Embed Size (px)
Citation preview
svn.org.uk 3rd Quarter 2015
�1
VASCULAR MATTERS 3rd Quarter 2015
The venous disease edition
Also inside breaking news about the 2015 SVN Conference
Follow the Society of Vascular Nurses on Facebook & Twitter for the latest vascular nursing news
@vascularnurses
svn.org.uk 3rd Quarter 2015
�2
President Research & Development Michael van Orsouw
Matron for Vascular C/O Luke & Evan Jones Wards, 1st Floor, North Wing, Dept of Vascular Surgery, St Thomas Hospital, Lambeth Palace Road, SE1 7EH 0207 188 7188, ext 54090, Bleep 2536 [email protected]
Vice President Nikki Fenwick
Vascular Nurse Specialist Sheffield Vascular Institute, 2nd Floor Nurses Home, Northern General Hospital, Herries Rd, Sheffield, S5 7AU. 01142 434343 Blp 2773 [email protected]
Past President Aisling Roberts
Vascular Nurse Specialist Wren Unit, The Great Western Hospital, Malborough Rd, Swindon, SN3 6BB 01793 604373 [email protected]
Vascular Matters Editor Emma Bond
Vascular Nurse Specialist Glan Clwyd Hospital, Sarn Lane, Bodelwyddan, N.Wales, LL18 3PS 01745 445405 [email protected] [email protected]
Vascular Matters Editor Website Co-Ordinator Leanne Atkin
Vascular Nurse Specialist Division of Podiatry, Dept of Health Sciences, Ramsden building, RG/11, The University of Huddersfield. [email protected]
Membership Sue Ward
Vascular Nurse Specialist C/O Mr Brooks’ Secretary, Royal Sussex County Hospital, Eastern Rd, Brighton 01273 696955 Blp 8213 [email protected]
Conference Organiser Louise Allen
Vascular Nurse Specialist St Mary’s Hospital, Praed St, London W2 1NY 0203 312 6246 [email protected]
Affiliation Ruth Chipp
Vascular Nurse Specialist C/O Vascular Secretaries, Sunderland Royal Hospital, Kayll Rd, Sunderland, SR4 7TP 0191 5656256 Ext 42409 [email protected]
Secretary Helen Sanderson
Vascular Nurse Specialist Southend Hospital, Wound Management Unit, Balmoral Ward, Prittlewell Chase, Westcliff On Sea, SS0 0RY 01702 385354 [email protected]
Interim Secretary Evening Symposium Claire Thomson
Vascular ANP Wd 14, Royal Bournemouth Hospital, Castle Lane, Bournemouth, Dorset, BH7 7DW 01202 303626 bleep 2620 [email protected]
Evening Symposium Organiser Corporate Sponsorship Gail Curran
Vascular Nurse Practitioner The Cambridge Vascular Unit, Box 201, Addenbrooks Hospital, Cambridge Biomedical Campus, Hills Rd, Cambridge, CB2 0QQ 01223 245151 Blp 154-226 [email protected]
Competencies Lead Lifetime Awards Kate Rowlands
Vascular Nurse Specialist C/O Ward B2, Cardiff Regional Vascular Unit UHW, Heath Park, Cardiff CF14 4XW 02920 742699, L/R Bleep 07623906342 [email protected]
Treasurer Bursaries Jayne Burns
Non-Committee Role
SVN COMMITTEE
svn.org.uk 2nd Quarter 2015
�3
Contents
Page 5 SVN President’s Welcome
Page 8 The Challenges of compression hosiery, the theory to practice dilemma, Wendy Hayes
Page 14 Venous Forum 2015, Ruth Chipp
Page 16 NAAASP referrals to The Sussex Vascular Unit 2014 – 2015, Sue Ward
Page 17 Venous Leg Ulceration: A look back on changes in practice, treatments and patients, Leanne Atkin
Page 23 Progress on a systematic literature review exploring mixed component elastic/inelastic compression systems, Lynne Welsh
Page 25 The Circulation Foundation Prize, Nikki Fenwick
Page 28 SVN Draft Conference Programme
Vascular Matters Editors
Leanne Atkin & Emma Bond
svn.org.ukThe official website of the Society of Vascular Nurses
Visit here for information on SVN membership, conference information, bursary applications and much, much more!
svn.org.uk 1st Quarter 2015
Vascular Matters �4
SVN Membership Form (also available online svn.org.uk)
FULL NAME:_____________________________________________________________________________
ADDRESS:______________________________________________________________________________
___________________________________________________________POSTCODE:__________________
Email:_____________________________________________________Tel no: ________________________
JobTitle:___________________________________________________Grade:________Hospital________
Area of work: (e.g.Community/Ward/Lab)__________________________________________________
MEMBERSHIP TYPE Full (circle as appropriate): NEW MEMBER / RENEWAL (all registered nurses)
ASSOCIATE (all other Healthcare professionals with an interest in vascular care)
WARD MEMBERSHIP Does this include a Nurse Specialist? Name of Nurse Specialist: _______________
ANNUAL MEMBERSHIP FEE: £20 OVERSEAS MEMBERSHIP £25WARD MEMBERSHIP £100
Cheques should be made payable to the ‘Society of Vascular Nurses’
In accordance with the Data Protection Act you are advised that enrolment information provided by members will be computerised and used for administration purposes. It may be shared with third parties in order to send you RELEVANT information (for example, information about vascular products, study days, courses, meetings etc).
I do not want my name and address circulated on mailing lists (please tick for NO)
Please return form and fee to: Sue Ward VNS Vascular Assessment Unit, The Royal Sussex County Hospital, Eastern Road, Brighton BN2 5BEEmail [email protected] Tel 01273 696955 bleep 8213
Confirmation of membership will be sent via emailplease email [email protected] if you have any queries or think your SVN membership has expired
svn.org.uk 1st Quarter 2015
Vasdcular Matters �5
President’s Welcome
Welcome to the 3rd quarter edition of the Society of Vascular Nurses’ newsletter. The committee has been very busy developing the agenda for the annual conference, which will take place on Thursday the 12th of November 2015 at the Bournemouth International Centre. As in previous years we plan to hold a vascular symposium, which will take place on the evening of the 11th of November 2015 prior to the conference. If you have never been to conference before I would thoroughly encourage you to come. Not only is the programme specifically designed for nurses caring for vascular patients it also gives nurses an opportunity to network with vascular nurses throughout the country.
