Добавил:
Sekretar
kiopkiopkiop18@yandex.ru
t.me/Prokururor I Вовсе не секретарь, но почту проверяю
Опубликованный материал нарушает ваши авторские права? Сообщите нам.
Вуз:
Предмет:
Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_782_Библиотеки_им_академика_М_И_Перельмана
.pdf
272 ASSESSMENT OF LEG ULCERATION
https://t.me/medicina_free
tibialpulses are from the same artery, so choose one or the other.
These are easier to access when the blood pressure cu is applied
to the leg.
Step2
Apply the cu rmly at the ankle just above the malleolus. Placing
the cu above the ankle will elevate the pressure and the ABPI
(Vowden and Vowden2018) (see Figure5.15). Ensure that the cu is
the right size for the ankle circumference.
Step3
Examine the foot and apply contact gel. Continue as for the brachial
pressure and record in the same way. Remember that the foot arteries
are not parallel with the skin and sometimes the probe must be
adjusted to have a clear signal. Repeat this step for at least two of the
pedal pulses. If the pulse is irregular, a slow deation of the cu will
help with accuracy.
FIGURE5.15 Lower limb cu position. Courtesy of Accelerate.
本书版权归John Wiley & Sons Inc.所有
Assessment of Leg Ulceration 273
anklesystolic BP
ABPI
https://t.me/medicina_free
Step4
Note the mmHg at the point of the sound returning (when the pulse
becomes audible again). This is the absolute pressure and inclusion
of this in the documentation is important, as it is an indicator of overall perfusion to the limb.
Step5
Note down the sounds– these are as valuable as the ABPI measurement.
Triphasic signal – this is represented by three sounds together
very quickly and indicates that the arteries are working well and
the artery has good elasticity. There are three parts to the waveform that can be seen visually if the Doppler device has a display
window or heard if the transmission is clear (Figure5.16).
Biphasic signal– this can be recognised as two sounds heard
together and indicates that the arteries are losing some of their
elasticity, which may be due to the ageing process. There are only
two parts to this waveform visually.
Monophasic signal– A single almost ‘banging’ sound indicates
the presence of advanced arterial disease and the artery will have
little or no elasticity in the vessel.
Calculation andInterpretation ofthe Ankle Brachial Pressure Index
The ABPI for each leg is calculated separately by taking the highest
reading of the foot pulse readings and dividing by the highest of the
brachial readings:
The ABPI values are reported numerically, for example 0.82 or
1.30, which indicates to the assessing clinician that the patient had
an arterial ow of oxygenated blood of approximately 82% or 130%.
Compression therapy may be safely used in venous leg ulcer patients
with an ABPI >0.8 (Table5.10).
本书版权归John Wiley & Sons Inc.所有
brachialsystolicBP
=
(a)
(b)
(c)
https://t.me/medicina_free
274 ASSESSMENT OF LEG ULCERATION
Systole
Late
Zero
flow
Baseline
Diastole
Systole
Diastole
Zero
flow
Baseline
Early
Early
Diastole
FIGURE5.16 Waveforms. (a) Triphasic; (b) biphasic; (c) monophasic.
本书版权归John Wiley & Sons Inc.所有
Assessment of Leg Ulceration 275
https://t.me/medicina_free
TABLE5.10
for
compression therapy.
ABPI = 1.01–1.3 No indicators of
ABPI=0.81–1.0 Mild
ABPI=0.51–0.8 Signicant
<0.5 Severe arterial disease No compression– urgent
ABPI
ABPI >1.3
a
A high ABPI may not always be indicative of peripheral vascular disease, but could
be a false high from poor technique. A toe Doppler will be able to conrm the presence
of arterial disease if calcication in the arteries has rendered them dicult to
compress. Calcication does not usually aect the smaller vessels in the toes
(Whayman2014). It is also useful to consider the absolute pressures as an indicator
ofperfusion.
Source: Adapted from Harding etal. (2015).
Ankle brachial pressure index (ABPI) indicators
Apply high levels of
peripheral
vascular disease
peripheral disease
arterial disease
a
Measure toe pressures
or refer to specialist
compression therapy
May have high levels of
compression therapy–
monitor ABPI
May have reduced
compression– refer to
specialist nurse/
vascular
referral to vascular
May have compression
therapy– liaise with
specialist nurse/
vascular
ABPI is a useful test to determine arterial suciency. It is
important that healthcare professionals understand normal values so
that abnormal values can be recognised.
