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Compression for Primary Prevention, Treatment, and Prevention of Recurrence of Venous Leg Ulcers: An Evidence-and Consensus-Based Algorithm for Care Across the Continuum

Ratliff, Catherine R.; Yates, Stephanie; McNichol, Laurie; Gray, Mikel

Journal of Wound Ostomy & Continence Nursing: July/August 2016 - Volume 43 - Issue 4 - p 347–364
doi: 10.1097/WON.0000000000000242
Wound Care

Chronic venous insufficiency is a prevalent disease that frequently leads to development of venous leg ulcers. While a number of evidence-based clinical practice guidelines have been developed that provide guidance for clinicians when caring for patients with chronic venous insufficiency, they lack adequate detail concerning selection and application of compression for prevention and management of venous leg ulcers. In order to address this need, the WOCN Society appointed a task force to develop an algorithm for compression for primary prevention, treatment, and prevention of recurrent venous leg ulcers in persons with chronic venous insufficiency. The task force used findings from a scoping literature review to identify current best evidence needed to support decision points and pathways within the algorithm. In addition, the task force convened a panel of 20 clinicians and researchers with expertise in lower extremity venous disorders in order to establish consensus around pathways and decision points within the algorithm lacking robust evidence. Following initial construction of the algorithm, a second interdisciplinary group of expert clinicians established content validity and provided additional qualitative feedback used to complete final revisions of the algorithm. This article reviews the process used to create this landmark algorithm, including generation of the evidence- and consensus-based statements used in its construction, the various pathways, and rich supplemental materials embedded within the algorithm, and the process used to establish content validity.

Catherine R. Ratliff, PhD, RN, GNP-BC, CWOCN, CFCN, School of Nursing, University of Virginia Health System, Charlottesville.

Stephanie Yates, MSN, RN, ANP-BC, CWOCN, Department of Advanced Clinical Practice, Duke University Medical Center, Durham, North Carolina.

Laurie McNichol, MSN, RN, GNP, CWOCN, CWON-AP, WOC Nurse, Cone Health, Greensboro, North Carolina.

Mikel Gray, PhD, RN, FNP, PNP, CUNP, CCCN, FAANP, FAAN, School of Medicine, Department of Urology, and School of Nursing, Department of Acute and Specialty Care, University of Virginia, Charlottesville.

Correspondence: Catherine R. Ratliff, PhD, GNP-BC, CWOCN, CFCN, Box 801351, University of Virginia Health System, Charlottesville, VA 22908 (

The authors declare no conflict of interest.

This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially.

© 2016 by the Wound, Ostomy and Continence Nurses Society.