As we do every year we will be running a prize presentation (The James Purdie prize) so please read the newsletter or have a look on the website for details of entering: http://www.svn.org.uk/conference/james-purdie-award/.
It is with regret that I have to announce that Ruth Chipp will be resigning from the committee in November and I would like to take the opportunity to thank Ruth for her years of hard work and dedication to the society. Her resignation does leave a vacancy on the committee and provides an opportunity to join the committee of the Society of Vascular Nurses and help steer the future of vascular nursing. Further information about the application process can be found within the newsletter.
Recently in my role as the vascular matron at St Thomas’ hospital I met one of the survivors of the 7/7 terrorist attack in London Gill Hicks. She was visiting as it was 10 years since the terrible attack: two things which stuck me about the meeting were firstly how fragile life can be and how Gill had managed to adapt so well to her horrendous injuries and secondly what stuck me was that 10 years had absolutely flown by - a sure sign of how time flies.
Finally I hope you all enjoy this edition and please send any articles, reviews, case studies or points of interest you may have to the editorial panel - it's always good to hear from you.
Michael van Orsouw
svn.org.uk 1st Quarter 2015
Vascular Matters �6
Find Wound Expo on Facebook
WoundExpo 2015
Media partners:
Wound Expo offers FREE, interactive education for nurses in the fundamental aspects of wound care. It helps front-line nurses strengthen their core skills and inspire better wound care practice.
Wound Expo TVN launches this year with free specialist education aimed at the progressive expert practitioner. Wound Expo TVN is aimed at providing the specialist nurse with education on areas of wound care not normally covered at events.
An unforgettable learning experience for front-line nurses
Exhibition Centre, Liverpool
2nd & 3rd September 2015
Register for your FREE place at www.woundexpo.com
WoundExpo TVN
svn.org.uk 1st Quarter 2015
Vascular Matters �7
The Society of Vascular Nurses Award for services to vascular nursing 2015
The society of vascular nurses is calling for applicants for this distinguished award, established in 2008. The award will be presented in recognition of outstanding leadership, participation and dedication to patients with vascular disease. Nominations will be reviewed by the committee and the award will be presented at the annual SVN conference, which this year will be in Bournemouth. The worthy recipient of this award will receive free lifetime membership to the society of vascular nurses, and free lifetime conference entry.
If you know of a nurse who you feel deserves this award, please submit your nomination with a 150 word attachment to support the application.
Eligibility requirements: The nominee for the award for Services to Vascular Nursing must meet the following criteria.
• Registered nurse or health care assistant working within the UK • Be involved in direct vascular patient care in either a ward, theatre, outpatient or
community setting • Nominator or nominee need not be a member of the SVN
NOMINEE Name: ……………………………………………………………………………………………………
Address: ………………………………………………………………………………………………...
……………………………………………………………………………………………………………
Phone: …………………………………………………... Email: ……………………………………..
NOMINATOR Name: ……………………………………………………………………………………………………
Address: …………………………………………………………………………………………………
Phone: ……………………………………………………. Email: ……………………………………
Please submit to Kate Rowlands
VNS c/o Ward B2 Vascular
University Hospital of Wales Heath Park
Cardiff CF14 4XW
Tel: 02920 742699 Email: [email protected]
svn.org.uk 1st Quarter 2015
Vascular Matters �8
The Challenges of compression hosiery, the theory to practice dilemma
Wendy Hayes, Vascular Nurse Consultant, Worcestershire Acute Hospitals NHS Trust
It is well documented that the use of compression hosiery is paramount in the prevention of recurrence of leg ulceration, (Barwell et al., 2004). Unfortunately, as we are all too aware, the application of theory to practice can be problematic.
Unfortunately personal experience last year really demonstrated this for me. In August of last year my Mum had a bad fall down stairs. This resulted in bilateral fractures to her arms – both of which required surgery. The right arm required a pin and plate repair, the left wrist was repaired with insertion of K wire. She also developed a haematoma to her right medial gaiter that subsequently progressed to ulceration.
The psychological effects of losing independence and control are well documented, (Briggs et al., 2007) it was very evident to all of her family that this was a definite issue for my Mum. As a result of her accident she had the ‘overnight’ transformation from being a totally independent lady, who was very mobile and really enjoyed socializing with her friends and family, regularly walking the mile or so into town, to being totally dependent on others for the most basic activities of daily living i.e. feeding, washing, toileting, dressing. She progressed well and after 12 weeks managed to be discharged home with a minimal package of care to support her in her own home. Her arms had healed well but had left her with very limited use and strength – the right arm was the most problematic, and unfortunately she is right hand dominant. Her leg ulcer was progressing well. Initially Community Nursing staff visited and redressed the wound. It was responding very well to compression therapy bandaging. As she became more mobile and regained her confidence she visited her GP Practice for dressing changes and after about 8 weeks the ulceration healed. In line with Royal College Nursing Guidelines, ( RCN, 2006) and the recent World Wide Wounds (WWW) Position Statement relating to compression hosiery, ( WWW, 2014), her Practice Nurse measured Mum for compression hosiery. It was at this point that the theory /practice issues began.
Due to her restricted range of movement and lack of strength Mum was unable to apply the hosiery. As she lives alone and some distance from other members of the family she was unable to obtain help to apply them. As a result of this, after discussion with her practice nurse it was decided not to apply any hose and to monitor the limb. Unfortunately within 5 days the very fragile new tissue was already displaying signs that the ulceration would recur.
