Maintain pressure on reforms to protect NHSVenous leg ulcer healing could improve thanks to a new assessment system
An assessment tool to predict venous leg ulcer healing has been developed at Cheltenham General Hospital’s Department of Vascular Surgery. The authors suggest it will help give more accurate prognosis information for patients and may help guide service provision.
The study showed that patient age, ulcer chronicity and a venous refill time of 20 seconds or less (measured with a digital photoplethysmography – PPG) were risk factors for ulcer healing. These were then used to devise a formula to identify patients unlikely to respond to conventional treatment.
Judy Harker, nurse consultant in tissue viability at Penine Acute NHS Trust, Manchester, said: ‘Given that venous leg ulcers are a common, chronic, recurring condition, the development of a tool to predict venous ulcer healing is welcomed by practitioners.
‘PPG is not available in all leg ulcer services and is likely to be restricted to more specialist vascular/leg ulcer units, thus limiting the use of the tool in routine practice. Nonetheless, it could be argued that this study highlights the need for greater time and attention to be directed towards assessing venous competence within a limb, especially as venous refilling time had the greatest impact on healing.’
She noted that adding venous investigations to the baseline assessment of a patient with a leg ulcer would have resource implications
for the health service.
Kulkarni, S.R. et al (2007) The Ulcerated Leg Severity Assessment score for prediction of venous leg ulcer healing. British Journal of Surgery; 94: 2, 189–193.
Reduce pain at dressing change
Oral transmucosal fentanyl citrate (OTFC) improves analgesia during painful dressing changes, a randomised controlled trial
has shown.
Nine patients who experienced pain at these times were given entonox plus either a placebo or OTFC for two consecutive dressings. A significant reduction in pain was identified when they received OTFC compared with the placebo and required less entonox. Patients did not report side-effects such as sedation and vomiting.
Fentanyl is a potent opioid that is absorbed by the oral mucosa and can be given as a lozenge. Analgesia is rapid.
The Smith and Nephew Foundation is looking for nurse researchers who will be able to contribute to the evidence base for the nursing care of patients with skin or tissue damage and vulnerability.
The Foundation is offering a Doctoral Research Studentship and a Post-doctoral Nursing Research Fellowship and is particularly interested in:
Factors influencing the physiological response to tissue damage;
The role of infection in delayed healing;
Factors influencing treatment decisions in skin/wound care;
Foundation seeks nurse researchers
The Leg Ulcer Forum’s conference in the south-east will run on 12 July at DeVere Harben Hotel, Newport Pagnell, Buckinghamshire.
www.legulcerforum.org.
l Mölnlycke Health Care’s Mepilex Border dressing, suitable for surgical wounds, now comes in new sizes: 10x20cm and 10x30cm.
l A Cochrane review shows there is insufficient evidence to say if topical agents or dressing types affect arterial leg ulcer healing.
Cochrane Database Systematic Review (2007) 24: 1, CD001836.
l A Cochrane review has shown there is insufficient evidence to support using topical silver dressings when managing contaminated or infected chronic wounds.
Cochrane Database Systematic Review (2007) 24: 1, CD005486.
l Coloplast has launched Biatain–Ibu. This is an absorbent wound dressing with a continuous local release of ibuprofen directly into the wound.
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