Medical factors that may aect the patient’s ability to undergo
ABPI assessment include:
DVT or suspected DVT.
Cellulitis.
Lymph node clearance.
Amputation (the automated ABPI device has an amputation
function).
Surgery to arm/leg.
Friable skin.
Mental health–related issues.
Dementia.
本书版权归John Wiley & Sons Inc.所有
276 ASSESSMENT OF LEG ULCERATION
https://t.me/medicina_free
Neurological disease (this may aect the patient’s ability to
stay still).
Cancer- related treatment.
Remember that when undertaking ABPI assessment, practitioners should always refer to their own local protocol, as there are local
variances between clinical services.
RED FLAGS FORTHE URGENT TREATMENT OF
PATIENTS WITHVENOUS LEG ULCERS
Infection of the leg or foot, identied by symptoms of increasing
pain, redness, oedema and local heat with purulent discharge.
Critical limb- threatening ischaemia.
Suspected untreated DVT.
Suspected skin malignancy.
REASSESSMENT ANDRECURRENCE
Leg ulcer assessment should be an ongoing process until the wound
is healed. When the wound is healed, maintenance and prevention of
recurrence are vital (Wounds UK 2016). The recurrence rate in
venous leg ulcers is estimated to be as high as 50.4% within the rst
12 months (Finlayson et al. 2018). Doppler ABPI reassessment is
essential every three months, or more frequently if changes in the
lower limb are observed.
CONCLUSION
Good assessment and history taking are pivotal to decision- making,
diagnosis, treatment and partnership working with patients with leg
ulcers. Communication between healthcare professionals and patients
is essential to gain trust, partnership and understanding. Consideration
must be given to patients with any additional vision, hearing or
literacy needs. It is essential for practitioners to have cultural
competence and awareness to ensure that patients’ cultural needs and
本书版权归John Wiley & Sons Inc.所有
Assessment of Leg Ulceration 277
https://t.me/medicina_free
beliefs are met. Assessment is not just something that happens at the
beginning of treatment, it should be ongoing throughout. Identifying
leg ulcer aetiology, causes and risk factors is essential to ensure that
treatment options and strategies are appropriate and eective. Having
an in-
depth understanding of the patient you are working with will
help you nd the most successful treatments.
REFERENCES
Atkin, L. (2019). Venous leg ulcer prevention 1: identifying patients who are
at risk. Nursing Times 115 (6): 24–28. https://www.nursingtimes.net/
clinical-archive/tissue-viability/venous-leg-ulcer-prevention-1identifying-patients-who-are-at-risk-28-05-2019/
Atkins, E., Mughal, N.A., Place, F., and Coughlin, P.A. (2020). Varicose veins
in primary care. BMJ 370, m2509. https://doi.org/10.1136/bmj.m2509.
Belczak, S., Ramos, R., and Pereira de Godoy, J. (2021). Association between
obesity and the aggravation of limited range of ankle mobility in chronic
venous disease. Phlebology 37 (3): 196–199.
Beldon, P. (2011). How to...Ten top tips for doppler ABPI. Wounds interna-
tional 2 (4): https://woundsinternational.com/journaltoten-
top- tips- for- doppler- abpi.
Birkhäuer, J., Gaab, J., Kossowsky, J. etal. (2017). Trust in the health care
professional and health outcome: a meta- analysis. PLoS One 12 (2):
e0170988. https://doi.org/10.1371/journal.pone.0170988.
Blomgren, L., Johansson, G., Dahlberg- Åkerman, A. etal. (2004). Recurrent
varicose veins: incidence, risk factors and groin anatomy. European
Journal of Vascular and Endovascular Surgery 27 (3): 269–274.
Brown, A. (2017). Managing exudate and maceration in venous legulcera-
tion within the acute health setting. British Journal of
26 (Sup20): S18–S24. https://doi.org/10.12968/bjon.2017.26.sup20.s18.
Buerger, L. (1924). The Circulatory Disturbances of the Extremities: Including Gan-
grene, Vasomotor and Trophic Disorders. Philadelphia, PA: W.B. Saunders.
Cai, P. and Forsyth, J. (2022). Acute limb ischaemia. Vascular surgery– II.
Surgery 40 (7): 450–459.
Carruthers, T.N., Farber, A., Rybin, D. et al. (2014). Interventions on the
supercial venous system for chronic venous insuciency by surgeons
in the modern era: an analysis of ACS- NSQIP. Vascular and Endovascu-
lar Surgery 48: 482–490.