The Practice Nurse was really helpful and understanding. I was very mindful that I did not want to be the overbearing Nurse Consultant who was interfering with my Mums care, but as her daughter I of course wanted to do my best for her to ensure that she got the correct treatment. Together with her Practice Nurse we explored the options that were available to her. Mum was very keen to be totally independent and not to have to attend surgery every week for bandaging. She also wanted to be able to wear her own ‘normal’ footwear rather than footwear to accommodate bandages. She still takes great pride in her appearance.
svn.org.uk 1st Quarter 2015
Vascular Matters �9
Most of the devices that are marketed for the application of hosiery were not suitable for Mum to use. She did not have the dexterity to thread plastic through holes or the amount of strength needed to stretch a garment over a metal frame. Then a ‘Eureka’ moment arrived. We were able to access an application aid that had a magnetic fastening mechanism, and also some gloves with rubber ‘pimples’ on the fingers which aided her very limited grip. The other decision that we made was that we would try a very reduced compression garment initially to see if Mum was able to manage that. If the ulceration displayed signs of recurrence the practice nurse would have to revert to compression therapy bandaging. This would not have been ideal but Mum agreed that this was better than ongoing ulceration. From a professional perspective I had empathy for the Practice Nurse who was trying her upmost to ensure that the ulceration remained healed even though it had an impact upon her caseload. The garment selected and prescribed was a 10mmHg liner stocking normally used as layer 1 of a 40mmHg Leg Ulcer Hosiery Kit. We were all delighted that Mum was able to manage to apply and remove this successfully.
We are now nearly 6 months from when the ulcer healed and I am very pleased to say that the ulceration has remained healed and that my Mum has regained her independence and enjoying life again and does not have to attend surgery for dressings.
This experience has served to highlight that over the last few years there have been many improvements and innovations in the variety of compression systems, hosiery garments and application aids. There are many options available but many remain to require an amount of strength and dexterity. Luckily in this instance communication and collaboration resulted in a very good outcome for my Mum. This also served to highlight that as specialist practitioners we do have a wealth of knowledge and experience and that sometimes we may know what the ‘theory’ is but in clinical practice it is not appropriate.
REFERENCES
Barwell J. et al (2004) Comparison of surgery and compression with compression alone in chronic venous ulceration. Lancet 2004 363 1854-59
**********Breaking News**********Dear Colleagues,
Following discussions with the Vascular Society, Society of Vascular Technologists and the Society of Vascular Nurses for this year we are going to change the registration procedure for the conference. As you aware, in previous years if you wanted to registrar for the Society of Vascular Nurses Conference this had to be carried out via the Society of Vascular Nurses web page. It was felt that this may have led to some confusion for nurses wanting to attend the conference particularly if they wanted to attend the Vascular Societies conference as well. So for this year nursing conference at Bournemouth on Thursday the 12th of November 2015 we have decided that the registration will be carried out via the Vascular Societies web page: http://www.vascularsociety.org.uk/ .It is hoped that this will makes the process of registering simpler and offer nurses access to both conferences. However as always we would welcome feedback about the change. For further detail please check the website on: http://www.svn.org.uk/Michael van OrsouwPresident of the Society of Vascular Nurses
svn.org.uk 1st Quarter 2015
Vascular Matters �10
Monday 19 October 2015 Hallam Conference Centre London
Recognised by
online payments
discount*Group booking
discount**
10%15%
Chair and Speakers Include
Virtual ClinicsSetting up and running
Mr Bibhas Roy Consultant Orthopaedic Surgeon & Virtual Orthopaedic Clinic Lead
Central Manchester University Hospitals NHS Foundation Trust
svn.org.uk 1st Quarter 2015
Vascular Matters �11
Circulation Foundation Vascular Nurses Award
The Society of Vascular Nurses would like to introduce the Circulation Foundation Vascular Nurses Award. It is a monetary award of £1000 that has been very generously granted by the Circulation Foundation, and each year there will be up to 5 awards available.
The award will be granted on an annual basis for the specific purpose of funding a project that will benefit patients with vascular disease, either directly or indirectly, and all proposals will be reviewed on a yearly basis. The closing date for applications is the 1st September, and the successful applicants will be formally announced at the SVN annual general meeting in November.
Please see below for information on eligibility to apply, and the application process:-• The applicant must be currently working within the specialty of vascular, caring for patients
with vascular disease, and working within Great Britain and Ireland.• Priority will be given to applicants who are members of the SVN, however non-member
applications will be considered once applications from members have been considered.• The project must have an outcome that benefits patients with vascular disease, or their
carers, directly or indirectly.• Examples of an appropriate project are those related to:
a higher educational course, such as an empirical research study an audit of current services an analysis of an area of vascular nursing a service development project a project to enhance the patient experience This list is not exhaustive, and any application will be considered.
• If the project involves changes to current services, the project must be agreed by the institution for which the applicant is working, and the award cannot be used to run the service.
• The project should be overseen by a senior vascular colleague, either a Consultant Vascular Surgeon or a Vascular Nurse Specialist.
• The award is granted by the Circulation Foundation, though the application process will be organised and overseen by the SVN.
• The maximum monetary award available to each applicant is £1000, with a total of £5000 awarded by the Circulation Foundation each year.
• The applicant must provide exact details on how the monetary grant will be used. The award can be for a monetary sum less than £1000.
• The successful applicant will receive a year’s membership to the Society of Vascular Nurses alongside the monetary award.
• The successful applicant will be expected to provide a report on the development and results of their project, and present at the Society of Vascular Nurses meeting. This will occur once the project is completed, or a year after the award is granted, whichever comes first.
This information and access to the application form will be found on the SVN website: www.svn.org.uk under the ‘Awards’ tab, once it has been updated. If you would like any further information in the meantime, or have any questions please contact Louise Allen, at [email protected].
svn.org.uk 1st Quarter 2015
Vascular Matters �12
THURSDAY)21ST)JANUARY)2016)
)
EDUCATION)CENTRE)
ROYAL)BOURNEMOUTH)HOSPITAL))
)An)interactive)day)of)workshops)&)talks)aimed)at)nurses,)HCSW)and)
Allied)Health)Professionals)who)care)for)vascular)patients.)
Attendance)will)provide)you)with)7.5)hours)of)participatory)CPD.))
