Mombu the Medicine Forum sponsored links

Go Back   Mombu the Medicine Forum > Medicine > Venous leg ulcers and elevation. (heart job)
User Name
Password
REGISTER NOW! Mark Forums Read

sponsored links


Reply
 
1 24th January 11:17
chris bacon
External User
 
Posts: 1
Default Venous leg ulcers and elevation. (heart job)


A relative has chronic venous leg ulcers, one on each leg. Elevation
is apparently highly recommended. I am looking for information on ways
to elevate the limb(s), bearing in mind that these wounds are painful,
and that my relative's general mobility is poor, due to other
complaints, and to being overweight.

The three positions where elevation might be useful are:

a) When seated, e.g. at the kitchen table, on an ordinary chair on
"raisers" (if that's the correct term - things that increase the
effective seat height). Possible elevation of foot to hip level.

b) When seated in an arm chair watching TV - the chair has with a
thick foam cushion to raise the effective seat height. Possible
elevation of foot or feet to hip level.

c) In bed. Possible elevation of foot to heart level or above.

Lying on the floor without some means of help getting up again is
out of the question.

In what ways might this elevation be easily (and comfortably!!)
achieved? Are there any devices available (or that could be made)
that would do the job, or help? Are (for instance) any low pressure
inflatable cushions, mattresses, or similar, available that could
be used to (for instance) position under the foot of a bed mattress,
or on the end of a couch? Any mechanical means to do the job?

Any help, advice, or pointers to further sources of information
will be much appreciated.
  Reply With Quote


  sponsored links


2 24th January 11:17
andrew heenan
External User
 
Posts: 1
Default Venous leg ulcers and elevation. (diabetes cardiovascular autoimmune thyroid exercise)


While it's good to see an assessment that extends beyond the wound, I still
think that elevation is much too narrow a solution.

Full assessment to determine the nature of the vascular problem is
essential, but from what you are saying, dietary advice and an exercise
program would be much better than an assumption of 'putting the feet up'.

It would also be useful to further extend that assessment to eliminate other
conditions that might have an impact, including endocrine issues (eg
diabetes and thyroid), cardiovascular, respiratory and autoimmune, if these
have not already been investigated.

To get back on topic, there are plenty of proprietary cushions available,
but I'd wait for the outcome of assessments; a 'common sense' solution might
be all that's needed for limb elevation - and you could save a fortune.
--
Andrew Heenan
http://www.realnurse.net/
  Reply With Quote
3 24th January 11:17
a2z
External User
 
Posts: 1
Default Venous leg ulcers and elevation. (down venous insufficiency heart)


============= snipped for brevity ============

Further to Andrew's excellent advice, Google found these using 'leg
elevation leg ulcers'.

Leg elevation encourages venous return and may reduce pain and leg swelling
[Royal College of Nursing, 2000a]. Raising the legs above hip level for 30
minutes three to four times a day will allow swelling to subside and improve
microcirculation in people with venous insufficiency. Placing several
pillows under the bed mattress will assist leg elevation at night. However,
there is insufficient evidence to recommend regular leg elevation as a
routine intervention.

Source: http://www.prodigy.nhs.uk/guidance.asp?gt=Leg%20ulcer%20-%20venous

Elevation and activity

When you are resting, if possible, try and keep your leg elevated (raised)
higher than your hip. This is particularly important if your leg is swollen.
The aim is to let gravity help to pull fluid and blood in the right
direction - towards the heart. This reduces swelling in the leg, and reduces
the pressure of blood in the leg veins.

Try to set 3 or 4 periods per day of about 30 minutes to lie down with your
leg raised. For example, lie on a bed or sofa with your foot on a couple of
pillows. However, do not spend all your time in bed or resting. For the rest
of the time, keep as active as you can, and do normal activities. If
possible, regular walks are good, but do not stand for long periods.

When you sleep overnight, if possible, try to keep your leg raised. You can
do this by putting some pillows under the bottom of the mattress. (It may
not be possible to sleep like this if you have certain other medical
problems or disabilities.)

Source: http://www.patient.co.uk/showdoc/23068777/

The higher the leg, the lower the pressure in the leg veins! If the foot is
elevated above the heart then the pressure in the foot drops to a normal
level. Put your legs up whenever you can and as high as you are able-the arm
of the sofa is good. Elevate the lower end of your bed (6 inches or so) so
that when in bed your feet are a little higher than your head. You can use
some old books for this.

Source; http://www.vascularsociety.org.uk/patient/legulcer.html

I don't understand why the doctor(s) or nurse(s) looking after your relative
haven't advised on this aspect of care. In my experience, patients can only
tolerate leg elevation for short periods when sitting because of the
discomfort caused by the hip joint being flexed. Elevating the lower leg
above the level of the heart, even when lying in bed, is neither practical
nor well tolerated!
  Reply With Quote


  sponsored links


4 24th January 11:17
peter parry
External User
 
Posts: 1
Default Venous leg ulcers and elevation.


The local Occupational Therapists should have access to a variety of
devices to help. For "made to measure" solutions try contacting your
local REMAP Panel (http://www.remap.org.uk).


--
Peter Parry
http://www.remapsherts.org.uk
  Reply With Quote
5 24th January 11:17
a2z
External User
 
Posts: 1
Default Venous leg ulcers and elevation.


============= snipped for brevity =============

Reduced mobility and "other complaints" are factors that can delay wound
healing. If your relative is elderly, then advanced age is another factor
that can delay wound healing. You say that your relative is overweight; it
can still be the case that an overweight person has some nutritional
deficiences which can include a deficit in the essential factors needed for
wound healing, such as proteins, vitamins and minerals. Nutritional
assessment can determine this, and from that attempts can be made to correct
any nutritional deficiences. As Andrew says, a full assessment is needed.
Obviously I don't know the full cir***stances but in a worse-case scenario
it is possible that complete healing of both these ulcers is not a realistic
goal in this particular case. I hope that isn't the case!
  Reply With Quote
6 24th January 11:17
a2z
External User
 
Posts: 1
Default Venous leg ulcers and elevation.


