172551-svn news conference edition · 2018. 5. 14. · on thursday the svn conference program is...

Vascular Matters4th Quarter 2017

Conference Edition#VSASM17

S o c i e t y o f Va s c u l a r N u r s e s

w w w . s v n . o r g . u k

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svn.org.uk 4th Quarter 2017


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Contents

Page 5 President’s Welcome

Page 7 Ankle waveform versus ABPI

Page 14 APPG Update

Page 16 Staff nurse development update

Page 17 A year seconded onto the SVN Committee

Page 18 An interview with….

Page 20 Evening Symposium

Page 25 Four reasons to attend a nursing conference

Page 26 SVN AGM Agenda

Page 27 SVN Conference Agenda

Page 28 James Purdie Prize Presentation

2 SVN Treasurer’s Report

Page 34 SVN Bursaries

Any articles, questions, queries or comments about Vascular Matters, please email the editors at [email protected] or [email protected]

Vascular Matters Editors

Leanne Atkin & Emma Bond

svn.org.ukThe official website of the Society of Vascular Nurses

Visit here for information on SVN membership, conference information, bursary applications and much, much more!

ContentsPage 4-5 Presidents Welcome

Page 6 Committee Members

Page 7 A farewell note from Aisling

Page 9 Call to action

Page 10-13 SVN Evening Symposium

Page 16-21 James Purdie Abstract Presentations

Page 22-23 Conference Programme

Page 24 AGM Agenda

Page 25 Treasurer’s Report

Page 26-27 Bursary Award Winner - Feedback

Page 28-33 The use of Farrow Wrap with lymphovenous oedema and active ulceration

Page 36-40 Manchester Amputation Reduction Strategy (the MARS project)

Page 42-43 Staff Nurse Secondment to SVN Committee


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Contents

Page 5 President’s Welcome

Page 7 Ankle waveform versus ABPI

Page 14 APPG Update

Page 16 Staff nurse development update

Page 17 A year seconded onto the SVN Committee

Page 18 An interview with….

Page 20 Evening Symposium

Page 25 Four reasons to attend a nursing conference

Page 26 SVN AGM Agenda

Page 27 SVN Conference Agenda

Page 28 James Purdie Prize Presentation

Page 32 SVN Treasurer’s Report

Page 34 SVN Bursaries

Any articles, questions, queries or comments about Vascular Matters, please email the editors at [email protected] or [email protected]

Vascular Matters Editors

Leanne Atkin & Emma Bond

svn.org.ukThe official website of the Society of Vascular Nurses

Visit here for information on SVN membership, conference information, bursary applications and much, much more!

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Presidents WelcomeWelcome to the conference edition of Vascular Matters. For those of you who are here and attending the conference, I hope that you are enjoying the experience and everything that Manchester has to offer. If you are not able to attend, now is the time to start planning for next year which will be in Glasgow. The Glasgow conference in 2018 will be the 25th Anniversary of the SVN being founded. We have gone from strength to strength over the years and are already planning ways to mark the occasion. We really hope that you will be able to start planning ahead to join in the celebration.

For this year’s program, the week is varied and has plenty to offer. Once again everyone will benefi t from the joint registration process, allowing delegates the freedom to go in-between the three different streams – Nursing (SVN), Surgical (VS) and Technology (SVT), so you can focus on sessions that are of most interest to you.

The SVN program starts on Wednesday evening. We are pleased to be back at the Radisson Edwardian Blu Hotel for the evening symposium. Mr Viquar Qurashi has kindly agreed to be our key note speaker and tell us about his work and the Naya Quadam Trust, working to provide prosthetic limbs to the people of third world countries. His incredible charity work has been covered in several TV documentaries, and we really want to give him a warm reception. Please ensure that you come along and enjoy complementary refreshments and the trade exhibition.

On Thursday the SVN conference program is full and varied and I hope this does not disappoint. I hope that you fi nd plenty to take away and feed back to your unit. The program, in part is devised from delegate feedback from the previous year. We always review the feedback, so let us know your thoughts and we will consider them into next year’s planning.

Thursday continues into the evening, with the social program. The Vascular Societies Annual dinner will this year have a slightly changed format with all of the prize winners being announced, including the James Purdy prize being given out. If you haven’t already got your ticket then don’t delay, an evening not to miss, there may well be tickets left and discounted for SVN members!