)
Topics)included:)
)
Pain)management) ) Nutrition)
Diabetes) ) ) Wound)Care)
Major)surgery) ) EVAR)&)Interventional)radiology)
Rehabilitation)&)physiotherapy)
)
To)book)a)place)please)email:)[email protected])
)
Cost:)£10)per)person)(including)lunch)&)refreshments))
)))))))))))))))))))))))))))))))))))))))))))))))))
svn.org.uk 1st Quarter 2015
Vascular Matters �14
Venous Forum 2015Ruth Chipp, Vascular Nurse Specialist, City Hospitals, Sunderland
I can’t believe that another year has passed since the last Venous Forum. I attended the 2015 Venous Forum held on May 28th-29th May at the Royal Society of Medicine in London. The meeting was well represented by members of the SVN committee.
As part of my committee role I am affiliated on to the Venous Forum and try to attend two meetings per year. One is held during the Vascular Society of Surgeons conference in November and the other in the spring time. This meeting is sponsored by wound care, stocking and graft companies
There is always a wide range of topics included in the meeting. This year some of the topics included:-• New VTE drugs and their complications • Management of the recalcitrant ulcer• Thrombolysis for DVT• An interactive session on difficult ulcer cases• A debate on foam sclerotherapy for ulcers• Venous imaging• Free paper session
The sessions are chaired by members of the Venous Forum. This year the SVN was invited by the Venous Forum to hold a joint session with them on the second day. This was titled ‘The Difficult Ulcer’. I co-chaired this session with Ms Sophie Renton, Consultant Vascular Surgeon. The session began with Dr Richard Bull, a Dermatologist. He spoke about ‘Rare causes of ulcers and how to spot them’. Dr Bull demonstrated within his slides the different types of ulcerations and their causes. He explained that chronic leg ulcers are not always from venous incompetency and could be due to skin cancer. This can be diagnosed by a skin biopsy of the edge of a suspicious lesion. There are many less common causes of ulcers including systemic diseases such as systemic sclerosis, vasculitis and various skin conditions especially pyoderma gangrenosum. Ulcers may be provoked by injury or pressure such as from a plaster cast or ill-fitting shoes. They may also be caused by bacterial infection, especially impetigo and cellulitis and less often tropical ulcer or tuberculosis.This session did make me think ‘outside the box’ and I will certainly be looking more closely at my own practice for the more unusual looking ulcer.Mr Manjit Gohel, consultant vascular surgeon from Addenbrooke’s Hospital in Cambridge spoke on ‘Foam Sclerotherapy for Ulcers’. Mr Gohel discussed the current treatment and management for his patients with venous leg ulcers. He has had good healing rates in patients who have had ultrasound
svn.org.uk 1st Quarter 2015
Vascular Matters �15
The next speaker was Michael Van Orsouw who is the current SVN President. He works as the Vascular Matron at Guy’s & St Thomas’. His talk was about ‘Evidence of Venous Ulcer Rates’. Michael spoke about the current healing rates and recommended treatments for venous leg ulcers. This included evidence from Community leg ulcer clinics and the Royal College Nursing guidelines. He then went on to demonstrate why leg ulcers are slow or fail to heal and whether healing is the best outcome measure.
Mr Mike Slater, consultant vascular surgeon from Southend University Hospital spoke on a ‘Secondary Care Wound Management Unit’. Mr Slater discussed how the unit was first established and the hurdles that were encountered. He then went on to talk about how the unit now works. Southend now have a ward specifically for complex wounds and very much have a multi-disciplinary approach to wound healing.
Next to speak was Leanne Atkin who is an SVN committee member. She works as a Vascular Nurse Specialist and Lecturer practitioner in Huddesfield. Leanne spoke on ‘Venous Ulceration: Management, evidence base and future developments’. Leanne’s presentation covered the prevalence and cost of venous leg ulcers, incorporating management, healing rates, challenges and recurrence rates. The presentation then went on to look at the future of leg ulcer management and future research needs.
The last speaker of the session was Simon Ward who is a Consultant Vascular Scientist from Brighton. Simon’s title was ‘Does everyone need a Duplex? How useful is an ABPI?’ Simon demonstrated how time consuming and difficult it is to scan all patients with ulcerations, especially those who find standing and walking problematic.
It was a very worthwhile exercise having the SVN working in collaboration with the Venous Forum. There are so many uncertainties and changes within the NHS that it is satisfying that 2 separate organisations can work so well together to gain experience and knowledge from each other. The overall opinion is that the vascular patients will be the main winner.
Next year the RSM’s Venous Forum will be a joint meeting with the European Venous Forum. This will be held at the Royal Society of Medicine in London on Thursday 7th – Saturday 9th July 2016. Please check your SVN newsletter for further details.
svn.org.uk 1st Quarter 2015
Vascular Matters �16
NAAASP referrals to The Sussex Vascular Unit 2014 – 2015
Sue Ward, Vascular Nurse Specialist, Sussex Vascular Unit The West Sussex Abdominal Aortic Aneurysm (AAA) screening programme is one of the oldest AAA screening programmes in the United Kingdom (UK). It was set up the mid 1980’s by Mr Alan Scott and his team at St Richards Hospital Chichester when men were invited to attend for an ultrasound scan. With the implementation of the National Abdominal Aortic Aneurysm Screening Programme (NAAASP), the West Sussex Programme expanded to include East Sussex and Brighton and Hove, to become the Sussex NAAASP in April 2012. The current Sussex AAA Screening programme has 670 men in surveillance, with an age range of 65 – 89 years.
All men who have reached the 5.5cm threshold are referred into the Sussex Vascular Unit, (SVU) at the Royal Sussex County Hospital. Men are offered an appointment in the next outpatient clinic, ideally at a hospital near where they live. Currently men are seen in Worthing, Brighton and Redhill. With the expansion of the Sussex Vascular Unit, patients will soon be able to be seen in Chichester, Eastbourne and Worthing. All surgery is carried at out the Royal Sussex County Hospital, this can be an open repair, Endo Vascular Aortic Repair (EVAR) or Fenestrated Endo Vascular Aortic Repair (FEVAR).
