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8 JCN
Supplement 2016
The success and feeling of relief after
healing a venous leg ulcer (VLU) may
be shortlived if adequate compression
therapy cannot be maintained thereafter.
Recurrence rates of venous leg ulcers
are high (Shenoy, 2014; Harding et al,
2015), which not only contributes a
cost burden to the over-stretched NHS
budget, but also has a financial and
social impact on the patient (Adderley
and Thompson, 2014).
Appropriate compression is
necessary to prevent recurrence
in venous leg ulceration
The National Institute for Health
and Care Excellence clinical knowledge
summaries (CKS) state that following
the healing of aVLU, education and
lifestyle changes are important to prevent
recurring breakdown (NICE, 2016).
NON-CONCORDANCE?
In the author’s experience, a label of
‘non-concordance’is usually given to
patients who are physically unable to
carry out the care advised, or who find
the prescribed treatment too painful.
Education plays a prominent role
in helping patients and their families/
caregivers understand the importance
of treating the underlying condition
to prevent further breakdown, with
compression therapy being key to
maintaining a healedVLU.
COMPRESSION HOSIERY
The level of compression that hosiery
delivers is indicated by its class, ranging
from 1–3. However, there are variations
in the level of mmHg depending on the
type of hosiery being used, i.e. British
While multilayer compression bandaging has traditionally been seen as gold standard therapy
for venous leg ulcers, success of treatment depends on the competency of the nurse applying the
bandages and patient concordance (Scottish Intercollegiate Guidelines Network [SIGN], 2010).
Furthermore, wearing compression is a lifelong commitment as, following healing, it is still needed
to prevent ulcer recurrence and skin breakdown. During this maintenance phase, compression
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(medi UK) is an alternative
maintenance system for those patients who cannot tolerate or apply compression garments.
This feature asks experts in their particular field to take a look at a therapy area and
examine some of the challenges that general practice nurses (GPNs) may face. Here, we
look at how...
(BS), RAL (German Standard) or
French Standard. So, just asking for
a class 1 garment will not allow for
accurate compression (or‘dosage’
of compression required).
The class of hosiery chosen should
always be in line with the severity
of symptoms to treat the underlying
disease, i.e. the more severe, the higher
the class of compression.
If aVLU has healed using 40mmHg
compression at the ankle (i.e. if the
patient’s ankle brachial pressure index
[ABPI] was within normal limits, the
compression required is 40mmHg; SIGN,
2010), and a class 1 BS compression
garment is applied (offering 14–17mmHg
at the ankle), the patient’s skin is likely to
breakdown relatively quickly as there is
not enough external pressure to correct
the internal (underlying) condition.
HOW COMPRESSION WORKS
Compression works by delivering the
highest level of compression at the ankle
(where most internal pressure is found
in chronic venous insufficiency [CVI]),
THE ANSWER
Monica Smith, clinical trainer,
medi UK
THE PROBLEM
Ask the expert