Tips for Managing and Caring for Venous Leg Ulcers
EIGHT SELF HELP TIPS
1. KEEP THE COMPRESSION BANDAGING IN PLACE
Instructions given by the nurse or physician as well as those provided by the manufacturer should be followed conscientiously regarding managing the compression bandage between visits.
The bandage should be applied like a sleeve not a clamp, otherwise it can create a tourniquet effect and this can cause pain. Avoid producing a high band of compression in the calf region of the leg which is a common mistake.
If the bandage has to be reapplied in the morning, make sure it is done before the person gets up or after he or she has been lying down for at least half an hour.
The more time the patient spends under good compression the more time the ulcer has to actively try to repair itself. Each time a little swelling is allowed to occur it must be reduced to start the healing process again. For this reason the medical team may decide on a system that stays on for a full week.
Check with the person in your care to see if there are some instructions she does not understand. Find out if she knows why compression is important. If she does not understand, explain the reasoning behind this treatment.
2. EXERCISE
Veins do not have their own muscles to pump blood out of the leg. For this reason they rely on us to use our foot and leg muscles to provide the pumping force.
Exercise without compression works against the treatment by forcing more blood into the lower leg and raising the venous pressure.
3. ELEVATE THE LEGS AND REST PROPERLY
Lie down and raise your feet higher than your heart by about six inches. This removes the problem of gravity trying to slow down the venous blood moving up your legs. Instead gravity is now working gently in your favor. Do this type of resting as frequently as possible.
4. USE COMPRESSION STOCKINGS CORRECTLY
After the leg ulcer has healed or before one develops the use of these stockings is vital to prevent swelling in the legs and therefore help prevent leg ulcers and venous problems.
Read the manufacturer’s instructions and ensure proper fitting with a specialist fitter.
For best results, compression stockings should be worn from dawn till dusk, all day long, every day.
They should be put on in the morning before getting out of bed. If the patient has left his bed without putting the stockings on, he should go back, lie down for a few minutes with his legs elevated and wiggle his toes. He should remain in this position and then pull on the stockings.
Over a time, due to swelling or becoming more muscular, a person may need to change the type of compression stockings he or she is using. Keep a record of the size of the stocking, and make a note of the stockings purchased, pinpointing the date for purchasing new ones.
A commonly asked question is, “Should you remove stockings if aching or tightness in the leg is experienced?” The answer is usually, No. The reasons for the symptoms are due probably to a period of inactivity and a build-up of fluid in the leg. Walking around or exercising the legs is recommended.
Compression stockings should be washed by hand in cool water with a mild soap. Wring them gently in a towel and avoid stretching them. Let them dry in the open air, away from sources of heat. And NEVER put them in the dryer.
5. ADHERE TO TREATMENT
Whether the person in your care is having surgery, taking medication, having stockings fitted and so on, she must fully understand what she needs to do to help herself.
6. MAINTAIN ADEQUATE SKIN CARE
As well as following the tips and using the recommended products, the skin must be inspected on a regular basis. Any changes or suspected problems should be reported immediately to the medical team. Remember, small fresh ulcers can heal quickly so the sooner they are detected and treated the less discomfort, bother and expense will be involved.
7. ASK FOR PAIN TREATMENT
Pain is a major quality of life issue and there is no need for the sufferer to accept pain as normal.
8. CHOOSE A HEALTHY LIFESTYLE
If you smoke, stop; eat nutritiously, lose weight if necessary, seek support from family, friends and caregivers, and maintain a positive attitude.
SEVEN COMMON SENSE TIPS
1. AVOID STANDING FOR LONG PERIODS OF TIME
If your job or certain activities demand you stand without moving for long periods of time, this will usually increase swelling and hinder the healing process. You must try to be assertive and ensure that you rest properly or obtain a chair or stool. Try to move about as often as possible and exercise the legs. Sitting in cramped quarters can also be a problem which should be avoided.
2. DO NO HARM
A knock on your ulcer can set back the healing process significantly. Even damage to skin that is vulnerable to leg ulcer development can bring on the condition.
Do not expose your legs to strong heat sources – this is a common mistake as people often think heat will help circulation. Instead, the heat can damage skin and veins.
Try to arrange your surroundings so that they are as accident free as possible. Get rid of protruding objects, make sure the floors are not slippery, and so on.
3. DON’T CROSS YOUR LEGS
When sitting or lying down do not cross your legs. It can reduce circulation and therefore worsen the venous problems.
4. AVOID WEARING RESTRICTIVE CLOTHING
Tight pants, tight socks, garters or anything that can restrict blood flow must be avoided.
5. MAINTAIN GOOD HYGIENE & INFECTION CONTROL
If you are involved with dressing changes or any activity around the leg ulcer make sure you have washed your hands thoroughly. An infection caused by unclean hands can seriously set you back as far as the healing process is concerned.
6. AVOID SCRATCHING
This is the most common way of bringing on a leg ulcer by your own actions. Often scratching can be due to dry itchy skin and there are products available that can rectify this. You may scratch without thinking so make sure your nails are kept short to minimize damage.
7. TRAVEL TIPS
When riding in the car, stop, get out and walk around frequently to avoid build-up of fluid in the legs.
If you sit for a long period of time in the same position on an airplane, try to get up and walk about or do the foot exercises. Informing the attendant of your needs may help you obtain a seat with more leg room or better access to the aisle.