These are some interesting facts and figures about the men referred into the Sussex Vascular Unit (SVU) from the Sussex NAAASP in 2014-2015:
• The age range of men referred into the SVU 64, (screened in his 65th year) to 91years• From April 2014 to 31st March 2015 a total of 45 referrals• 28 have had surgery, 15 EVAR, 12 open repairs, 1 Nellix (Addenbrooks)• 9 were operated on within the 8 weeks from referral• 3 breeched 8 weeks (This was over the Christmas period with 13 men referred in from the beginning of November 2014 to the end of December 2014, 10 have undergone AAA surgery)• 15 weren’t operated on within 8 weeks for valid reasons, including patient’s choice, required further investigations pre op, required intervention for a previously undiagnosed condition prior to AAA surgery• 1 was referred to Addenbrooks Hospital and has had a Nellix Graft• 1 man still waiting for surgery, he was admitted for surgery, but had an infection and so needed antibiotics prior to intervention, still awaiting a new date• 8 not fit for surgery at the moment, may have surgery at a later date• 8 men either declined surgery or they themselves declined surgeryThe data is taken form unit held data and confirmed with National Vascular Register data and data submitted to Northgate from the NAAASP.
svn.org.uk 1st Quarter 2015
Vascular Matters �17
Venous Leg Ulceration: A look back on changes in practice, treatments and patients
Leanne Atkin, Vascular Nurse Specialist, Mid Yorks NHS Trust, Wakefield.
Four layer bandaging has been in existence for the past twenty five years, and for majority of this time compression bandaging has been classed as the ‘gold standard’ management for the treatment of venous leg ulceration. Compression bandaging has revolutionised the care of patients, prior to their introduction there was very little understanding of leg ulceration in the nursing world, for the most severe ulcers the only ‘treatment’ option available to clinicians was to admit patients to hospital for periods of bed rest. Clearly this was never an ideal option, due to the risks of bed rest combined with the short term benefits, as within a few weeks of the patient being back upright and mobile the ulcer often would reoccur. Furthermore nurses’ knowledge relating to the management of leg ulceration has improved significantly since the 1980’s, when the likes of A-ha and Wham were topping the charts, this article looks back and outlines some of the changes that have happened in relation to compression therapy, the nursing profession and patient population.
Compression therapy per se is not new, ancient Egyptians described the use of bandages made of non-extensible fabric to wrap chronic wounds on legs. In 400BC Hippocrates, who himself had a leg ulcer, wrote ‘in the case of an ulcer, it is not expedient to stand, especially if the ulcer is situated on the leg’, (Sarkar & Ballantyne, 2000). However, it was not until the late 1980’s that Charing Cross hospital, London, designed the first four layer compression bandage system. By the early 1990’s the Charing Cross bandage system was being routinely used at the founding hospital. In 1990 His Royal Highness the Prince of Wales visited the annual Charing Cross symposium and witness the application of the Charing Cross 4 layer bandage. Unlike many clinical developments in wound care, the four layer bandage system was designed by a group of clinicians rather than industry and was based upon the underlying concept that there was a requirement for sustained high level of compression to reverse the underlying abnormal venous pressures, (Moffatt, 2004).
The power of the Charing Cross system spread throughout the vascular communities with many of the vascular consultants learning how to apply compression bandages, seeing this as an important skill, just like learning to operate. Within Yorkshire a vascular consultant started his own leg ulcer clinic, seeing patients on a weekly basis to review the wounds and re-apply the compression, a nurse was present but only needed to prepare the room and pass the bandages! Rather hard to imagine in today’s world, but these times are still talked about with great passion.
svn.org.uk 1st Quarter 2015
Vascular Matters �18
The mass marketing of compression bandage systems started around mid 1990’s and four layer bandaging was welcomed with excitement throughout the nursing communities, it seemed the ideal solution to accommodate the clinical problems of leg ulceration such as high exudate level, unusual limb shape and limb sizes. Additionally, and probably its most important advantage, was the fact that the system was designed to only require weekly renewal, this resulted in a significant reduction in nursing time. Since this time many nurses have been happily applying the trusted four layer system. However, compression bandaging does have its negative side, patients can find the bandages to be uncomfortable, hot, restrictive it also limits patient’s choice of clothes, footwear and ability to bath/shower. Even though clinicians have always been mindful of these negative factors they have always ‘sold’ the bandages to the patient as the best/only solution to venous ulceration, often spending hours with patients negotiating ways forward and trying to find any glimmers of willingness from the patient to give compression a try.
Over the last decade alternatives to traditional four layer bandages have been brought to market. There are n o w o p t i o n s o f t w o l a y e r compression bandage kits, short stretch bandages, compression hosiery kits and leg wraps all designed to provide the proven 40mmHg pressure at the ankle, which is required to reserve the venous hypertension. This increased choice for practitioners provides huge benefits when trying
to find solutions on an individual patient basis. The beauty of options such as compression hosiery kits or leg wraps is the possibility for patients to self-care; something that has thought to be impossible for many years. Treatments continues to evolve and future management could involve the use of progressive compression rather than the current graduated compression or even electrical stimulation devices to mimic the action of compression bandaging.
The role of the nurse has changed substantially over the last ten to twenty years, nursing has become a more independent autonomous profession. Whole system assessment and diagnosis of underlying diseases/conditions was once seen as the role of the doctor, today nurses frequently assess patients to ascertain differential diagnosis. Twenty years ago who would have thought that the nurse of the twenty first century would be able to diagnosis, prescribe, lead the management of complex patients, refer patients for investigations and even list patients for interventions? Looking back some of the first formal practices of nurse led diagnosis was in relation to the aetiology of leg ulceration, using nurses’ skills and knowledge to undertake in depth assessment to determine the underlying pathophysiology and recommend appropriate treatment.
svn.org.uk 1st Quarter 2015
Vascular Matters �19
The majority of patients with leg ulceration are managed successfully in community services, when asked many community staff fail to recognise the fact that they are making a diagnosis. They see that act of forming a diagnosis as the role of the advanced nurse practitioner or doctor and often fail to recognise the importance of their decisions (diagnosis) in the management of leg ulceration. Rather alarmingly in the last decade the numbers of qualified district nurses has fallen by over 40%, (Queens Nursing Queens Nursing Institute, 2013), and only in time will the impact of this huge reduction in skilled knowledgeable practitioners be realised.