Cirqui, M., Denenberg, J., Bergan, J. et al. (2007). Risk factors for chronic
venous disease: the San Diego Population Study. Journal of Vascular
Surgery 46 (2): 331–337.
articles/how-
Nursing
本书版权归John Wiley & Sons Inc.所有
278 ASSESSMENT OF LEG ULCERATION
https://t.me/medicina_free
Collares, F. and Faintuch, C. (2017). Varicose Veins: Practical Guides in Inter-
ventional Radiology. NewYork: Thieme Medical Publishers.
Cutting, K.F. (2004). Exudate: composition and functions. In: Trends in
Wound Care: Volume III (ed. R. White), 41–49. London: Quay Books.
Cutting, K.F. and White, R.J. (2002). Avoidance and management of peri-
wound maceration of the skin. Professional Nurse 18 (1): 33–36.
Danielsson, G., Eklof, B., Grandinetti, A., and Kistner, R.L. (2002). The inu-
ence of obesity on chronic venous disease. Vascular and Endovascular
Surgery 36 (4): 271–276. https://doi.org/10.1177/153857440203600404.
Deptuła, M., Zieliński, J., Wardowska, A., and Pikuła, M. (2019). Wound
healing complications in oncological patients: perspectives for cellular
therapy. Advances in Dermatology and Allergology 36 (2): 139–146.
https://doi.org/10.5114/ada.2018.72585.
Dini, V., Janowska, A., Oranges, T. etal. (2020). Surrounding skin manage-
ment in venous leg ulcers: a systematic review. Journal of Tissue Viability
29: 169–175.
Eder, S., Dissemond, J., Vanscheidt, W. etal. (2019). Buergers test/pole test:
simple clinical tests to screen the arterial perfusion before compression
therapy. Phlébologie 49 (02): 108–110. https://doi.org/10.1055/a- 0865- 7947.
Edward-
Eklof, B., Rutherford, R.B., Bergan, J.J. etal. (2004). Revision of the CEAP
Finlayson, K.J., Parker, C.N., Miller, C. etal. (2018). Predicting the likelihood
Frescos, N. (2011). What causes wound pain? Journal of Foot Ankle Research
Godeberge, P., Sheikh, P., Zagriadskiĭ, E. etal. (2019). Hemorrhoidal disease
Gouin, J.P. and Kiecolt- Glaser, J.K. (2011). The impact of psychological stress
Green, J., Corcoran, P., Green, L., and Read, S. (2018). A new quality of life
Guest, J.F., Gerrish, A., Ayoub, N. etal. (2015). Clinical outcomes and cost-
Jones, V. (2018). Microbiology and malodourous wounds. Wounds
UK 14 (4): 72–75.
classication for chronic venous disorders: consensus statement. Jour-
nal of Vascular Surgery 40 (6): 1248–1252.
of venous leg ulcer recurrence: the diagnostic accuracy of a newly devel-
oped risk assessment tool. International Wound Journal 15(5): 686–694.
4 (Suppl 1): P22. https://doi.org/10.1186/1757-
and chronic venous insuciency: concomitance or coincidence; results
of the chorus study (chronic venous and Hemorrhoidal Diseases Evalu-
ation and Scientic Research). Journal of Gastroenterology and Hepatol-
ogy 35 (4): 577–585. https://doi.org/10.1111/jgh.14857.
on wound healing: methods and mechanisms. Immunology and Allergy
Clinics of North America 31 (1): 81–93. https://doi.org/10.1016/
j.iac.2010.09.010.
wound checklist: the patient voice in wound care. Wounds UK 14(4): 40–45.
eectiveness of three alternative compression systems used in the man-
agement of venous leg ulcers. Journal of Wound Care 24 (7): 300–310.
1146- 4- S1- P22.
本书版权归John Wiley & Sons Inc.所有
Assessment of Leg Ulceration 279
https://t.me/medicina_free
Guest, J., Fuller, G., and Vowden, P. (2018). Venous leg ulcer management in
clinical practice in the UK: cost and outcomes. International Wound
Journal 15 (1): 29–37.
Guo, S. and DiPietro, L.A. (2010). Factors aecting wound healing. Journal
of Dental Research 89 (3): 219–229. https://doi.org/10.1177/002203
450935912.
