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Assessment and Management of Venous Leg Ulcers
be trained and experienced. The RNAO guideline development panel found no trials assessing
and comparing reliability and accuracy based on levels of training.
Recommendation • 2
A comprehensive clinical history and physical examination including blood pressure
measurement, weight, urinalysis, blood glucose level and Doppler measurement of Ankle
Brachial Pressure Index (ABPI) should be recorded for a client presenting with either their
first or recurrent leg ulcer and should be ongoing thereafter.
(Level of Evidence = C – RNAO Consensus Panel, 2004)
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An assessment for a history of venous insufficiency also includes:
Family history of venous disease.
Client history of deep vein thrombosis (DVT).
Lower leg fracture or other major leg injury, previous vein surgery, varicose veins, or prior
history of ulceration with/without use of compression stockings.
History of episodes of chest pain, hemoptysis, or history of a pulmonary embolus.
Lifestyle factors (e.g., sedentary lifestyle, chair-bound), obesity, poor nutrition.
An assessment for signs indicative of Non-Venous Disease also includes:
Family history of non-venous etiology.
Heart disease, stroke, transient ischemic attack.
Diabetes mellitus.
Peripheral vascular disease (PVD)/intermittent claudication.
Smoking.
Rheumatoid arthritis.
Ischemic rest pain.
A combination of the features described above may be indicative of mixed arterial/venous
disease (RCN, 1998).
Discussion of Evidence:
Several clinical studies show strong support for the need for thorough history taking for
assessment of venous insufficiency (NZGG, 1999; RCN, 1998). The New Zealand Guidelines
Group (1999) further suggests assessing the history of the ulcer, the mechanism of injury, and
previous methods of treatment.