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Library : Venous Stasis Ulcers
Venous Stasis Ulcers
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.
Comprehensive care for patients with venous ulcers must include local wound care and adequate compression therapy. Wound care protocol should include the following:
• Skin care
• Infection control
• Compression 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.