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Evidence to Improve Care

Venous Leg Ulcers

Care for Patients in All Settings

Click below to see a list of brief quality statements and scroll down for more information.​​


Quality standards are sets of concise statements designed to help health care professionals easily and quickly know what care to provide, based on the best evidence. ​

See below for the quality statements and click for more detail.​


Quality Statement 1: Screening for Peripheral Arterial Disease
People with a suspected venous leg ulcer are screened for peripheral arterial disease using the ankle-brachial pressure index (ABPI) or an alternative such as the toe-brachial pressure index (TBPI) if ABPI is not possible. Screening is conducted by a trained health care professional during the initial comprehensive assessment and at regular intervals (at least every 12 months) thereafter.


Quality Statement 2: Patient Education and Self-Management
People who have developed or are at risk of developing a venous leg ulcer, and their families or caregivers, are offered education about venous leg ulcers and who to contact for early intervention when needed.


Quality Statement 3: Comprehensive Assessment
People with a venous leg ulcer undergo a comprehensive assessment conducted by a health care professional trained in leg ulcer assessment and treatment, to determine the healing potential of the wound. This assessment informs the individualized care plan.


Quality Statement 4: Individualized Care Plan
People with a venous leg ulcer have a mutually agreed-upon individualized care plan that identifies patient-centred concerns and is reviewed and updated regularly.


Quality Statement 5: Compression Therapy
People who have developed or are at risk of developing a venous leg ulcer are offered compression therapy that is applied by a trained individual based on the results of the assessment and patient-centred goals of care.


Quality Statement 6: Wound Debridement
People with a venous leg ulcer have their wound debrided if it is determined as necessary in their assessment, and if it is not contraindicated. Debridement is carried out by a trained health care professional using an appropriate method.


Quality Statement 7: Local Infection Management
People with a venous leg ulcer and a local infection receive appropriate treatment, including antimicrobial and non-antimicrobial interventions.


Quality Statement 8: Deep/Surrounding Tissue Infection or Systemic Infection Management
People with a venous leg ulcer and a suspected deep/surrounding tissue infection or systemic infection receive urgent assessment (within 24 hours of initiation of care) and systemic antimicrobial treatment.


Quality Statement 9: Wound Moisture Management
People with a venous leg ulcer receive wound care that maintains the appropriate moisture balance or moisture reduction in the wound bed.


Quality Statement 10: Treatment with Pentoxifylline
People with large, slow-healing venous leg ulcers are assessed for appropriateness for pentoxifylline in combination with compression therapy.


Quality Statement 11: Referral to Specialist
People with a venous leg ulcer that is atypical, or that fails to heal and progress within 3 months despite optimal care, are referred to a specialist.


Quality Statement 12: Health Care Provider Training and Education
People who have developed or are at risk of developing a venous leg ulcer receive care from health care providers with training and education in the assessment and treatment of venous leg ulcers.


Quality Statement 13: Transitions in Care
People with a venous leg ulcer who transition between care settings have a team or provider who is accountable for coordination and communication to ensure the effective transfer of information related to their care.

5

Compression Therapy

People who have developed or are at risk of developing a venous leg ulcer are offered compression therapy that is applied by a trained individual based on the results of the assessment and patient-centred goals of care.


Compression therapy supports venous return (blood flow back to the heart), reduction in venous pressure, and prevention of venous stasis (decreased circulation). Compression therapy can be used to prevent initial and recurrent venous leg ulcers and is an effective treatment for venous leg ulcers. People who have developed or are at risk of developing a venous leg ulcer should be offered the highest-level (strongest) compression they can tolerate and maintain. Recurrence rates are lower when people use high compression therapy (for example, 40 to 50 mm Hg), but adherence rates are higher with medium compression therapy (for example, 30 to 40 mm Hg). 

Compression therapy studies have generally not included people with diabetes, cardiovascular disease, malignancy, or mixed venous/arterial ulcers. Compression may be contraindicated for people with heart failure, peripheral arterial disease, an ankle-brachial pressure index (ABPI) score at or below 0.5 or above 1.2, peripheral neuropathy, and some vasculitic ulcers. People with mixed venous/arterial leg ulcers require close care and monitoring. In these situations, modified compression therapy should be used and the person should be closely monitored for signs and symptoms of complications.

For Patients

As part of your care plan, you should be offered compression therapy, which can include special bandages or stockings that support your veins and increase the circulation in your legs. You should talk to your health care professional about the most appropriate form of therapy for you.


For Clinicians

To treat an existing ulcer or prevent initial or recurrent ulceration, offer compression therapy to people who have developed or are at risk of developing a venous leg ulcer, based on the results of the assessment and patient-centred goals of care.


For Health Services

Ensure access to compression therapy for people who have developed or are at risk of developing a venous leg ulcer, to treat and heal an existing ulcer or prevent initial or recurrent ulceration.

Process Indicators

Percentage of people who have developed or are at risk of developing a venous leg ulcer and are offered compression therapy based on the results of the assessment and patient-centred goals of care

  • Denominator: number of people who have developed or are at risk of developing a venous leg ulcer and in whom compression therapy is not contraindicated

  • Numerator: number of people in the denominator who are offered compression therapy based on the results of the assessment and patient-centred goals of care

  • Data source: local data collection


Percentage of people who have developed or are at risk of developing a venous leg ulcer and receive compression therapy that is applied by a trained individual

  • Denominator: number of people who have developed or are at risk of developing a venous leg ulcer and in whom compression therapy is not contraindicated

  • Numerator: number of people in the denominator who receive compression therapy that is applied by a trained individual

  • Data source: local data collection


Structural Indicator

Local availability of health care providers with specific training in the application of compression therapy

Risk of developing a venous leg ulcer

People should be offered compression therapy if they have signs and symptoms of venous disease and:

  • Have or have had a leg ulcer

  • Have a history of thrombophilia, venous thromboembolism, or phlebitis

  • Have chronic leg swelling

  • Have impaired/limited calf muscle pump function and restricted ankle range of motion


Compression therapy

Application of compression bandages, garments, or pumps to the legs.


Trained individual

May include a health care provider, the patient, or a family member/caregiver who has received training in the application of compression therapy.

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