Hands-On Clinical Lab: Assessment and Treatment of Arterial, Venous and Neuropathic Ulcers – Kim Saunders

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Lower extremity wounds are difficult to diagnose and heal if the correct etiology is not diagnosed. Thus the clinician needs bedside non-invasive diagnostic tools that can be used to screen perfusion and determine sensory neuropathy. Also, learn ways to off-load a diabetic neuropathic ulcer, even in rural areas.

This clinical lab will outline best practice guidelines for arterial, venous, and neuropathic ulcers. It will also provide hands-on clinical labs to practice leg assessments, wound treatments, ankle-brachial index, monofilament testing, and off-loading neuropathic ulcer techniques.

OUTLINE

Define Lower Extremity Arterial Disease (LEAD) Guidelines

• Pathophysiology of LEAD
• Best Practice Guidelines: Assessment
  • Pathophysiology
  • Diagnostic Assessment: Invasive & Non-Invasive
    • Arterial Duplex & Angiogram
    • TCOM & Bedside ABI
  • Clinical Exam
• Best Practice Guidelines: Treatment
  • Risk Stratification
  • Perfusion Strategies
  • Oxygen Strategies
  • Maintenance recommendations: Non-reconstructable
• HANDS-ON LAB:
  • Perform Sensory Deficit Testing
• HANDS-ON LAB:
  • Simulate Neuropathic Off-loading techniques

Define Lower Extremity Venous Disease (LEVD) Guidelines

• Pathophysiology of LEVD
• Best Practice Guidelines: Assessment
  • Pathophysiology
  • Lymphedema, Lipedema, Venous Insufficiency Edema
  • Clinical Exam
    • Lymphangitis, Stasis Dermatitis, Hemosiderin Staining
    • Atrophie Blanche, Lipodermatosclerosis, Vasculitis
• Best Practice Guidelines: Treatment
  • Perfusion Determination
  • Matching Compression to Perfusion
• HANDS-ON LAB:
  • Venous Insufficiency Leg & Ulcer Assessment
  • Determine Plan of Care

Lower Extremity Neuropathic Disease (LEND) Guidelines

• Pathophysiology of LEND
• Best Practice Guidelines: Assessment
  • Labs, Nutrition
  • Skin, Edema, Malformations, Neurosensory
  • Tissue Perfusion: Diagnostics & Referrals
  • Classification Systems
• Best Practice Guidelines: Treatment
  • Off-loading Options: TCC, Half Shoe, Healing Sandals
  • Diagnosing Infection & Treatment
  • Wound Care & Adjunctive Therapies
  • Emerging Technology
  • Surgery
• HANDS-ON LAB:
  • Perform Ankle-Brachial Index (ABI)
• HANDS-ON LAB:
  • Neuropathic Foot Ulcer Assessment & Plan of Care
• HANDS-ON LAB:
  • Arterial Disease Leg & Ulcer Assessment
  • Determine Plan of Care

OBJECTIVES

1. Analyze treatment goals when vascular ulcers are non-reconstructable
2. Evaluate the arterial flow in any setting using the bedside ABI
3. Evaluate the arterial diagnostic work-up for recommended referrals
4. Analyze treatment goals when vascular ulcers are non-reconstructable
5. Distinguish between lymphedema, lipedema, and venous insufficiency edema
6. Differentiate assessment/treatment for stasis dermatitis, atrophie blanche, Lipodermatosclerosis
7. Match level of compression to ankle-brachial index
8. Justify wound treatment to perfusion
9. Contrast diabetic ulcer classification systems to predict time to heal & referrals recommended
10. Contrast neuropathic foot off-loading options