In parallel to the changes in compression and the nursing profession, similar dramatic changes have been seen in the patient population. In 1970 the bioethics movement in the United States started a wave of changes that saw medicine move from a paternalistic model to placing higher values on patient autonomy. The drivers to increase patient autonomy continues today with patient empowerment now becoming common practice. Patients appear more involved in their care, seem more knowledgeable and more engaged with services, asking questions and weighing up the pros and cons of treatment options. As the current generation of technology savvy people get older, the trend of patients ‘Googling’ their condition, seeking best practice or alternative solutions will grow, making patients more informed but potentially more challenging. However, more than 60% of the current population has a negative or fatalistic attitude towards their own health, articulately in the more disadvantage groups, if this current attitude continues the rates of avoidable ill health is likely to grow, (Office for National Statistics, 2011).
People born in the baby boom years following the end of the Second World War will reach their late eighties by 2035 and are more likely to reach that age than any previous generation. From 2012 – 2032 the populations of 65 to 84 year olds is set to increase by 39%, additionally there will be a 106% increase in the over 85’s, (Office for National Statistics, 2011).
Venous ulceration affects 1% of the adult population however, it affects 3.6% of people aged over 65 years, (Agale, 2013) therefore the aging population will result in increased numbers of patients with venous ulceration.
svn.org.uk 1st Quarter 2015
Vascular Matters �20
Improving
Anticoagulation Therapy Services
Improving Patient Safety & Quality
card payments
discount*Group booking
discount**
10%15%
Wednesday 7 October 2015 Colmore Gate Conference Centre, Birmingham
Chair and Speakers Include: Nicky Fleming Chair
Anticoagulation in Practice (AiP) Society
Diane EatonProject Manager
Anticoagulation EuropeSupporting Organisation
svn.org.uk 1st Quarter 2015
Vascular Matters �21
Furthermore, current lifestyles present a serious threat to population health, 66% of adults are not meeting recommended minimum activity levels, 26% are obese and 21% smoke, (Office for National Statistics, 2011). Although reported levels of physical activity are predicted to rise and levels of smoking are declining slightly, the rates of obesity continue to rise. The prevalence of adult obesity increased from 15% in 1993 to 26% in 2010, (Office for National Statistics, 2011) and this is estimated to rise to 37% of men and 34% of women by 2020 and in 2035 it is predicted that 40% of women and 46% of men will be obese, (Wang, McPherson, Marsh, Gortmaker, & Brown, 2011). Carrying excess body weight puts increased strain on the heart, lymphatic and venous system thus increasing the risk of lower limb oedema, (Lawrance, 2014). Therefore obese patients are at increased the risk of lymphoedema, (Greene, 2015) and patients with lymphoedema have a higher incidence of cellulitis, broken skin and venous ulceration, (Gethin, Byrne, Tierney, Strapp, & Cowman, 2011). Obesity not only influences the development of lymphoedema and leg ulceration but it also can restrict how patients can be treated. Management of patients who are obese can be difficult for practitioners due to the risk of manual handling of heavy limbs, lack of specialist equipment, difficulties with bandaging and challenges of limb sizes/shapes. Additionally, treatment of obese patients can be generally less effective, taking longer to heal and even in experienced hands there can be difficulties with bandages slipping or creasing, (Lawrance, 2014). Obesity and the increased risk of chronic disease reduces life expectancy by 10 years and is estimated to cost the NHS £4.2 billion per year in related treatments, (Office for National Statistics, 2011). The increase in prevalence of obesity, its associated health problems and related costs will continue to be one of the most significant challenges practitioners and the NHS will face in the future years. The last thirty years has witnessed tremendous improvement in the way patients with venous leg ulcers are treated, an increasing number of patients have benefited from these advancements. Compression bandages revolutionised care of patients and continues to be the cornerstone treatment for venous ulceration. Patients and the nursing profession have also changed significantly, at times unrecognisable from the past, however the challenges remain the same; to provide high quality care for all.
References
Agale, S. V. (2013). Chronic Leg Ulcers: Epidemiology, Aetiopathogenesis, and Management. Ulcers, 2013, 9. doi: 10.1155/2013/413604Gethin, G., Byrne, D., Tierney, S., Strapp, H., & Cowman, S. (2011). Prevalence of lymphoedema and quality of life among patients attending a hospital based wound management and vascular clinic. . International Wound Journal, 9, 120-125. Greene, A. (2015). Obesity-Induced Lymphedema. In A. K. Greene, S. A. Slavin, & H. Brorson (Eds.), Lymphedema (pp. 97-104): Springer International Publishing.Lawrance, S. (2014). Obesity and lymphoedema. LymphLine. Moffatt, C. (2004). Four-layer bandaging: from concept to practice. Part 1: The development of the four-layer system. World Wide Wounds. Office for National Statistics. (2011). Statisitical Bulletin: 2010 based population projections.Queens Nursing Institute. (2013). Report on District Nurse Education in England, Wales and Northern Ireland 2012/13. Sarkar, P. K., & Ballantyne, S. (2000). Management of leg ulcers. Postgraduate Medicine Journal, 76(901), 674-682. Wang, Y. C., McPherson, K., Marsh, T., Gortmaker, S. L., & Brown, M. (2011). Health and economic burden of the projected obesity trends in the USA and the UK. Lancet, 378, 815-825.
svn.org.uk 1st Quarter 2015
Vascular Matters �22
The SVN is very proud of all the nurses who care for patients with vascular disease. We also know that there are some nurses that are going the extra mile to improve patient care, or make a difference to the experience felt by patients with vascular disease.
The award for services to vascular nursing could be given to a nurse you know; someone who has made an impression upon you for their work and dedication in caring for patients with vascular disease. Neither the nominated or nominator does not have to be a member of the SVN, although new members are always welcome!
Have you worked with someone you feel qualifies for this award? This person maybe a member of your team, either in the ward area, theatres or a clinic setting, and as a junior or senior colleague. The award is also open to both qualified and unqualified nurses.
Many hospitals and vascular units have seen changes over the last few years and some nurses are either developing or supporting new vascular services. Perhaps one of these nurses might inspire you to send in a nomination?
To nominate someone, all you have to do is fill in the nomination form in this newsletter, and send it to Kate Rowlands (address provided) with a supporting summary (150 words). Information can also be found on our website.