Harding, K., Dowsett, C., Fias, L. etal. (2015). Simplifying venous ulcer man-
agement: consensus recommendations. Wounds International London.
https://woundsinternational.com/consensus venous- leg- ulcer- management- consensus- recommendations
Harper, C. and Crane, J. (2022). Atrophie blanche. In: StatPearls. Treasure
Island, FL: StatPearls Publishing https://www.ncbi.nlm.nih.gov/books/
NBK544285.
Haughton, W. and Young, T. (1995). Common problems in wound care: mal-
odorous wounds. British Journal of Nursing 4 (16): 959–963.
https://doi.org/10.12968/bjon.1995.4.16.959.
Hess, C.T. (2020). Checklist for successful wound healing outcomes.
Advances in Skin & Wound Care 33 (1): 54–55. https://doi.org/10.1097/
01.asw.0000617008.87552.bc.
Iannuzzi, A., Panico, S., Ciardullo, A.V. etal. (2002). Varicose veins of the
lower limbs and venous capacitance in postmenopausal women: relationship with obesity. Journal of Vascular Surgery 36: 965–968.
International Wound Infection Institute (IWII) (2016). Wound infection in
clinical practice. Wounds International. https://woundsinternational.
com/consensus- documents/wound- infection- in- clinical- practice principles- of- best- practice
Ismail, L., Normahani, P., Standeld, N., and Jaer, U. (2016). A systematic
review and meta- analysis of the risk for development of varicose veins
in women with a history of pregnancy. Journal of Vascular Surgery:
Venous Lymphatic Disorders 4 (4): 518–524.
Kawano, Y. (2010). Physio- pathological eects of alcohol on the cardiovascular
system: its role in hypertension and cardiovascular disease. Hypertension
Research 33 (3): 181–191. https://doi.org/10.1038/hr.2009.226.
Lurie, F., Passman, M., Meisner, M. et al. (2020). The 2020 update of the
CEAP classication system and reporting standards. Journal of Vascular
Surgery and Venous Lymphatic Disorders 8 (3): 342–352. https://doi.
org/10.1016/j.jvsv.2019.12.075.
Lymphoedema Framework (2006). International consensus: Best practice for
the management of lymphoedema. https://www.lympho.org/uploads/
les/les/Best_practice.pdf
Matic, M., Matic, A., Djuran, V. etal. (2016). Frequency of peripheral arterial
disease in patients with chronic venous insuciency. Iranian Red Cres-
cent Medical Journal 18 (1): e20781. https://doi.org/10.5812/ircmj.20781.
documents/simplifying-
本书版权归John Wiley & Sons Inc.所有
280 ASSESSMENT OF LEG ULCERATION
https://t.me/medicina_free
McVittie, E. and Holloway, S. (2015). Aetiology and management of atrophie
blanche in chronic venous insuciency. British Journal of Community
Nursing 20 (Supp12): S8–S13.
Minasian, R.A., Samaha, Y., and Brazio, P.S. (2022). Post-
lymphedema: review of the literature and surgical treatment options.
Plastic and Aesthetic Research 9: 18. https://doi.org/10.20517/2347-
9264.2021.128.
Mintz, B., Ja, M., and Mintz, J. (2013). Atlas of Clinical Vascular
Chichester: Wiley.
Mioc, M.- L., Prejbeanu, R., Vermesan, D. etal. (2018). Deep vein thrombosis
following the treatment of lower limb pathologic bone fractures– a
comparative study. BMC Musculoskeletal Disorders 16: 213.
Mitchell, A. (2017). Assessing the value of practice-
to inform recommendations for change in practice. British Journal of
Community Nursing 22 (Supp12): S28–S34.
Mitchell, A. (2018). Adult pressure area care: preventing pressure ulcers.
British Journal of Nursing 27 (18): 1050–1052. https://doi.org/10.12968/
bjon.2018.27.18.1050.
Mitchell, A. (2020). Assessment of wounds in adults. British Journal of Nurs-
ing 29 (20): S18–S24.
Mitchell, A. (2022). Skin assessment in adults. British Journal of Nursing
31 (5): 274–278. https://doi.org/10.12968/bjon.2022.31.5.274.
Mitchell, A. and Elbourne, S. (2020). Lower limb assessment. British Journal
of Nursing 29 (1): 18–21.
Mitchell, A. and Hill, B. (2020). Moisture-
view of its diagnosis and management. British Journal of
Nursing 25 (3): S12–S18. https://doi.org/10.12968/bjcn.2020.25.Sup3.S12.