On Friday morning, specifi cally for nurses there is a hand on endovascular training session in association with UKETS. This course aims to provide nurse candidates a better understanding and appreciation for endovascular intervention, the potential risks and principles of safe practice. Places are limited for this, so if you don’t have one booked speak to the Fitwise team for possible availability.

I would like to take this moment to say a huge thank you to our conference organising teams: Garry Kinnear and the Fitwise team do an amazing job along with Gail Curran and Jane Todhunter from the SVN committee and the Vascular Society team.

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I have been in the role of President for more than a year now. It’s been an interesting learning curve for me, and one of my main aims to make the SVN as accessible as possible for nurses to become involved with. For this reason, we are once again offering the opportunity for staff nurses to take up a secondment role to the SVN for a year. This is an excellent chance for personal development as well as getting involved with, and having an impact on Vascular Nursing at a national level. Please contact or speak to Sue Ward for further information. [email protected]

This time next year I will be handing over to an excellent Vice President Louise Allen. In the meantime I hope to make the next 12 months count, and will endeavour to keep you updated within our quarterly journal of projects and work streams ongoing.

Before I sign off, I would like to thank to the hardworking SVN team for whom I am very grateful of everyday. I would also like to thank every single SVN member and conference delegate who make carrying out this role so worthwhile. Long may your enthusiasm and passion for Vascular Nursing continue.

Best wishes Nikki Fenwick, SVN President



Don’t forget to visit www.svn.org.uk for up to date information on courses,

conferences, bursaries and more!

Follow the SVN on Twitter: @vascularnurses

&Facebook: Society of Vascular Nurses

Please tweet throughout the conference and let us know what you think #VSASM17

Visit the app store and search VS Yearbook 2017 for full details Vascular Societies program and speakers

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President

Vice PresidentJames Purdy Prize & Circulation Foundation

Membership NHS England CRG

Secretary elect Services to Vascular Nursing

Vascular Matters Editor Website Co-OrdinatorLegs Matter Campaign

Vascular Matters Editor

Nurse Competencies Lead

Conference Organiser

Conference Organiser (Shadow)Research & Development

Evening Symposium Organiser

Social MediaWebsite Co-ordinator

Treasurer & Bursaries Non-Committee Role

Nikki FenwickVascular Nurse Specialist

Louise AllenVascular Nurse Specialist

Sue WardVascular Nurse Specialist

Kate RowlandsVascular Nurse Specialist

Leanne AtkinVascular Nurse Specialist

Emma BondVascular Nurse Specialist

Claire ThomsonVascular ANP

Gail CurranVascular Research Nurse

Jane TodhunterVascular Nurse Practitioner

Suzanne Austerberry Vascular Nurse Specialist

Aisling RobertsVascular Nurse Specialist

Stephanie HoustonStaff Nurse

Jayne Burns

Sheffield Vascular Institute, 2nd Floor Nurses Home, Northern General Hospital, Herries Rd, Sheffield, S5 7AU. 01142 434343 Blp 2773 [email protected]

St Mary’s Hospital, Praed St, London W2 1NY0203 312 6246 [email protected]

C/O Mr Brooks’ Secretary, Royal Sussex County Hospital, Eastern Rd, Brighton 01273 696955 Blp 8213 [email protected]

C/O Ward B2, Cardiff Regional Vascular Unit UHW, Heath Park, Cardiff CF14 4XW02920 742699, L/R Bleep 07623906342 [email protected]

Division of Podiatry, Dept of Health Sciences, Ramsden building, RG/11, The University of Huddersfield. [email protected]

Glan Clwyd Hospital, Sarn Lane, Bodelwyddan, N.Wales, LL18 3PS01745 445405 [email protected] [email protected]

Wd 14, Royal Bournemouth Hospital, Castle Lane, Bournemouth, Dorset, BH7 7DW01202 303626 bleep 2620

The Cambridge Vascular Unit, Box 201, Addenbrooks Hospital, CambridgeBiomedical Campus, Hills Rd, Cambridge, CB2 0QQ

North Cumbria Acute Hospital Trust, Cumberland Infirmary Newtown Road, Carlisle, CA2 7HY 01228 814424

Manchester Vascular Centre. Division of Surgery Central Manchester University Hospitals NHS Foundation Trust Manchester Royal Infirmary Oxford Road, Manchester M13 9WL 0161 [email protected]

Wren Unit, The Great Western Hospital, Malborough Rd, Swindon, SN3 6BB 01793 604373 [email protected]

Vascular Surgery, Royal Victoria Hospital, 274 Grosvenor Road, Belfast, BT12 6BA.02890633156 [email protected]

[email protected]

Committee Members

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A farewell note from AislingIt all started when I was in still in my 20’s!

