Venous Insufficiency Ulcers Flashcards by Alli Volkens

What percent of the population is diagnose with chronic venous insufficiency, aka post-phlebetic syndrome?

1-2%

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Of the 7 million Americans with venous insufficiency, __% will develop a venous insufficiency ulcer

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__-__% of leg ulcers are due to VI

70-90

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Are men or women more at risk for developing VI ulcers?

women have 3x greater risk

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The risk of ulceration is __ times greater in individuals over the age of 65

7.5

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What is the recurrence rate of venous ulcers?

13-81%

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What is correlated with recurrence?

nonadherence

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Pressure within the venous system generaly drops to around __ mm Hg and decreases to almost _ mm Hg by the time it reaches the R atrium

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Although the names of the 3 layers of the veins is the same as the arteries there are 3 differences, what are they?

Thinner
Smaller amounts of smooth muscle
Less connective tissue support

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At any one time, the venous system stores approximately __-__% of the total blood volume

70-80

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What are the 3 types of veins?

deep
superficial
perforating

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What are 3 examples of deep veins?

femoral
popliteal
tibial

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The deep veins carry __-__% of blood back to heart

80-90

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What are 2 examples of superficial veins?

greater and lesser saphenous

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What are the 2 roles of superficial veins?

Drain skin and subcutaneous tissues

- Assist with temperature regulation

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What is the function of the perforating veins?

Connect deep and superficial veins

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The proximal flow of venous blood relies on what 3 things?

Respiratory pump
Calf muscle pump
Valves

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It is generally agreed that sustained _____ _______ is required for the development of venous insufficiency ulcerations

venous hypertension

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What are the 2 most common causes of venous HTN?

Vein dysfunction

- Calf muscle pump failure

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What are the 2 main theories as to the etiology of venous insufficiency ulcers?

fibrin cuff theory

- WBC trapping theory

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According to the fibrin cuff theory vessel HTN and distention cause what?

an increase in vascular permeability

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Describe the fibrin cuff theory

Fluid and proteins are allowed to move from within these vessels into the interstitium, the protein fibrinogen is converted to fibrin. Fibrin adheres to capillary walls, forming a “cuff”, This cuff is thought to pose a barrier to the exchange of oxygen and nutrients, causing local hypoxia and malnutrition and ultimately cell death and ulceration.

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What is hemosiderin staining caused by?

Leakage of red blood cells into the tissue

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According to the WBC trapping theory vessel HTN and distention cause what?

congestion

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Describe the WBC trapping theory

WBCs trap and plug capillaries leading to tissue ischemia. The WBCs move into the interstitium and release proteolytic enzymes and inflammatory mediators causing tissue damage.

What are the 6 risk factors contributing to VI ulcers?

- Vein Dysfunction - Calf Muscle Pump Failure - Trauma - Previous VI Ulcer - Advanced Age - Diabetes Mellitus

What is the main cause for venous HTN?

valve damage

What are 5 means of valvular damage?

- Degeneration - Scarring - Inflammation - Clot sequelae - Varicosity

Describe why retrograde flow exacerbates venous HTN

The valves may close completely but fail to prevent retrograde flow due to venous distention. Distended veins have an increased vessel diameter allowing some blood to flow backward through the closed, but not overlapping, valve leaflets

What are varicosities?

Varicose veins Dilated veins characterized by an increase in length and tortuosity

What are 4 risks for developing calf muscle pump failure?

- calf weakness/paralysis - decreased DF - prolonged standing - incompetent valves

Venous ulcer recurrence rates are as high as __%

81%

What are the 3 reasons why repeat ulcerations commonly occur in the same location as previous ulcers?

- repeat ulcer may be due to the same cause as the first ulcer - the scar tissue resulting rom previous ulceration has less tensile strength and elasticity - VI ulcers will recur if the precipitating factors are not addressed

Valve degeneration may explain the ____fold increase in venous insufficiency in individuals over the age of 65

seven

How does diabetes lead to an increased risk for VI ulcers?

- increased microvascular disease - impaired immune response - impairs all 3 phases of wound healing

What are the 5 most common clinical tests and measures used to assess individuals with venous insufficiency?

- Clinical Assessment for DVT - Ankle-Brachial Index - Trendelenburg Test - Doppler Ultrasound - Venous Filling Time

What is the gold standard for assessing DVT?

Venogram

When using the clinical assessment guideline for DVT patients scoring less than or equal to _ should be considered to have a high probability of DVT and further assessment should be requested.

Coexisting AI and VI coexist in __-__% of all LE ulcers

15-25

Patients with venous insufficiency ulcers and an ABI less than __ should not be managed with compression due to coexisting arterial insufficiency

0.7

What is the suggested pathology if it takes less than 20 seconds for venous distention to occur with the tourniquet on in the Trendelenburg test?

deep or perforating vein incompetence

What is the suggested pathology if it takes less than 10 seconds for venous distention to occur with the tourniquet removed in the Trendelenburg test?

superficial vein incompetence

What is the gold standard for evaluating the venous system?

