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PRACTICE RECOMMENDATIONS |
*Type of Evidence |
Comprehensive Assessment |
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1 |
Assessment and clinical investigations should be undertaken by healthcare professional(s) trained and experienced in leg ulcer management. |
C |
2 |
A comprehensive clinical history and physical examination includes:
The above should be documented in a structured format for a client presenting with either their first or recurrent leg ulcer and should be ongoing thereafter. |
C |
3 |
A comprehensive assessment of an ulcer should include:
Measure the surface areas of ulcers, at regular intervals, to monitor progress.Maximum length and width, or tracings onto a transparency are useful methods.
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C
B |
4 |
Regular ulcer assessment is essential to monitor treatment effectiveness and healing goals.
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C
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Diagnostic Evaluation |
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5 |
An Ankle Brachial Pressure Index (ABPI) measurement should be performed by a trained practitioner to rule out the presence of peripheral arterial disease, particularly prior to the application of compression therapy. |
B |
6 |
An Ankle Brachial Pressure Index (ABPI) >1.2 and <0.8 warrants referral for further medical assessment. |
C
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7 |
Prior to debridement, vascular assessment, such as Ankle Brachial Pressure Index (ABPI), is recommended for ulcers in lower extremities to rule out vascular compromise and ensure healability. |
C
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Pain |
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8 |
Pain may be a feature of both venous and arterial disease, and should be addressed. |
B |
9 |
Prevent or manage pain associated with debridement. Consult with a physician and pharmacist as needed. |
C
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Venous Ulcer Care |
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10 |
Develop treatment goals mutually agreed upon by the patient and healthcare professionals, based on clinical findings, current evidence, expert opinion and patient preference. |
C
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11 |
Local wound bed preparation includes debridement when appropriate, moisture balance and bacterial balance.
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C
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12 |
Cleansing of the ulcer should be kept simple; warm tap water or saline is usually sufficient. |
B |
13 |
First-line and uncomplicated dressings must be simple, low adherent, acceptable to the client and should be cost-effective. |
A |
14 |
Avoid products that are known to cause skin sensitivity, such as those containing lanolin, phenol alcohol, or some topical antibiotic and antibacterial preparations. |
C
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15 |
Choose a dressing that optimizes the wound environment and patient tolerance. |
C
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16 |
No specific dressing has been demonstrated to encourage ulcer healing. |
A |
17 |
In contrast to drying out, moist wound conditions allow optimal cell migration, proliferation, differentiation and neovascularization. |
A |
18 |
Refer clients with suspected sensitivity reactions to a dermatologist for patch testing. Following patch testing, identified allergens must be avoided, and medical advice on treatment should be sought. |
B |
19 |
Venous surgery followed by graduated compression hosiery is an option for consideration in clients with superficial venous insufficiency. |
A |
Infection |
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20 |
Assess for signs and symptoms of infection. |
A |
21 |
Manage wound infection with cleansing and debridement, as appropriate. Where there is evidence of cellulitis, treatment of infection involves systemic antibiotics. |
B |
22 |
The use of topical antiseptics to reduce bacteria in wound tissue should be reserved for situations in which concern for bacterial load is higher than that of healability. |
C
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Compression |
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23 |
The treatment of choice for venous ulceration uncomplicated by other factors is graduated compression bandaging, properly applied and combined with exercise. (Level A)
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24 |
External compression applied using various forms of pneumatic compression pumps can be indicated for individuals with chronic venous insufficiency. |
A |
25 |
The client should be prescribed regular vascular exercise by means of intensive controlled walking and exercises to improve the function of the ankle joint and calf muscle pump. |
A |
Complementary Therapies |
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26 |
Consider electrical stimulation in the treatment of venous leg ulcers. |
B |
27 |
Therapeutic ultrasound may be used to reduce the size of chronic venous ulcers.
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A |
Reassessment |
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28 |
If signs of healing are not evident, a comprehensive assessment and re-evaluation of the treatment plan should be carried out at three month intervals, or sooner if clinical condition deteriorates. |
C
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29 |
For resolving and healing venous leg ulcers, routine assessment at six-month intervals should include:
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C
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Client Education for Secondary Prevention |
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30 |
Inform the client of measures to prevent recurrence after healing:
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C
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