Mitchell, A. and Llumigusin, D. (2021). The assessment and management of
hypergranulation. British Journal of Nursing 30 (5): S6–S10. https://doi.
org/10.12968/bjon.2021.30.5.S6.
Miteva, M., Romanelli, P., and Kirsner, R. (2010). Lipodermatosclerosis. Der-
matologic Therapy 23 (4): 375–388.
Moatt, C., Franks, P.J., Doherthy, D.C. etal. (2009). Psychological factors in
leg ulceration: a case-
(4): 750–756. https://doi.org/10.1111/j.1365- 2133.2009.09211.x.
National Institute for Health and Care Excellence (NICE) (2020). Leg ulcer
infection: antimicrobial prescribing. NICE guideline [NG152].
https://www.nice.org.uk/guidance/ng152/chapter/Recommen
dations#treatment
National Institute for Health and Care Excellence (NICE) (2021). Leg ulcer–
venous. https://cks.nice.org.uk/topics/leg- ulcer- venous
National Institute for Health and Care Excellence (NICE) (2022). Venous
eczema and lipodermatosclerosis: how should I assess the person?
control study. British Journal of Dermatology 161
associated skin damage: an over-
based leg ulcer education
traumatic
Medicine.
Community
本书版权归John Wiley & Sons Inc.所有
Assessment of Leg Ulceration 281
https://t.me/medicina_free
https://cks.nice.org.uk/topics/venous- eczema- lipodermatosclerosis/
diagnosis/assessment
National Institute for Health and Care Excellence (NICE) (2023). Leg ulcer–
venous. https://cks.nice.org.uk/topics/leg-
NHS (2020). Universal personalised care: implementing the comprehensive
model. https://www.england.nhs.uk/wp- content/uploads/2019/01/
universal-
NHS (2022). Causes: Peripheral neuropathy. https://www.nhs.uk/
peripheral-
NHS Inform (2022). Varicose eczema. https://www.nhsinform.scot/illnesses-
and-
Nicholls, S.C. (2005). Sequelae of untreated venous insuciency.
in Interventional Radiology 22 (3): 162–168.
Nichols, E. (2016). Wound assessment part 2: exudate. Wound Essentials
11 (1): 36–44.
Nickles, M.A., Ennis, W.J., O’Donnell, T.F. Jr., and Altman, I.A. (2023). Com-
pression therapy in peripheral artery disease: a literature review.
of Wound Care 32 (Supp 5): S25–S30. https://doi.org/10.12968/jowc.
Oh, D.M. and Phillips, T.J. (2006). Sex hormones and wound healing. Wounds
18 (1): 8–18.
Onida, S. and Davies, A. (2016). Predicted burden of venous disease. Phlebol-
ogy 31 (1): 74–79.
Ortega, M.A., Fraile- Martínez, O., García- Montero, C. etal. (2021). Under-
standing chronic venous disease: a critical overview of its pathophysiology and medical management. Journal of Clinical Medicine 10 (15):
3239. https://doi.org/10.3390/jcm10153239.
Ousey, K. and Cook, L. (2012). Wound assessment made easy. Wounds UK.
https://wounds- uk.com/made- easy/wound- assessment- made- easy
Platsidaki, E., Kouris, A., and Christodoulou, C. (2017). Psychosocial aspects
in patients with chronic leg ulcers. Wounds: A Compendium of Clinical
Research and Practice 29 (10): 306–310. https://doi.org/10.25270/
wnds/2017.10.306310.
Robertson, L.A. (2013). Incidence of varicose veins, chronic venous insu-
ciency and venous reux in the general population and associated risk
factors: the Edinburgh Vein Study follow up. PhD thesis, Edinburgh
Research Archive. https://era.ed.ac.uk/handle/1842/8149.
Robinson, T. and Scullion, J.E. (2021). Oxford Handbook of Respiratory Nurs-
ing. Oxford: Oxford University Press.
Ruggiero, M., Grande, R., Naso, A. etal. (2016). Symptoms in patients with
skin changes due to chronic venous insuciency often lead to emergency care service: an Italian observational study. International Wound
Journal 13 (5): 967–971.
personalised- care.pdf
neuropathy/causes
conditions/skin- hair- and- nails/varicose- eczema
ulcer- venous
conditions/
Seminars
Journal
本书版权归John Wiley & Sons Inc.所有
Соседние файлы в папке Библиотека им академика М.И. Перельмана