Chronic venous insufficiency: A review for nurses.

Chronic venous insufficiency (CVI) is a potentially debilitating disorder associated with serious complications such as lower extremity venous ulcers. This article reviews the incidence and pathophysiology of CVI, nursing assessment, diagnosis and interventions, and patient education needed to manage the disease and prevent complications.

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.

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.

Approaches to the application and removal of compression therapy: A literature review.

Compression therapy is used in the treatment of venous disorders, lymphoedema and burns. Adherence to compression therapy is reported to be poor, due to a number of factors, including difficulty in applying and removing the compression garments. A literature review was conducted to identify aids, equipment and other approaches to ease the application and removal of compression therapy garments. Some 12 studies were identified. Most studies focused on chronic venous insufficiency and venous ulcers. Four methods of easing compression garment application and removal were identified: (1) devices to assist in application and removal; (2) altered compression stocking design; (3) adjustable compression wrap devices; and (4) education. Patients prescribed compression therapy should be educated on how to apply and remove the compression garments, and have application devices made available to them.

[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.

[Assessment of oedema]. / L'evaluation de l'oedème.

Oedema signals a more or less significant disturbance of the capillary balance. Generalised or localised, it usually affects the lower parts of the body, notably the lower limbs. It can be a sign of heart failure which is why it is important for nurses to know how to spot, classify and above all assess the different types of oedema.

Tratamento endovascular das obstruções venosas crônicas do segmento iliocaval / Endovascular treatment of chronic obstructions of the iliocaval segment

A insuficiência venosa crônica é um grave problema de saúde pública no mundo, consumindo grandes quantias de recursos e causando grande prejuízo na qualidade de vida dos pacientes portadores de suas formas mais avançadas. A cirurgia para o tratamento de obstruções no sistema venoso profundo não foi incorporada à prática da maioria dos cirurgiões vasculares, ficando restrita a poucos centros em alguns países. Com o advento da cirurgia endovascular, a possibilidade de tratar alguns tipos de lesões obstrutivas por uma técnica minimamente invasiva e com resultados promissores renova o interesse da comunidade vascular pelas formas mais complexas de doença venosa.

Chronic venous insufficiency is an important public health issue worldwide, that consumes significant amounts of resources and impairs the quality of life of patients who suffer from its more severe clinical types. Surgery for the treatment of deep venous system obstruction has not been incorporated to the practice of most vascular surgeons, being restricted to a few medical centers in some countries. With the advent of endovascular surgical techniques, the possibility of treating some obstructive lesions with a minimally invasive technique that has promising results has renewed the interest of the vascular community for the treatment of more complex forms of vascular disease.

The effect of a cryotherapy gel wrap on the microcirculation of skin affected by chronic venous disorders.

AIM: The aim of this randomized clinical trial was to investigate a cryotherapy (cooling) gel wrap applied to lower leg skin affected by chronic venous disorders to determine whether therapeutic cooling improves skin microcirculation. BACKGROUND: Chronic venous disorders are under-recognized vascular health problems that result in severe skin damage and ulcerations of the lower legs. Impaired skin microcirculation contributes to venous leg ulcer development, thus new prevention therapies should address the microcirculation to prevent venous leg ulcers. METHODS: Sixty participants (n = 30 per group) were randomized to receive one of two daily 30-minute interventions for four weeks. The treatment group applied the cryotherapy gel wrap around the affected lower leg skin, or compression and elevated the legs on a special pillow each evening at bedtime. The standard care group wore compression and elevated the legs only. Laboratory pre- and post-measures included microcirculation measures of skin temperature with a thermistor, blood flow with a laser Doppler flowmeter, and venous refill time with a photoplethysmograph. Data were collected between 2008 2009 and analysed using descriptive statistics, paired t-tests or Wilcoxon signed ranks tests, logistic regression analyses, and mixed model analyses. RESULTS: Fifty-seven participants (treatment = 28; standard care = 29) completed the study. The mean age was 62 years, 70% female, 50% African American. In the final adjusted model, there was a statistically significant decrease in blood flow between the two groups (-6.2[-11.8; -0.6], P = 0.03). No statistically significant differences were noted in temperature or venous refill time. CONCLUSION: Study findings suggest that cryotherapy improves blood flow by slowing movement within the microcirculation and thus might potentially provide a therapeutic benefit to prevent leg ulcers.

A pilot study of venous photoplethysmography screening of patients with chronic venous disorders.

In office and clinical practice settings, standard methods do not exist to objectively quantify lower extremity venous dysfunction. This pilot feasibility study examined venous refill time, an objective measure of skin microcirculation reflux, using photoplethysmography in 13 patients with known chronic venous disorders. The test was found to be feasible and easy to administer and provided objective data to corroborate clinical signs. Further research is needed to evaluate and validate the relationships among clinical signs, comorbid conditions, and objective findings with the severity of venous dysfunction in patients with suspected or known chronic venous disorders.

Terapia combinaa en úlcera vascular complicada. Primer premio Biatain 2008. Caso clínico úlcera vascular infectada / Combined Therapy for a Vascular Ulcer. 2008 BIATAIN First Prize. A Clinical Case of a patient with an infected vascular ulcer

La utilización de una terapia combinada (apósitos hidropoliméricos con plata iónica y apósitos liberadores de ibuprofeno), junto con una reevaluación constante, hace que se consiga cicatrizar una úlcera de 10 años de evolución. Para ello se partió de la evidencia de que, en el complicado proceso que constituye la cicatrización de las heridas tórpidas y de difícil curación, aparece una serie de factores involucrados en la regeneración tisular que son, a la vez, no esperados y desencadenantes del retraso y la ralentización de dicho proceso (colonización crítica e infección, el estado nutricional y metabólico, las infecciones de repetición, el estado vascular o las alteraciones hormonales). Trabajo ganador del Primer Premio Biatain 2008 en la categoría «Caso Clínico sobre úlcera vascular infectada(AU)

The use of a combined therapy which includes hydropolymeric dressings with ionic silver and dressings which release of ibuprofen together with a constant reevaluation made it possible to heal an ulcer which had afflicted a patient for 10 years. In order to succeed in doing so, medical professionals started off with the evidence that, in the complicated process which the cicatrization of long-lasting wounds difficult to cure constitutes, a series of factors involved in tissue regeneration appear which, at the same time, are not expected and which delay and slow down this process (critical colonization and infection, nutritional and metabolic state, repetitive infections, vascular state or hormonal alterations). This case story won the 2008 Biatain First Prize in the category «Clinical Case Study of a patient with an infected leg ulcer»(AU)

Lower extremity venous disorders: implications for nursing practice.

Lower extremity chronic venous disorders are significant and common causes of vascular morbidity and mortality worldwide. Venous ulcer relapse rates are as high as 72% and account for approximately 80% to 90% of all lower extremity ulcers. Venous disorders, much like arterial disease, are often progressive and chronic in nature, resulting in enormous economic and human costs in terms of treatment, pain, and suffering. Individuals with skin changes are at high risk of recurrent leg ulcers, which negatively affect the quality of life for both the individual and the family. Prevention efforts should target anatomical vein dysfunction, edema, and skin changes to prevent leg ulcers. This article presents an overview of both clinical and laboratory assessments of lower extremity chronic venous disorders, including descriptions of the risks and pathogenesis for differential diagnosis and implications for nursing.