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Venous Insufficiency & Venous Stasis Ulcers.
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Venous stasis, the cessation or impairment of venous flow, and the accompanying ulceration is a commonly occurring problem. Management of this condition presents a large problem to community nursing services and consumes considerable health resources.
Venous stasis ulceration occurs as an end result of sustained high pressure in the veins of lower extremities. Damage to either the deep or superficial veins then results. As the venous pressure rises and venous stasis occurs, capillaries are stretched and become more permeable. The protein leaks out of the vascular bed into the surrounding tissues. Fibrinogen is converted to fibrin and coats the capillaries, interfering with the exchange of oxygen and nutrients. Tissue breakdown begins and venous ulceration occurs.
Venous stasis leg ulcers are characteristically persistent and slow to heal - making a multifaceted treatment protocol necessary. Traditionally, many approaches have focused only on dressing systems which are directed to the wound healing process itself, as opposed to the underlying cause.
Treatment:
Comprehensive care for patients with venous ulcers must include local wound care and adequate compression therapy. Wound care protocol should include the following:
• Debridement
• Skin care
• Infection control
• Revascularization
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Compression therapy
•
ReidSleeve therapy
Ulcers should be cleaned with either peroxide, Dakin's solution or potassium permanganate once per day. Bio-occlusive dressings can be applied and changed every 2-7 days. These dressings promote formation of good granulation tissue and rapid healing.
Compression therapy protocol should include the following:
• Medical Compression Stockings
• Pneumatic Compression Pump Therapy
In many cases, particularly in older patients, the effective level of compression required is greater than that which the patient can tolerate. Thus, an alternative approach is to include a pneumatic compression pump in the protocol. The compression pump reduces venous stasis by promoting venous blood flow and has been shown to enhance fibrinolytic activity.
Compression therapy must continue after the ulcer is healed, often for the duration of the patient's lifetime.
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ReidSleeve:
Lymphedema Cast Study:
Female, Bilateral Lower Extremity
Female,
Bilateral Lower Extremity Edema, Lymphedema secondary to
carcinoma treatment, HealthSouth, Vero Beach Florida.
Female with bilateral lower extremity lymphedema secondary
to treatment for cancer. The lymphedema was a sudden onset
that progressively worsened. Previous treatments included,
MLD, Bandaging, day-time compression garments and mechanical
pump. Patient reported a history of one infection.
Patient presented with right lower extremity edema on June
18, 1999 with moderate to severe lymphedema involving the
foot, ankle, calf, knee, thigh and distal to mid abdomen.
She exhibited extreme fibrotic tissue proximal thigh and
distal right to medial abdomen. Right lower extremity medium
hard tissue with discoloration light brown with white spots
in the foot and ankle areas. Slightly shiny skin in shinbone
area. Medium dry skin.
Patient states that executing staircases was not possible
and she experienced a general unsteadiness while ambulating.
Walking over time periods of 30 minutes was difficult. Range
of motion was limited to 45 degrees at the knee. Patient was
unable to operate a vehicle do to lack of range of motion.
Patient was fit with ReidSleeve Classic of her right lower
extremity and was scheduled for her first follow up on June
27, 1999.
Patient was on a catheter to measure fluids. Normal excess
between 8:00pm and 8:00am is approximately 800-900 ccL.
Patient passed 2000 ccL after first night with ReidSleeve.
Patient wears ReidSleeve 10-12 hours per night. Patient
reported some itching sensation while sleeve was applied.
Significant decreased hardening in the affected extremity
was noted. Range of motion increase, patient is now able to
bend extremity to 90 degree.
Patient reported on July 7, 1999 with increased walking and
ability to stand. Patient did not wear the ReidSleeve on one
night and reported an increase in circumference the
following day. No change in skin discoloration.
Below is a graph of total volume reduction.
Patient reports on August 29, 2000 that she continues
compliance with the ReidSleeve in place of bandaging. When
the patient was asked her objective opinion of what overall
percent of improvement she believed to have, stated she felt
she was 85% improved.
Additional comments: 6-18-99 - Patient was asked on initial
evaluation from a scale from 0-10 with 0 meaning none and 10
unbearable;
Limb sensation: Hot-4, Full-8, Numb-3, Hard-5, Heavy-8,
Tired-8, Stiff-8, Achy-6, Painful-6, Tingles-4,
Needles/pins-0, Decreased function-9, Bursting Sensation-8.
8-29-2000 - Patient reported:
Limb sensation: Hot-2, Full-2, Numbness-0, Hardness-3,
Heavy-3, Tired-4, Stiff-5-6, Achy-2, Painful-2, Tingles-1,
Needles/pins-1, Function-4, Bursting Sensation-1.
This case was followed by HealthSouth in Vero Beach Florida.
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