Posts Tagged ‘lower extremity ulcers’

Venous vs. Arterial Ulcers: What’s the Difference?

Friday, July 21st, 2017

How can you remember the difference between venous vs. arterial ulcers? Visualization is a good place to start.

Venous vs. Arterial: What’s the Difference?

 

One of the most basic lessons in wound care education is learning the characteristics of venous vs. arterial ulcers – and being able to tell the difference between the two. It can be downright tricky – especially for new clinicians. Fortunately, we have a handy technique for remembering what to look for. And it all starts with visualizing what causes the wound in the first place.

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Lower Extremity Ulcers: Go With the Flow

Wednesday, October 21st, 2015

Lower Extremity Ulcer - Is this Pressure?

Imagine, if you will, the following scene: a wound care clinician is asked to weigh in on a lower extremity ulcer consultation, and upon arrival is told that it’s a pressure ulcer. So she seeks more information about blood flow:

Clinician #1: Tell me about the blood flow to the lower extremity.

Clinician #2: It seems okay because pulses are palpable on the foot.

Clinician #1: Are there recent Ankle Brachial Index (ABI) assessments in order to obtain a much more reliable assessment of blood flow?

Clinician #2: Um … no.

Here’s the truth

Unfortunately, this kind of conversation happens all the time, so let’s set the record straight: palpation of pulses is not a reliable assessment of blood flow to the foot. They can be misleading and leave you hanging – without the information you need to properly and safely manage the wound.  An ABI will reveal what you need to know about the blood flow to the lower extremity, and give you vital clues to the underlying disease process causing the ulcer. Only when this information has been gathered can you properly develop a plan of care that will help, and not hurt, the patient.

The 2014 International Pressure Ulcer Guidelines mentions performing a vascular assessment on every lower extremity ulcer.  That means, at a minimum, we need to check pulses and toe measurements, and perform an ABI. This will assist in identifying the true cause of the wound, whether it be pressure, venous, arterial, or mixed venous/arterial.

What’s this about an ABI?

An ABI is considered the gold standard of tests that can be easily performed at bedside – all you need is a blood pressure cuff and a hand-held Doppler. It is also the most useful test to assess lower extremity arterial perfusion, and compares the systolic blood pressure of the ankle to that of the arm (brachial). When should you perform ABI?

  • When pulses aren’t clearly palpable or are weak
  • On all patients with lower extremity ulcers
  • When the ulcer is not healing
  • Always before starting compression therapy

Compression therapy is the standard of care for the treatment of venous stasis ulcers.  ABI results will help identify significant arterial disease and determine the amount of compression (if any) that can be applied safely. You never want to compress a lower extremity that has significant arterial flow compromise, for fear of cutting off all blood flow and causing harm to your patient.

Blood flow assessment is a must

Earlier, we used the example of a patient who has a possible “pressure ulcer.” When we are not sure of the type of wound we are treating, we need to ask some serious questions:

  • Could there be arterial blood flow compromise that will make healing problematic or even unrealistic?
  • Is there venous disease complicating the clinical picture that could benefit from appropriate levels of compression?
  • Or is this strictly a pressure ulcer where the treatment plan will require off-loading interventions first and foremost?

The bottom line

When assessing a lower extremity ulcer, it is vital to determine the assessment of blood flow.  Without the information obtained from an ABI, your care plan can be inappropriate, your goal setting can be unrealistic, and your patient could be harmed.

What do you think?

We want to know about your experiences with this topic. When do you typically obtain an ABI in practice? In long-term care settings, how often do you obtain ABI measurements? If you’re not obtaining ABIs, what are you using? Please share your experiences below.

 

Venous, Arterial or Mixed Ulcer…How Do I Know For Sure?

Monday, December 15th, 2014

Proper assessment is essential for differentiating between venous and arterial ulcers.

Venous, Arterial or Mixed Ulcer...How Do I Know For Sure?

 

Your patient has a lower extremity wound. You aren’t sure what exactly you are dealing with. You know you need to measure the ankle-brachial index (ABI), but as you wait for results, some of your wound assessment findings offer clues.

Characteristics of Venous Ulcers

Let’s start with the venous ulcer, typically found on the medial lower leg, medial malleolus and superior to the medial malleolus. Seldom will you see them on the foot or above the knee. They tend to be irregular in shape, are superficial, have a red wound bed, have moderate to heavy amount of exudate and the patient may have no pain or a moderate level of pain. Surrounding skin can be warm to the touch, edematous, scaly, weepy and you may see hemosiderin staining present. An ABI provides a definitive answer and will come back at 0.9.
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Lower Extremity Ulcers: What are the costs?

Friday, July 3rd, 2009

How many of you are taking care of lower extremity wounds? They seem to be very common to the wound care specialists. It appears that many of you are taking care of these wounds on a day to day basis. Costs are staggering for health care. Not only are lower extremity ulcers  monetarily costly in supplies, but the time we spend on education and actually treating the patients that have these wounds are costly.

What do you think the average costs are for treating a lower extremity ulcer? $10,000? $20,000? $30,000? What would you say if the costs were actually averaging $40,000 for the treatment of just one lower extremity ulcer? Hard to believe huh? Take a look at this video below as Donna Sardina RN briefly describes the costs of lower extremity ulcers.

As wound care certified nurses, we are called to care for individuals who have wounds. You can imagine what the costs are to care for these individuals and their wounds. If you are interested in becoming wound care certified, check out http://www.wcei.net for more information on the Wound Care Education Institute’s Wound Care Certification Course.