Clinical Pathways for the 5 Wound Types

Choose a wound type to view the associated clinical pathways and guidelines.

Venous Ulcer Pathway

References

Bryant, R., & Nix, D. (2012). Lower-Extremity Ulcers of Vascular Etiology. Acute and chronic wounds: current management concepts 3rd ed., 262-265??. St. Louis, MO: Mosby-Elsevier.

Formosa, C. Screening for peripheral vascular disease in patients with type 2 diabetes in Malta in a primary care practice. Quality in Primary Care, 2012, 409-14.

Venous Ulcer Guidelines

Patient Instructions

Patient should elevate legs above level of heart when sitting
If complaint that wraps/stockings feel too tight, patient should lie down and elevate legs above heart for 45 minutes to reduce swelling; if no relief, patient should contact provider for further instructions
Encourage patient to ambulate
Once ulcer is healed, patient will need to wear compression stockings for rest of life

Nutritional Support

Obtain nutritional labs (comprehensive metabolic panel to include pre-albumin, albumin levels)
Order dietician to evaluate for adequate calories and protein to promote healing
Add daily vitamins and nutritional supplementation as needed

Optimize Host Factors

Manage impact of co-morbidities
Improve patient adherence to care plan
Provide caregiver/patient education

Compression Therapy

The gold standard for venous ulcer management

Graduated compression of lower leg from base of toes to below base of knee, if arterial flow in intact (ABI of 0.8 – 1.0)
Multilayer compression wraps (2, 3, or 4 layers depending on manufacturer: Change 1 - 2 times per week depending on drainage strikethrough

-OR-

Compression stockings, wrap-type garment: Pneumatic compression device with daily to every-other-day dressing changes

ABI Value	Interpretation	Recommendation
Greater than 1.4	Calcification/vessel hardening	Refer to vascular specialist
1.0 - 1.4	Normal	None
0.9 - 1.0	Acceptable	None
0.8 - 0.9	Some arterial disease	Treat risk factor
0.5 - 0.8	Moderate arterial disease	Refer to vascular specialist
Less than 0.5	Severe arterial disease	Refer to vascular specialist

Venous Ulcer