Also, your local primary care or community NHS Trust should have an
equipment store and facilities for loaning equipment free of charge to
patients at home or in community settings. The nurse at your local GP
surgery should have a list of equipment available and be able to write a
requisition form. For example, devices to raise the foot of the bed.
  Reply With Quote
7 20th March 20:13
chris bacon
External User
 
Posts: 1
Default Venous leg ulcers and elevation. (heart job)


A relative has chronic venous leg ulcers, one on each leg. Elevation
is apparently highly recommended. I am looking for information on ways
to elevate the limb(s), bearing in mind that these wounds are painful,
and that my relative's general mobility is poor, due to other
complaints, and to being overweight.

The three positions where elevation might be useful are:

a) When seated, e.g. at the kitchen table, on an ordinary chair on
"raisers" (if that's the correct term - things that increase the
effective seat height). Possible elevation of foot to hip level.

b) When seated in an arm chair watching TV - the chair has with a
thick foam cushion to raise the effective seat height. Possible
elevation of foot or feet to hip level.

c) In bed. Possible elevation of foot to heart level or above.

Lying on the floor without some means of help getting up again is
out of the question.

In what ways might this elevation be easily (and comfortably!!)
achieved? Are there any devices available (or that could be made)
that would do the job, or help? Are (for instance) any low pressure
inflatable cushions, mattresses, or similar, available that could
be used to (for instance) position under the foot of a bed mattress,
or on the end of a couch? Any mechanical means to do the job?

Any help, advice, or pointers to further sources of information
will be much appreciated.
  Reply With Quote
8 20th March 20:14
andrew heenan
External User
 
Posts: 1
Default Venous leg ulcers and elevation. (diabetes cardiovascular autoimmune thyroid exercise)


While it's good to see an assessment that extends beyond the wound, I still
think that elevation is much too narrow a solution.

Full assessment to determine the nature of the vascular problem is
essential, but from what you are saying, dietary advice and an exercise
program would be much better than an assumption of 'putting the feet up'.

It would also be useful to further extend that assessment to eliminate other
conditions that might have an impact, including endocrine issues (eg
diabetes and thyroid), cardiovascular, respiratory and autoimmune, if these
have not already been investigated.

To get back on topic, there are plenty of proprietary cushions available,
but I'd wait for the outcome of assessments; a 'common sense' solution might
be all that's needed for limb elevation - and you could save a fortune.
--
Andrew Heenan
http://www.realnurse.net/
  Reply With Quote
9 20th March 20:14
a2z
External User
 
Posts: 1
Default Venous leg ulcers and elevation. (down venous insufficiency heart)


============= snipped for brevity ============

Further to Andrew's excellent advice, Google found these using 'leg
elevation leg ulcers'.

Leg elevation encourages venous return and may reduce pain and leg swelling
[Royal College of Nursing, 2000a]. Raising the legs above hip level for 30
minutes three to four times a day will allow swelling to subside and improve
microcirculation in people with venous insufficiency. Placing several
pillows under the bed mattress will assist leg elevation at night. However,
there is insufficient evidence to recommend regular leg elevation as a
routine intervention.

Source: http://www.prodigy.nhs.uk/guidance.asp?gt=Leg%20ulcer%20-%20venous

Elevation and activity

When you are resting, if possible, try and keep your leg elevated (raised)
higher than your hip. This is particularly important if your leg is swollen.
The aim is to let gravity help to pull fluid and blood in the right
direction - towards the heart. This reduces swelling in the leg, and reduces
the pressure of blood in the leg veins.

Try to set 3 or 4 periods per day of about 30 minutes to lie down with your
leg raised. For example, lie on a bed or sofa with your foot on a couple of
pillows. However, do not spend all your time in bed or resting. For the rest
of the time, keep as active as you can, and do normal activities. If
possible, regular walks are good, but do not stand for long periods.

When you sleep overnight, if possible, try to keep your leg raised. You can
do this by putting some pillows under the bottom of the mattress. (It may
not be possible to sleep like this if you have certain other medical
problems or disabilities.)

Source: http://www.patient.co.uk/showdoc/23068777/

The higher the leg, the lower the pressure in the leg veins! If the foot is
elevated above the heart then the pressure in the foot drops to a normal
level. Put your legs up whenever you can and as high as you are able-the arm
of the sofa is good. Elevate the lower end of your bed (6 inches or so) so
that when in bed your feet are a little higher than your head. You can use
some old books for this.

Source; http://www.vascularsociety.org.uk/patient/legulcer.html

I don't understand why the doctor(s) or nurse(s) looking after your relative
haven't advised on this aspect of care. In my experience, patients can only
tolerate leg elevation for short periods when sitting because of the
discomfort caused by the hip joint being flexed. Elevating the lower leg
above the level of the heart, even when lying in bed, is neither practical
nor well tolerated!
  Reply With Quote
10 20th March 20:14
peter parry
External User
 
Posts: 1
Default Venous leg ulcers and elevation.


The local Occupational Therapists should have access to a variety of
devices to help. For "made to measure" solutions try contacting your
local REMAP Panel (http://www.remap.org.uk).


--
Peter Parry
http://www.remapsherts.org.uk
  Reply With Quote
Reply


Thread Tools
Display Modes




Copyright 2006 SmartyDevil.com - Dies Mies Jeschet Boenedoesef Douvema Enitemaus -
666