Venous Wounds

superficial veins

veins located in the subcutaneous tissue; valves more abundant in lower leg vs. thigh

deep veins

veins that accompany the arteries and are deep to fascia and muscles

perforating veins

veins that penetrate fascia to connect the superficial and deep veins

greater saphenous vein, lesser saphenous vein

2 major superficial veins

muscle pump

most important mechanism in returning venous blood; pushes blood out of the deep veins and into the central circulation

backflow

damage to valves causes ____ of blood from the deep to superficial vein

negative

the movement of the diaphragm creates a ____ pressure in the chest; this assists the return of blood from the legs to the heart

inadequate vascular support, excessive pressure, inadequate nutritional support

three reasons wounds do not heal

Wells criteria and probability of DVT?

Diagnostic test based on Wells score?

clinical prediction rule to assess the probability of a DVT (-2 to 9)

low

a score of less than or equal to 1 on the wells criteria indicates a ____ probability of DVT

high

a score of greater than 1 on the wells criteria indicates a ___ clinical probability of a DVT

treatable

chronic venous disorders are ____ but not curable

venous hypertension

failure of valves results in this; causes distention of superficial veins and fluid is forced into interstitial space

extravasation

leakage of fluids from vessels into surrounding tissues; caused by venous hypertension

venous

Lipodermatosclerotic changes seen with ____ wounds; localized limb pain that is decreased with elevation, pain with deep pressure palpation, pedal pulses present, increased temperature around wound, indistinct irregular wound edges, lower extremity edema, substantial drainage, hemosiderin staining

Fibrin Cuff Theory

theory of chronic venous insufficiency; fibrin accumulates in the dermis and causes a "fibrin cuff" that creates hard, non-pitting edema. This allows large macromolecules to escape into the interstitial space and edema forms in the leg due to pooling of fluid in the dermis. Fibrin forms a mechanical border and lessens the delivery of oxygen and other nutrients to the skin

White Blood Cell-Trapping Hypothesis

theory of chronic venous insufficiency; chronic venous hypertension causes WBCs to become trapped in microcirculation of the legs, leading to tissue damage and ulceration. Elevations in venous pressures decrease capillary blood flow, resulting in trapping of WBCs at the capillary level. This plugs the capillary loops and results in areas of localized ischemia. Ischemia and possible WBCs release of proteolytic enzymes aid in cell death

Stage C0

Stage of venous insufficiency; no visible signs - legs may feel heavy, tired, or ache. May experience cramps

Stage C1

Stage of venous insufficiency; spider veins - may or may not hurt

Stage C2

Stage of venous insufficiency; Varicose veins - veins become swollen, twisted, and more noticeable. Likely feel heaviness, aching, burning

Stage C3

Stage of venous insufficiency; Leg edema - feet, ankles, legs are swollen by end of day, fluid leaking out of over pressured veins

Stage C4A

Stage of venous insufficiency; Skin and subcutaneous changes - hemosiderin deposits

Stage C4B

Stage of venous insufficiency; Skin and subcutaneous changes - lipodermatosclerosis

red

Hemosiderin staining occurs because ___ blood cells also leak out of the dilated vessels; iron-containing hemosiderin and stimulated melanin get trapped in the skin around the problematic area and cause a darkening of the surrounding tissues

Lipodermatosclerosis

A result of inflammation of the subcutaneous adipose tissue; tissue becomes sclerotic overtime - becomes thick, hard, and contracted (dark pigmented, may be painful, becomes bound down) **Inverted champagne-bottle appearance

Stage C5

Stage of venous insufficiency; healed venous ulcer

Stage C6

Stage of venous insufficiency; current venous ulcer - open, weeping, active ulcer, requires wound care

ambulatory venous hypertension

Sustained high pressure in lower pressure veins caused by retrograde flow from incompetent valves - edema builds up in legs due to congested superficial veins and capillaries

painless

venous woulds are typically _____ to moderate pain

LE

venous wounds are typically on the ____ NOT involving the feet

heavy

venous wounds have moderate to ____ drainage

irregular

venous wounds have _____ borders

shiny

the skin around venous wounds is often ____, taut, and sclerotic

edema

_____ is one of the biggest barriers to healing, especially for LE ulcers

1+

Pitting edema scale; slight pitting, no visible distortion, disappears rapidly

2+

Pitting edema scale; somewhat deeper pit, disappears in 10-15 seconds

3+

Pitting edema scale; noticeable deep and may last more than one minute

4+

Pitting edema scale; pit is very deep, lasts 2-5 minutes, extremity is grossly distorted

0.7

if ABI is < ____, compression is contraindicated

1.0 1.4

normal ABI value is ___-____

1.4

an ABI of greater than ___ indicates calcification/vessel hardening

0.9 - 1.0

an ABI of __-___ is considered acceptable

0.8 0.9

an ABI of ___-___ is considered some arterial disease

0.5 0.8

an ABI of ___ to ____ is considered moderate arterial disease

0.5

An ABI of less than ___ is considered severe arterial disease

< 0.6

abnormal toe brachial index

toe

___ brachial index is more accurate in diabetics with calcification of vessels

10 15

a venous fill time of ___-___ seconds is considered normal circulation; in venous insufficiency volume increased RAPIDLY through arterial flow and venous backflow

compression

_____ therapy is highly recommended for treatment of venous wounds; important to decrease edema, optimize wound healing, emphasize exercise/walking program, nutrition management, medical management

exercise

_____ is important to improve the efficiency of the calf muscle pump

short

____ stretch compression bandaging (30-40 mm Hg) is used for edema management of CVI

ABI <0.7, thrombus, infection, acute CHF

contraindications for compression

absorbent

_____ dressings are important for venous wounds (alginates, foams, hydrofibers)

absorbent necrotic bacterial

wound interventions; ____ dressings, remove ____ tissues, maintain _____ balance