Ask the expert: How to prevent leg ulcer recurrence when moving into compression hosiery. Leg ulceration

Once patients’ leg ulcers are healed, it is recommended that you move them from compression bandaging into leg ulcer hosiery kits or maintenance hosiery. But nurses often have difficulty in getting patients to comply with long-term hosiery use — which does require a lot of commitment — and ulcers often return. We asked Leanne Atkin, vascular nurse specialist at Mid- Yorkshire NHS Trust, how to ensure that your patients keep healing and remain healed when they move into maintenance compression hosiery

Understanding and applying compression therapy

Atkin L, Shirlow

Cellulitis of the lower limbs: incidence, diagnosis and management

Cellulitis is a common clinical condition that is often inaccurately diagnosed. Risk factors for the development of cellulitis include obesity, lymphoedema and lower limb ulceration. It is important to accurately diagnose and effectively treat cellulitis in order to provide cost effective care and reduce patient suffering. This article will deliver an overview on the burden of cellulitis, provide information that will aid accurate diagnosis and summarise current treatment options

Foam dressings: a review of the literature and evaluation of fluid-handling capacity of four leading foam dressings

Posnett and Franks (2008) have calculated that 200,000 people in the UK have a chronic wound, with an estimated treatment cost of between £2.3 billion and £3.1 billion per year. With an ever-increasing ageing population, it can be assumed that costs associated with the management and treatment of wounds will also continue to rise. The Business Service Authority (2014) reported that in 2013 between £160 and £185 million was spent on wound care dressings within primary care services in England, of which foam dressings accounted for £22.6 million of the overall spend. Foam dressings are frequently used in wound care to assist with the management of wound exudate, helping to prevent maceration of the wound bed, protect the surrounding skin and prevent cross-infection caused by strikethrough. The aim of dressings is to provide an optimum environment at the interface with the wound bed to promote wound healing. With limited financial resources within health care, the cost-effectiveness of each type of wound dressing is high on the agenda. It is, however, important that costs are not considered in isolation; the outcomes (general health benefits) associated with interventions (e.g. wound healing and reduction in wound pain) must also be taken into account alongside close collaboration with the patient, and in some cases the carer (Rippon et al, 2008). This article provides a summary of the published literature relating to foam dressings, investigating their impact on healing rates, pain on dressing removal, fluid-handling capacity and their costeffectiveness. It focuses on the independent assessment of the fluid-handling capacity of eight commonly-prescribed foam dressings: four bordered (Cutimed® Siltec B, Mepilex® Border, Allevyn® Life and Tegaderm™ foam adhesive) and four non-bordered (Cutimed® Siltec/Cutimed® SiltecPLUS, Mepilex®, Allevyn® Non-Adhesive, and Tegaderm™ foam)

The changing role of the tissue viability nurse: an exploration of this multifaceted post

This article explores the role of the tissue viability nurse in the UK and discusses the diversity of the role and key attributes and skills required to run a successful service. The article highlights that services differ between organisations and that there is a lack of clarity of the core functions of the role published in the literature. This is compounded by an absence of valid and reliable tools that can be used to measure the effectiveness of the tissue viability service. This article suggests it is now time to revisit the tissue viability role and explore the competencies required, and offer guidance as to the qualifications required for this multifarious post to enable staff to manage the changing needs of a diverse patient group

A new pathway for lower limb ulceration

Leg ulceration is a common cause of suffering for patients, additionally it places a significant burden on the NHS. As the NHS continues to face times of austerity, services need to find other ways of working to reduce cost and release nursing time whilst maintaining standards of care. The implementation of a pathway for the treatment of leg ulceration, which aids diagnosis and uses compression hosiery kits as a first-line management for venous leg ulceration, can form part of the solution by ensuring patient safety, improving patient experience, releasing nursing time and increasing effectiveness of care

Abdominal aortic aneurysms

Abdominal Aortic Aneursym (AAA) is an enlargement of the aorta. The aorta is the main artery that runs from the heart suppling oxygented blood to all the major organs. AAA tended only to be found by coincIndence when patients underwent some form of imaging, although in many cases AAA went undiagnosed until rupture occurred. The survival rate following rupture of AAA is only around 20%, meaning that for 80% of patients a rupture would be fatal, (Mureebe et al., 2008). To try and eliminate death from rupturing of AAA the National Abdominal Aortic Anneursym Screening Programme (NAAASP) was introduced in England in 2008, with the national roll out of the programme completed in 2012. Similar programmes were introduced across Wales, Scotland and Northern Ireland in 2013. Across the UK the NAAASP invites all men in their 65th year to attend screening for abdominal aortic aneursym. With the full implementation of NAAASP nurses working in primary care will come into contact with men invited for screening or patients undergoing regular surviellence of known AAA. This article aims to provide an update for practice based nurses reviewing knowledge and evidence base relating to the causes, management and treatment of patients with known AAA

Exploring the role of the Tissue Viability Nurse

Aim: To explore the role and identify key responsibilities of the Tissue Viability Nurse (TVN) in the UK. Methods: Mixed methodology using questionnaires distributed via SurveyMonkey and semi-structured interviews. Results: 261 respondents completed the online questionnaire and seven participated in semi-structured interviews. Of the 261 respondents to the questionnaire, 63.7% were employed as TVNs. Almost all respondents claimed to have access to a tissue viability service and the mean TVN team size was 4.7. Some 81.9% of respondents stated they had a team vision, with 75.9% stating that their service had set criteria for referrals. Analysis showed a statistical significance (χ2 (1)=16.6; p<0.001) between TVNs’ and non-TVNs’ knowledge of the referral criteria, with the latter being more aware. There was a variety of other titles used for the role, with interviewees affirming this was poorly understood by patients. Discussion: The results of this study identified that there is no national job title for the TVN role. Data identified that patients do not fully understand the title ‘Tissue Viability Nurse’. The TVN role is complex and not just about the management of a wound. However, what is also clear from the analysis of the data is that there are no clear criteria, or educational level, for the role. Data also suggest that review of current service provision, including partnership working with the multidisciplinary team and industry, is required to develop national competencies, guidance and quality assurance measures