Doppler ultrasound

What is the difference between venous and arterial Doppler ultrasound?

When performing an arterial Doppler the clinician must identify the presence or absence of sound. When performing a venous Doppler the clinician must also interpret changes in the sound's intensity.

A Doppler examination consists of 3 parts, what are they? What is the suggested pathology if each test is found positive?

- Resting test: venous obstruction - Augmentation test: partial venous obstruction - Reflux test: valve incompetence

How is venous filling time assessed?

Patient supine, note superficial veins on dorsal foot. Elevate the limb 60° for 1 minute or until veins are drained by gravity. Lower limb to dependent position, note time for veins to refill.

What is normal venous filling time?

5-15 seconds

What is immediate venous filling predictive of?

venous insufficiency

What are the 4 indications for venous filling time?

- Unable to tolerate ABI - ABI > 1.1 - History of diabetes or vessel calcification - Suspected concomitant arterial insufficiency

What are the 7 CEAP Classification System for Chronic Venous Disease?

- C0-C6

Describe C0 classification for chronic venous insufficiency

asymptomatic

Describe C1 classification for chronic venous insufficiency

spider veins

Describe C2 classification for chronic venous insufficiency

varicose veins greater than or equal to 3 mm

Describe C3 classification for chronic venous insufficiency

leg edema

Describe C4 classification for chronic venous insufficiency

skin and subcutaneous tissue changes

Describe C4A classification for chronic venous insufficiency

Hemosiderin deposition

Describe C4B classification for chronic venous insufficiency

Lipodermatosclerosis

Describe C5 classification for chronic venous insufficiency

healed venous ulcer

Describe C6 classification for chronic venous insufficiency

current venous ulcer

Describe pain complaints associated with venous insufficiency ulcers

mild to moderate pain complaints Typically complain of dull, aching leg pain or "heaviness"

What increases and what decreases pain associated with VI ulcers?

Increased with dependency and relieved by elevation

Are VI ulcers most usually located medially or laterally?

medially

What is the typical presentation of a VI ulcer?

Generally superficial, irregularly shaped and have moderate to high amounts of drainage. The wound bed contains beefy red granulation tissue but may take on a ruddy appearance. A thin, yellow fibrous coating may cover the wound bed giving it a glossy look.

What are typical periwound characteristics associated with VI ulcers?

dermatitis, cellulitis, edema, hemosiderin deposition, lipodermatosclerosis

Are pulses generally decreased or normal in VI ulcers?

normal

Is temperature generally decreased, increased, or normal in VI ulcers?

normal to mild warmth

What is the average healing time for full-thickness venous ulcers with appropriate interventions?

8 weeks

What is the healing time for full-thickness smaller venous ulcers with appropriate interventions?

5-7

What is the healing time for full-thickness larger venous ulcers with appropriate interventions?

10-16

What are 5 guidelines for patients with VI ulcers?

- Control swelling - Protect your feet and legs - Live healthy - Know when to call clinician - Inform patients of proper positioning and exercises to enhance venous return

What are the 3 precautions for patient to be aware of with VI ulcers?

- concomitant arterial disease - allergic reactions and sensitization - inappropriate whirlpool use

Under what 5 circumstances should further medical testing be requested?

- Patients scoring 3 or more on DVT clinical prediction guidelines - Wounds that fail to progress - Suspected infection - If bone or capsule is exposed request bone scan/X-ray - Wounds that do not present with typical VI ulcer characteristics

What are the 4 keys to local VI ulcer wound care?

- Protect Surrounding Skin - Address Wound Bed - Enhance Venous Return - Educate Patient/Caregivers

What are the keys to protecting the surrounding skin?

- moisturize dry, scaling skin - use topical steroids to decrease inflammation or weeping - use topical agents prudently to avoid sensitization

What are 2 suggestions when addressing the wound bed?

choose absorptive dressings and use skin sealants

What are 2 ways to enhance venous return?

- Apply compression (if appropriate) | - Instruct patients in methods to decrease edema

List the 8 effects of compression

- Enhances calf muscle pump - Improves venous return - Decreases peripheral edema - Reduces venous distension - Increases tissue oxygenation - Softens lipodermatosclerosis - Protects limb from trauma - Limits need for prolonged elevation/bed rest

What are the general compression parameter recommendations for mild to moderate venous insufficiency at the ankle? At the infrapatellar notch?

30-40 mm Hg 10 mm Hg

For severe venous insufficiency, distal pressures of __-__ mm Hg may be required

40-50

What are the 6 contraindications to compression?

- ABI less than 0.7 - acute infection - pulmonary edema - uncontrolled or severe congestive heart failure - active DVT - claustrophobia

Venous Insufficiency Ulcers Flashcards

(80 cards)