In addition to a certificate, which acknowledges their work, the worthy recipient of this award will receive free lifetime membership to the society of vascular nurses, and free lifetime conference entry. This award will be presented at the annual conference, which this year will be in Bournemouth on November 12th.
So, does someone you know need to be recognised for their dedication, or inspiring work? Have a think about who you would like the SVN to consider for this prestigious award and complete the nomination form today.
Thank youKate RowlandsVascular Nurse Specialist & Clinical AAA MDT CoordinatorCardiff Regional Vascular UnitTel 0292074 2699Pager 07623 906342
Award for services to vascular nursing
svn.org.uk 1st Quarter 2015
Vascular Matters �23
Progress on a systematic literature review exploring mixed component elastic/inelastic compression systems
Lynn Welsh, Community Vascular Specialist Nurse, NHS Greater Glasgow and Clyde, [email protected]
Earlier this year, whilst reading through the SVN Newsletter, I came across some information encouraging members to apply for the bursary scheme to use towards courses, conferences, study etc. relating to the vascular practice. I was nearing the end of my MSc in Advanced Practice in Nursing at Edinburgh Napier University, with only my dissertation to complete. I had been fortunate enough to receive some funding from my employing health board towards my course, but it didn’t cover the cost of £350 for dissertation, which I intended to pay myself. The application form was
straightforward to complete and I figured I had nothing to lose, so I went ahead and applied. I was delighted to find out in only a matter of a couple of months that I had been successful and would not hesitate to encourage any members in a similar situation to apply. We can all relate to the challenges of the work/life/study balance and this support has given me one less thing to worry about so that I can focus on the task at hand.
My role as community Vascular Specialist Nurse in NHS Greater Glasgow and Clyde comprises three main work streams: service development activity, provision of vascular and leg ulcer education to community nurses and provision of clinical support when specialist input is required. In the past year, a significant amount of my time has been spent as a member of a multidisciplinary formulary development group who have just launched the first NHS Greater Glasgow and Clyde Compression Bandage Formulary. Throughout this process, I spent quite a bit of time reviewing the evidence on the different bandage systems, materials and brands to help support our choices. I was particularly interested in the increasing move from traditional four-layer elastic systems in favour of inelastic and two-layer systems that combine both elastic and inelastic components. Since this work corresponded with the completion of my MSc Dissertation, I figured it might be an interesting topic on which to base my systematic literature review.
I was able to source quite a lot of literature comparing four layer elastic bandages with inelastic and found that evidence was fairly consistent with regards to the benefits of each. Whilst four-layer elastic had better results with maintaining interface pressure and outcomes such as healing rates, inelastic, by virtue of its low resting pressure, seemed to have better results for patient comfort and concordance as well as a higher safety profile. This led me to think about how more modern systems are starting to combine both elastic and inelastic materials, with what I presume to be a “best of both” approach; however whilst I could see the logic in this, I also wondered whether combining effective elements necessarily leads to the improved merits of both. Might the reverse not also be argued; that combining materials actually dilutes rather than reinforces their strengths? My research question was finally born:
svn.org.uk 1st Quarter 2015
Vascular Matters �24
“What is the existing evidence for mixed component compression bandage systems containing both elastic and inelastic properties in the treatment of venous leg ulcers?”
I found a total of nine papers that fit my inclusion criteria and although I am still at the stage of synthesising my findings, the following themes are beginning to emerge:
• The investigating clinicians’ training, skill and experience with bandage application are variables that affect the validity of most studies’ results. For example, if a study is carried out in the United Kingdom where four-layer bandages have been traditionally used, the findings might support their efficacy over an alternative system that clinicians are not as experienced at applying.
• In several studies, there is no significant difference in outcomes relating to ulcer healing rates between four-layer systems and mixed elastic/inelastic two layer systems; however, the latter are significantly favoured for comfort, tolerability and ease of application.
• I have not identified any studies that investigate the merits of combining elastic/inelastic components as a determinant of efficacy in itself; rather, the studies I have found include mixed component systems but explore other outcomes such as slippage, healing rates, comfort and ease of application.
• A large proportion of literature on compression therapy is industry-led or sponsored, meaning that declaration of interest is often corporate rather than evidence driven and bias cannot be ruled out.
I hope to complete my dissertation in time for the university’s examination board in September and will look forward to applying my new found knowledge to practice. I would very much like to extend my sincere thanks to the SVN Committee for supporting my study with a gratefully received bursary-it has made the juggle my life has become a whole lot easier to manage!
svn.org.uk 1st Quarter 2015
Vascular Matters �25
The Circulation Foundation Prize 2015 (commemorating Mr James Purdie)Nikki FenwickVice- President of the Society of Vascular Nurses and Research and Development: SVN
There is still time for you to submit an abstract for our annual prize giving session to be held at the annual conference at the Bournemouth International conference centre on the 11th November 2015. The closing date for applications on the 1st of September 2015. All registered nurses working within any vascular setting are eligible to apply.
This is an excellent opportunity to share your practice and enhance your CV by presenting at a national meeting. We know that there is excellent work being carried out every day, by vascular nurses throughout the UK. This is an opportunity to show how your work off, and influence the practice of other nurses through sharing practice.
Abstracts must adhere to the following criteria:•They must be about an original piece of work. Acceptable submissions include research, audit, practice development projects or original case studies, demonstrating an innovative approach to care. Large or small-scale studies are equally welcome.•The work must not have been previously published or presented elsewhere (other than at local audit or teaching sessions).•The entrant must have made a substantial contribution to the work, must be the principal author (up to 2 co-authors may be listed) and must deliver the paper in person. (Entrants must confirm with their manager before submitting the abstract that they will be allowed to attend the conference if their paper is selected.)•The entrant is required to be a member of the Society of Vascular NursesMaximum length for abstracts is 250 words. Any above this length will automatically be rejected. Up to 3 key references may be included if necessary.
