Edema

In a recent survey, we asked our WoundSource Editorial Advisory Board members what outdated wound care practices they continue to see in the field. Depending on what health care setting clinicians work in, there are specific guidelines, policies, and procedures that may impact standard of care. Our board members come from a variety of backgrounds, so their answers varied based on their areas of expertise, but there were a few practices that they could all agree should be left in the past. Do you still use any of these?

By Laurie Swezey RN, BSN, CWOCN, CWS, FACCWS Arterial ulcers can cause much pain for patients and consternation for the wound care professionals tasked with managing them. Arterial ulcers can be a catch-22 in that many patients with arterial ulcers present with edema, but due to the nature of their problem cannot be safely compressed.

By Laurie Swezey RN, BSN, CWOCN, CWS, FACCWS Lymphedema can be defined as swelling of one or more limbs which may also include a portion of the corresponding trunk. Lymphedema can also affect the breast, head, neck or genitalia. It occurs when fluid and other components such as protein accumulate in the tissue spaces as a result of a disparity between the creation of interstitial fluid and its transport or movement. It may be caused by damage to the lymphatic system (i.e., as a result of cancer treatment) or as the result of a congenital malformation of the lymphatic system. It is a chronic condition with no cure, but it can be managed if diagnosed early on.

It is important for nurses to strive toward excellence. Our patients deserve the best we are able to give, and sometimes we need to look critically at how we care and how we might improve outcomes. In theory, we update practice because we read research that indicates a change needs to be incorporated into what we do. More often, maybe we follow a colleague and like what we see, or the patient indicates a preference and we change an approach. It may be that a company representative visits and what they say makes sense, has the support of management, and we gladly (or not) incorporate a product into our practice. Looking at a standard of practice and reflecting on how we measure up require honesty and an openness that some might shy away from. Such reflective practice, combined with clinical supervision, leads to high-quality care and is an excellent method of reviewing, updating, and improving practice for patients with problems of the lower leg.

By the WoundSource Editors Complex wounds pose a significant challenge for many health care providers. These wounds are often multifaceted, making treatment tremendously difficult. They represent a substantial burden on the health care industry, with annual costs in North America alone estimated at $10 billion annually. They often also result in patient discomfort and pain, caregiver frustration, individual economic losses, and diminished quality of life.

by the Wound Source Editors Chronic non-healing wounds affect millions of patients each year and contribute significantly to their morbidity and mortality. These wounds have a substantial impact because of their economic burden and the significant effect on the reduction in quality of life, as well as the increased risk of death for those patients affected by them.1 A 2014 study of Medicare data showed that chronic non-healing wounds and associated complications affect nearly 15% or 8.2 million Medicare beneficiaries. The study also estimated the cost to treat these wounds at between $28.1 billion and $31.7 billion annually.2 The highest costs were associated with infected or reopened surgical wounds, and outpatient care had the highest site-of-service costs. In addition to being older, most of these patients have obesity and diabetes. Underlying causes often include diabetic foot ulcers, venous leg ulcers, arterial insufficiency, and pressure ulcers. The list of complications contributing not only to chronicity but also to further deterioration is quite lengthy.

By Janet Wolfson PT, CLWT, CWS, CLT-LANA Acute care wound or edema professionals are bombarded with multiple kinds of edema that can be treated in many ways—and with many choices of compression garments. What to choose?

By Janet Wolfson, PT, CLWT, CWS, CLT-LANA Reflecting back on "In the Trenches With Lymphedema," WoundSource's June Practice Accelerator webinar, many people sent in questions. I have addressed some regarding compression use here.

Compression therapy is a well-established treatment modality for a number of conditions, including venous disorders, thrombosis, lymphedema, and lipedema. It is also very effective in treating various kinds of edema.1 Based on patient diagnostic data, many patients with these conditions can benefit from targeted compression therapy.