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Leg ulcer - venous - Management
How do I assess a person with a venous leg ulcer?
- An assessment should be carried out by a healthcare professional trained in leg ulcer management.
- Carry out Doppler studies to exclude arterial insufficiency.
- Ask about pain (site, nature, severity), odour, and discharge.
- Examine the legs for oedema, venous eczema and varicose veins.
- Look for signs of an infected leg ulcer such as:
- Enlarging ulcer.
- Increased exudate.
- Increased pain.
- Pyrexia.
- Foul odour.
- Cellulitis: surrounding skin is red, hot and non-scaling.
- Inspect and record details about the ulcer, to compare at follow up in order to determine how well the ulcer is healing. Assess:
- Size and depth — trace out the ulcer margin onto a transparent sheet, or if possible and appropriate, a photograph may be helpful. Examine to assess the depth of the ulcer.
- Wound bed — look for fibrous or necrotic tissue which may need to be removed to allow healing. Look for signs of healthy granulation tissue. Look for exudate to help determine which dressing is needed.
- The ulcer edge often give a good indication of progress and should be carefully documented (for example shallow, epithelialising, punched out).
- The position of the ulcer(s) should be clearly described.
- Assess the impact that the symptoms are having on the person's quality of life. For example, can they move around and carry out normal activities of daily living such as shopping, housework, or employment?
- Assess risk factors (such as immobility or obesity) and comorbidities (such as diabetes mellitus or rheumatoid arthritis) which need treatment or referral to promote ulcer healing.
Basis for recommendation
- These recommendations are based on clinical guidelines The nursing management of patients with venous leg ulcers published by the Royal College of Nursing [RCN, 2006] and the Scottish Intercollegiate Guidelines Network guideline Management of chronic venous leg ulcers [SIGN, 2010], together with the best available trial evidence, informed expert opinion, and current good clinical practice.
- Lack of appropriate clinical assessment in the community of people with limb ulceration has often led to long periods of ineffective and even inappropriate treatment. A thorough assessment, as suggested, will help identify both the underlying cause and any associated conditions, and will influence decisions about prognosis, referral, and management [RCN, 2006].
- Assessing serial measurement of the surface area: this is important as it is a reliable index of ulcer healing [SIGN, 2010].
- Assessing the depth of leg ulcer: this is important as deep ulcers involving deep fascia, tendon, periosteum or bone may have an arterial component [SIGN, 2010].
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