For the 261 patients included in the study, 27% of CB were applied as described in the guidelines. The main difference was that the heel was not included in the bandage in 48% of patients. The freelance nurses interviewed reported taking patient views into account in order to encourage adherence. Discussion: The nursing knowledge identified from the nurse interviews was compared to Carper's "Patterns of Knowing" classification. It would seem that Carper's empirical knowledge is not the only "pattern of knowing" taken into consideration. Patient involvement in the choice of CB application technique, which could be likened to Carper's "esthetic knowledge," helps guide nursing practice.

A systematic review of qualitative research into people's experiences of living with venous leg ulcers.

AIM: To systematically identify, evaluate and synthesize qualitative research that examined the symptoms and health-related quality of life themes that are important from the perspective of patients with venous leg ulceration. BACKGROUND: Venous leg ulceration is a common chronic condition; the symptoms and associated treatments have a negative effect on health-related quality of life. Qualitative research methods can provide insight into the personal experiences of patients with venous leg ulceration. DESIGN: Qualitative evidence synthesis (using framework synthesis). DATA SOURCES: Multiple electronic databases including MEDLINE, EMBASE, PsycINFO and CINAHL were comprehensively searched from inception to November 2015. REVIEW METHODS: Systematic identification, quality assessment and synthesis of existing qualitative research were performed; framework synthesis was conducted on included studies. An inductive approach was used and emergent themes were identified. The final stage in the synthesis involved the development of new interpretations. RESULTS: Thirteen studies met the inclusion criteria; the overall quality of the included studies was good. Four overarching themes were identified; physical impact, psychological impact, social impact and treatment and, in these, further subthemes were identified. Ulcer and treatment-related pain, as well as odour and exudate appeared to have significant and direct negative effects on quality of life, with additional and cumulative effects on sleep, mobility and mood. CONCLUSION: The themes identified in this review should be considered by professionals providing services, care and treatment for venous leg ulcer patients and in the selection, or development, of patient-reported outcome measures for use with this population.

Strategies for improving outcomes in venous leg ulcer care.

In May 2018, BSN Medical hosted a symposium, 'The management of venous leg ulcers: the value of high-quality care', at the European Wound Management Association (EWMA) conference in Poland. It focused on the impact of excessive exudate on venous leg ulcer outcomes, how to address it, and concluded with a stepwise strategy for improving the quality of care.

Improving patient outcomes through the implementation of a person-centred leg ulcer pathway.

OBJECTIVE: To develop a holistic pathway for leg ulcer assessment and management, implemented within a local community organisation. The primary aim for this pathway was to reduce time-to-healing. METHOD: A leg ulcer pathway was designed to be used in all care settings to support continuity, and contains quality of life (QoL) assessment tools, a treatment algorithm, guidance for use, a leg ulcer assessment form, and a wound treatment chart. RESULTS: Data analysis, carried out 12 months after implementation, compared pre- and post-averages for ulcer time-to-healing: 123.7 days (median: 84 days), n=46 pre-implementation, versus 69.1 days (median: 46 days), n=30 post-implementation, respectively, which demonstrated a minimum 44% reduction in time. Cost saving analysis demonstrated a minimum cost reduction of 45% in nursing time. CONCLUSION: The implementation of a structured, person-centred leg ulcer pathway has provided many benefits to patients, clinicians and the hospital and community trust. Enhancing correct dressing product placement by ensuring the right dressing is used at the right time, in tandem with the correct compression regime, improved healing outcomes. The patient journey has become more streamlined providing the best chance to achieve full healing quickly.

A case study of venous leg ulceration.

Venous ulcers or stasis ulcers account for 80% of lower extremity ulcerations. Approximately 1-2% of the population will suffer from the chronic debilitating condition, with chronic venous insufficiency affecting up to 50% of the adult population. There are many methods of treatment and common treatments include conventional, surgical or mechanical methods. This article examines the complications of leg ulcer management, with the emphasis on the use of antibiotics. The case study demonstrates the positive impact self-care can have as part of a treatment plan.

Understanding venous leg ulcers.

Venous leg ulcers are open lesions between the knee and the ankle joint, which occur in the presence of venous insufficiency. There are theories to explain the causes of venous insufficiency, which ultimately leads to venous hypertension and can result in leg ulceration. Although many patients present with evidence of venous hypertension, others do not, except for the manifestation of the ulcer. There are risk factors associated with venous insufficiency and a holistic approach must be taken in order to influence the management approach of venous leg ulceration. This article discusses venous insufficiency as a disease process, and explores the nursing assessment process, when assessing venous leg ulcers related to venous insufficiency.

Chronic venous leg ulcer care: Putting the patient at the heart of leg ulcer care. Part 1: exploring the consultation.

This article, the first of two, summarises a study that explored the lived experiences of patients with leg ulcers and the impact of this condition on their quality of life. The study had four study phases; phases 1 and 2 employed qualitative methods and are reported here. Initially, unstructured interviews were held; these revealed significant issues for the patients including the dominance of pain, issues relating to exudate and odour, social isolation and psychological effects. A checklist based on these issues was completed by the researcher during observations of routine care for these same patients; this revealed the extent and depth to which these matters were addressed. On many occasions, significant issues were not disclosed or explored during consultations. These findings confirmed that participants with chronic venous leg ulcers have concerns far beyond wound care.

Can early detection prevent venous leg ulceration?

Venous leg ulceration is the most common form of leg ulceration, affecting 1.5% of the UK adult population. This was reviewed within the latest best practice statement (2016) which set out to create clear guidance on the assessment, management and preventing the reoccurrence of venous leg ulceration. With a growing elderly population at risk of venous insufficiency, early identification of those at risk is vital in the fight to reduce the number of people suffering with chronic venous ulceration. This article looks at the need for early assessment and commencement of appropriate treatment in order to reduce the occurrence of venous ulceration and improve clinical processes across the UK.