By Lindsay D. Andronaco RN, BSN, CWCN, WOC, DAPWCA, FAACWS
Patients who come in with venous insufficiency ulcers and lower extremity arterial disease (LEAD) should be evaluated for...
By Laurie Swezey RN, BSN, CWOCN, CWS, FACCWS
Compression therapy is the “gold standard” for the treatment of venous ulcers. However, compression therapy is not a one-size-fits-all treatment and the clinician must decide on the right type of compression therapy for the individual client in order to prevent complications from occurring, such as ischemia and necrosis.
In individuals with chronic venous insufficiency, pressure in the veins during ambulation consistently exceeds 40mmHg, far higher than the 22mmHg pressure in the veins of people without venous insufficiency. The reason for this? Pressure decreases during ambulation due to foot and calf pump activity. Decreased range of motion in the ankle and calf pump dysfunction have been shown to be important factors in the development of venous ulcers.
Compression therapy serves several purposes in the treatment of venous insufficiency:
Compression therapy products are usually classified according to the level of compression they provide at the ankle. For patients who do not have arterial disease, aim for a pressure of approximately 40mmHg at the ankle.
Short Stretch Bandages
Long Stretch Bandages
Compression stockings should be worn once the venous ulcer has healed to prevent reoccurrence. Compression stockings come in knee-high and thigh-high lengths. Accurate measurements of the legs must be obtained (calf/ankle circumference and length of the lower leg). Most stockings provide pressures of 30 to 40mmHg, but compression strength should be specified as there is no standardization among stocking classifications. Compression stockings should ideally be replaced every three to six months. They should be donned first thing in the morning before the client gets out of bed and are removed at bedtime. Compression stockings are sometimes used to treat small, superficial venous ulcers.
Compression therapy may be initially uncomfortable, and many patients may opt out of treatment due to this discomfort. It is important to educate the patient regarding the pathophysiology of their disease and the possible outcomes that may occur as a result of nonadherence to therapy. Work with the client to minimize discomfort and allow clients some choice in therapy whenever possible.
Sloan-Rivera, N. & Wu, S. (2012). A Guide to Compression Dressings for Venous Ulcers. Podiatry Today online, 25(2). http://www.podiatrytoday.com/print/2960
About The Author
Laurie Swezey RN, BSN, CWOCN, CWS, FACCWS is a Certified Wound Therapist and enterostomal therapist, founder and president of WoundEducators.com, and advocate of incorporating digital and computer technology into the field of wound care.
The views and opinions expressed in this blog are solely those of the author, and do not represent the views of WoundSource, Kestrel Health Information, Inc., its affiliates, or subsidiary companies.
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