I returned to my nursing love, that is vascular disease, and as part of my new role as a CNS I was encouraged to join the SVN. As a member I enjoyed getting the magazines and hearing all that was new, I did however feel I needed more......

My manager at the time was an ex SVN president and she raved about the committee and how effective it was at representing ‘vascular nurses’. She encouraged and supported me when I applied to join the committee.It was a winter’s conference in Edinburgh when I began my adventure, I remember the comedy sketch which closed the meeting and it was then I knew I’d joined a great bunch of girls.

I’ve had 12 years packed with many an up and down, I’m pleased to say the former outweighed the latter. I’ve had various roles within the SVN and enjoyed them all. The committee changed members several times during my stint however it’s always been a warm, friendly group of ladies and the occasional brave man. I always felt supported and have benefi tted from shared knowledge, skills which have enhanced my clinical practice.

Vascular disease is a constantly changing entity and as a committee we had to adapt to meet this. In my early years in the committee we were only embarking on the technology boom-I’m still back in the 90’s when it comes to ‘tech’. I was very happy, to work with the other members to help bring our committee up to date and in line with larger societies. On occasions it was a trial and error exercise, but we got through it and now have a fantastic website and newsletter.

In addition we had the arduous annual task of organising the conference; although fun it was a momentous task. Like most things this too has evolved and I’m very proud of what we now offer members.

I was fortunate to be involved within the committee for many a celebration and as a member will no doubt benefi t from all the hard work which goes on behind the scenes to mark these occasions, the next being 25 years of the SVN.

I will miss everyone but like those who’ve left before me, our friendship will continue.

Slan mo charas.

Aisling Roberts

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Next Year’s Conference

Glasgow Scottish Exhibition Centre

Thursday 29th November 2018

SAVE THE DATE

Thursday 29th November 2018

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ATTENTION WE NEED YOU TO RESPOND – SURVEY CLOSING SOON! Dear SVN members, National Survey for Vascular Research – urgent participation required Some of you will already be aware of the National Survey for Vascular Research, it is a collaborative initiative involving the SVN, SVT, Vascular Society, Rouleaux Club and VERN. In round one we invited colleagues to suggest what areas of the vascular specialty they thought should be prioritised for research. The SVN provided a fantastic 70% response rate, however participation in this second round is disappointingly low at 30%. We strongly recommend that all SVN members join in, it is your opportunity to make your opinion count. The survey is accessible via the online link which will also be sent to you in an email; https://hull.onlinesurveys.ac.uk/national-survey-for-vascular-research-round-two It takes just 15 minutes and you can save and return to the survey at any point. You can all join in, even if you didn’t take part in the first round. This is your last chance to tell us what area of vascular research you think is important, the survey will be closing soon. Thank you in advance for your support. On behalf of the Vascular Research Group

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SVN Evening SymposiumWe are pleased to be hosting the 5th SVN evening symposium. This year, it will be held back at the lovely Radisson Blu Edwardian, a 5 star hotel located in one of Manchester’s most celebrated buildings, the historic Free Trade Hall. It is just moments away from Manchester Central convention centre, where the conference is being held.

We are being supported by a variety of interesting trade stands which you will be able to view, and as always you have the added bonus of canapés and wine while you browse their products. The SVN would like to thank all of the companies for their support of this event.

There will be a quiz with a question from each company and all completed forms will go into a prize draw to win a bottle of Champagne! This will be drawn by our guest speaker, who this year is Mr Viquar Qurashi of the Naya Qadam Trust.

We do hope you join us and enjoy the evening.

Suzanne Austerberry, Evening Symposium Organiser & Vascular Nurse Specialist, Manchester Royal Infirmary

SVN EVENING SYMPOSIUMWednesday 22nd November 2017

PanRadisson Blu Edwardian Hotel, Manchester

1730 Canapés and drinks reception

Viewing of Trade exhibition

1830 Open and welcome – Sue Ward, SVN Committee Member

1835 Key note speaker: Mr Viquar Qurashi

Consultant Trauma and Orthopaedic Surgeon

‘The Naya Qadam Trust’

1930 Close of meeting – Sue Ward

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Evening SymposiumKey Note SpeakerViquar Qurashi is a specialist trauma and Orthopaedic surgeon based in Birmingham, he is a member of the British Associate Parliamentary Limb Loss Group, a group that meets several times a year in Parliament to advise and set policies regarding amputees living in the UK. However, he also works to improve the quality of life for amputee patients across the world and founded the Naya Qadam trust to achieve this. Naya Qadam is a UK registered charity, with main workshops based in Pakistan but operating in countries across the world. The aim of Naya Qadam is simple, to provide prosthetic limbs and treatment for amputees in developing and impoverished countries where the patients would otherwise be unable to receive them.

