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Nursing Best Practice Guideline
The New Zealand Guidelines Group (1999) reports that there is sufficient evidence to conclude
that hyperbaric oxygen may reduce ulcer size in non-diabetic, non-atherosclerotic leg ulcers,
and should be considered as a complementary therapy for venous leg ulcer clients.
There have been several randomized controlled trials examining the effect of ultrasound on
chronic venous leg ulcers. In addition, a meta-analysis published by Johannsen, Gam &
Karlsmark (1998) found a significant effect of ultrasound on wound size of chronic venous
leg ulcers.
In a search of the literature, the RNAO guideline development panel also found that there is
insufficient evidence to give clear direction on the use of laser therapy, maggot therapy, sugar,
honey, vitamins, hormones, Vacuum Assisted Closure (VAC) Therapy , growth factors,
mineral elements, and normalthermic therapies in the treatment of venous ulcers.
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H. REASSESSMENT
Recommendation • 53
With no evidence of healing, a comprehensive assessment should be carried out at threemonth
intervals, or sooner if clinical condition deteriorates.
(Level of Evidence = C – RNAO Consensus Panel, 2004)
Recommendation • 54
For resolving and healing venous leg ulcers, routine assessment at six-month intervals
should include:
physical assessment
Ankle Brachial Pressure Index (ABPI)
replacement of compression stockings
reinforcement of teaching
(Level of Evidence = C – RNAO Consensus Panel, 2004)
Discussion of Evidence:
Refer to a specialist (Dermatologist or Vascular physician) if there is a deterioration of the
ulcer status, client status or if non-venous etiology is identified or suspected (e.g., rheumatoid
disease; suspected malignancy; acute congestive heart failure (CHF); renal failure; diagnostic
uncertainty; rapid deterioration of ulcers; new diagnosis of diabetes; lack of healing; recurrent
ulceration; ischemic limb or foot infection; pain management; or for potential surgery).