Registered Nurses' Association of Ontario

Specialist Medical Referrals

  • A Specialist medical referral may be appropriate for:
    •  treatment of underlying medical problems
    •  ulcers of non-venous etiology (rheumatoid; diabetic; arterial; mixed etiology)
    •  suspected malignancy
    •  diagnostic uncertainty
    •  reduced ABPI (e.g., <0.8 – routine vascular referral; 0.5 – urgent vascular referral)
    •  increased ABPI (> 1.2 as in calcification of vessels)
    •  rapid deterioration of ulcers
    •  newly diagnosed diabetes mellitus
    •  signs of contact dermatitis (spreading eczema; increased itch)
    •  cellulitis
    •  consideration for venous surgery
    •  ulcers which have received adequate treatment, and have not improved for three months
    •  recurring ulceration
    •  ischemic foot
    •  infected foot
    •  pain management  
    • clients with suspected sensitivity reactions (should be referred to a dermatologist for patch testing). Following patch testing, identified allergens must be avoided and medical advice on treatment should be sought
    •  a non-healing or atypical leg ulcer which should be considered for biopsy
Clinical Management
Assessment and Management of Venous Leg Ulcers
Point of Care Resources