Dressings and moisture balance

1. Margi Moncrieff Nurse Practitioner FMC Dressings and moisture balance Hydrogels Hydrocolloids Foams Alginates Aquacel dry moderately exuding heavily exuding moist (optimal healing)

2. Venous ulcers and assessment Although the ulcer may appear venous, the assessment process is aimed at eliminating an arterial component, so that safe and effective treatment can be offered. If an arterial pathology is detected, then a referral to the vascular surgeon is required.

3. Doppler (ABPI) • Lie the patient flat for at least 10 minutes • Apply appropriate size cuff around upper arm; locate brachial pulse; apply gel and hold Doppler probe at angle of 450:inflateuntil pulse disappears, deflate and record the point at which the pulse returns; = brachial systolic reading • Repeat on the other arm and record the highest reading of the two, to calculate ABPI

4. Doppler (ABPI) continued • Place cuff around ankle, above malleoli (any higher up the leg can give a higher reading) • Locate DP; apply gel; hold Doppler probe at angle of 450 :inflateuntil pulse disappears, deflate and record the point at which the pulse returns; repeat for PT; Record the highest pressure • Repeat process for other foot: Record the highest pressure • Divide the highest ankle pressure by the highest brachial pressure to give your ABPI

5. Ankle Brachial Pressure Index 1 – 1.2….Normal 0.9……….Mild arterial effect (safe to compress) < 0.7 …..Significant arterial disease < 0.6…….Severe PVD >1.3………Refer to vascular specialist • > 1.3; If the arteries of the leg are calcified or hardened, they may fail to occlude even at high pressure. The systolic ankle pressure may then appear higher, and a false high reading recorded. Other conditions giving higher readings are renal disease and gross oedema