When writing your abstract, Kark (2010) suggests you include these specific elements and components:• Background: A statement that identifies the nature of the work• Aim: A statement of the purpose of the work• Method: A sentence or two that explains how the work was done • Results: Several sentences that describe the main findings• Conclusion: Final sentence that describes the major impact of the work
Abstracts must be submitted electronically to Nikki Fenwick, Vascular Nurse Specialist, Sheffie ld Teach ing Hosp i ta ls NHS Trus t , a t the fo l low ing ema i l address [email protected]. A completed abstract submission form must be submitted (available on the Society of Vascular Nurses’ website (http://www.svn.org.uk/awards.php)or from [email protected]
svn.org.uk 1st Quarter 2015
Vascular Matters �26
A subcommittee of the SVN will then grade the abstracts anonymously. Please avoid using any identifying details, e.g. the name of your hospital, in the abstract. If any abstracts have been submitted by a colleague or student of one of the judges, they will declare their interest and will not score that abstract. The marks awarded by the other judges will be adjusted accordingly. The best abstracts will be selected to be presented at the SVN conference. Any which have not been selected but which reach a satisfactory minimum standard will be invited to give a poster presentation.
Closing date for applicants is the 1st of September and successful applicants will be informed by the end of September.
Successful applicants will be required to give a 12 minute presentation at the SVN conference (10 minutes plus 2 minutes for questions). The winning presenter will receive a Circulation Foundation Prize of £500. The lead author or presenter of the paper will be able to register for the conference free of charge.
The criteria by which the abstracts will be selected for presentation are described below. (Maximum score = 10)
For tips on presenting at conferences I suggest you read the following article: http://www.nursingtimes.net/stand-up-and-be-heard-at-presentations/201128.article
Score 0 – no 1-partly 2-yes
1 Is the background to the study explained?
2 Are the aims of the study stated?
3 Are the methods used clearly described and appropriate?
4 Are the results or outcomes clearly presented?
5 Are the implications for vascular nursing practice and/or further research explained?
svn.org.uk 1st Quarter 2015
Vascular Matters �27
Poster Presentation at the SVN conference
For the fifth year in a row there will also be a poster exhibition. The committee invites you to submit an abstract for your poster that, if accepted, will be exhibited at the SVN conference. The posters will be judged by a panel and the winning entry will receive a £100 kindly donated by the Circulation Foundation.
This is an excellent way of sharing good practice, and may not be quite as daunting as giving an oral presentation at conference. Your poster may feature any aspect of vascular clinical practice, research or innovation. It does not need to be commercially produced. The size of the poster should not exceed standard A1 poster size (594mm x 841mm). So come on get thinking and putting your ideas together. Again if anyone would like help or information please feel free to contact us.
For tips on preparing a poster I suggest you read the following excellent article: http://www.mc.vanderbilt.edu/documents/evidencebasedpractice/files/How%20to%20create%20an%20effect%20Poster%20Pres.pdf
Registration for the SVN Conference opens on the 1st of September 2015 via the Vascular Societies website vascularsociety.org.uk
svn.org.uk 1st Quarter 2015
Vascular Matters �28
SVN CONFERENCETHURSDAY 12TH NOVEMBER 2015 BOURNEMOUTH INTERNATIONAL CONFERENCE CENTRE
Draft Programme Lower Limb Amputation Deep Venous Disease Impact of Centralisation on the Diabetic Foot AAA Screening Debate
svn.org.uk 1st Quarter 2015
Vascular Matters �29
Draft SVN Conference Programme – Bournemouth 201508.30 Registration
09.00 Welcome and James Purdie Prize Presentations
11.00 Symposium 1:Lower Limb Amputation•NCPOD – Lower Limb Amputation: Working TogetherProf. Michael Gough, NCPOD Clinical Co-ordinator, Consultant Vascular Surgeon. Leeds•Prosthetic’s provided to patients following an amputationJohn Sullivan, Prosthetist•What is it like to live with an Amputation?Mike Chin Chen, vascular patient, Bournemouth
12.00 Symposium 2: Deep Venous Disease•What is Deep Venous Disease?Steve Black, Consultant Vascular Surgeon, London•Post-operative Care after Deep Venous SurgeryBelen Quintana, Vascular Nurse Specialist, London•Anti-coagulation for Patients with Deep Venous DiseaseJason Mainwaring, Haematologist, Bournemouth
13.00 Award Presentations
14.15 AGM (SVN members only)
14.30 Symposium 3: Impact of Centralisation on the Diabetic Foot•Centralisation Pathway for the Diabetic FootRobert Hinchliffe, Consultant Vascular Surgeon, London•The Impact on the Nurse Specialist in the HubClare Martin, Lead Vascular Nurse Specialist, Frimley•The Impact on the Nurse Specialist in the SpokeLouise Wilson, Vascular Nurse Specialist, Eastbourne
15.30 Symposium 4: AAA Screening Programme•The Screening ProgrammeTim Lees, Consultant Vascular Surgeon, Newcastle•The Role of the Nurse SpecialistShelagh Murray, Vascular Nurse Specialist, London
16.00 Debate: Can Vascular Nurse Specialist’s become too Advanced?For the Motion: Michael Van Orsouw, Vascular Matron, LondonAgainst the Motion: Louise Allen, Vascular Nurse Specialist, London
16.30 Close of Meeting
svn.org.uk 1st Quarter 2015
Vascular Matters �30
Annual General Meeting Thursday 12th November 2015
Bournemouth
This is an advanced notice to inform all members that the Annual General Meeting of The Society of Vascular Nurses will take place on Thursday 12th November 2015. The time will be confirmed at least three weeks before the meeting.
The SVN committee propose to discuss the following items:1. Financial report2. Presidents report3. Election of new committee member (s)4. Ward membership, what does this mean and what should ward members be entitled to5. The SVN will become a committee elected position6. Clarification of how many bursaries can be allocated per year and who should be eligible
Any other items for the agenda, please email Sue Ward by the 1st October 2015 [email protected]
svn.org.uk 1st Quarter 2015
Vascular Matters �31
SVN Evening Symposium 11th November 2015
Bournemouth Highcliff Marriott in the Bryanston Suite
Claire Stephens from Woundcare4heroes
Pathways for Life - Woundcare4Heroes Military Trauma Aftercare
Please join us for canapés and drinks on the evening before our conference.
