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Venous Etiology Clinical Pathways Integrated with Evidence-Based Decisions

Part 2

Hess, Cathy Thomas BSN, RN, CWOCN

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Advances in Skin & Wound Care: May 2013 - Volume 26 - Issue 5 - p 240
doi: 10.1097/01.ASW.0000429322.74562.7c
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The key to treating any chronic wound is to address the underlying problem. Because elevated venous pressure and resulting edema are the problem with venous ulcers, compression therapy to control this is crucial to successful management. Leg elevation, dressings, and debridement all play important roles in managing venous ulcers.

Technologies—such as skin substitutes and biologics, growth factors, and gene therapy—provide additional choices for the treatment of chronic venous ulcers.

When assessing a venous ulcer at week 4, take time to look at the wound to determine progress, stagnation, or decline. Review the prior documentation and interventions. Introducing new approaches into the plan of care may be appropriate at this time. The sample Figure, in this column and previous columns, provides clinicians and physicians with evidence-based recommendations for the care of venous-related wounds. Key decision points are provided based on research that combines healing rates, at 4 weeks, with expected outcomes. If the patient does not meet a given healing rate, closure objective research suggests that he/she will experience delayed healing in the weeks to come. The provider may, at this point, act on further evidence-based adjunctive therapy recommendations altering the patient’s expected negative outcome.

Figure 1
Figure 1:


1. Robson MC, Cooper DM, Aslam R, et al.. Guidelines for the treatment of venous ulcers. Wound Repair Regen 2006; 14: 649–62.
2. Registered Nurses Association of Ontario (RNAO). Assessment and management of venous leg ulcers. Toronto (ON): Registered Nurses Association of Ontario (RNAO). 2004 [112 pp, 64 references]. Last accessed March 22, 2013.
    3. Hess CT. Clinical Guide: Skin and Wound Care. 7th ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2012.
      © 2013 Lippincott Williams & Wilkins, Inc.