Viquar Qurashi is a specialist trauma and Orthopaedic surgeon based in Birmingham, he is a member of the British Associate Parliamentary Limb Loss Group, a group that meets several times a year in Parliament to advise and set policies regarding amputees living in the UK. However, he also works to improve the quality of life for amputee patients across the world and founded the Naya Qadam trust to achieve this. Naya Qadam is a UK registered charity, with main workshops based in Pakistan but operating in countries across the world. The aim of Naya Qadam is simple, to provide prosthetic limbs and treatment for amputees in developing and impoverished countries where the patients would otherwise be unable to receive them.

The charity was initially formed after the 2005 South Asia Earthquake, after seeing the devastation caused by the disaster and in particular the number of people left physically disabled by the event and unable to receive the treatment they so urgently needed. However, since then his work has expanded over many countries, having visited the war-torn Turkey-Syria border, Bangladesh, Mexico and other countries to fi nd and help amputee patients.

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Naya Qadam have already made thousands of prostheses, both upper and lower limb and the effect that this has had on patients is phenomenal, with children able to return to school and adults to work, while also enabling them to do everyday tasks they could not without the limb. Naya Qadam are also committed to empowering local communities, by educating local healthcare workers and technicians in fracture management and the prosthesis making process. The prostheses costing under £50 to make, use local

materials as far as possible boosting the communities’ economy and ensure the people continue to make the limbs independently once Naya Qadam have left the country.

The charity was initially formed after the 2005 South Asia Earthquake, after seeing the devastation caused by the disaster and in particular the number of people left physically disabled by the event and unable to receive the treatment they so urgently needed. However, since then his work has expanded over many countries, having visited the war-torn Turkey-Syria border, Bangladesh, Mexico and other countries to find and help amputee patients.

Naya Qadam have already made thousands of prostheses, both upper and lower limb and the effect that this has had on patients is phenomenal, with children able to return to school and adults to work, while also enabling them to do everyday tasks they could not without the limb. Naya Qadam are also committed to empowering local communities, by educating local healthcare workers and technicians in fracture management and the prosthesis making process. The prostheses costing under £50 to make, use local materials as far as possible boosting the communities’ economy and ensure the people continue to make the limbs independently once Naya Qadam have left the country.

His work has not gone unnoticed, Both ITV and the BBC have documented his work and the effect on his patient’s lives in ‘Cutting Edge’ and ‘Inside Out’, the work of Naya Qadam was also featured on the BBC3 video series ‘Amazing Humans’.

His work has not gone unnoticed, Both ITV and the BBC have documented his work and the effect on his patient’s lives in ‘Cutting Edge’ and ‘Inside Out’, the work of Naya Qadam was also featured on the BBC3 video series ‘Amazing Humans’.

The words Naya Qadam translate to ‘New Step’ embodying what Viquar Qurashi works to achieve with his patients, both their literal new steps on their prosthesis but also their re-entry into society where they were previously stigmatised due to their disability and helping them gain independence to progress in their life

The words Naya Qadam translate to ‘New Step’ embodying what Viquar Qurashi works to achieve with his patients, both their literal new steps on their prosthesis but also their re-entry into society where they were previously stigmatised due to their disability and helping them gain independence to progress in their life.

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Many thanks the sponsors of Many thanks the sponsors of the evening symposium

Many thanks the sponsors of Many thanks the sponsors of the evening symposiumthe evening symposium

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JOIN OUR NEW NURSING TEAM AND VASCULAR HUB Opening April 2018 BCUHB is proud to be opening our brand new, Vascular Hub in Glan Clwyd Hospital, in North Wales. The unit includes a new Hybrid Suite, IR Suite, and Vascular Ward.

This has led to the development of new nursing roles, which includes funded places on a Vascular Masters Module.

Preceptorship and

Competency Support

Funding for Vascular Nursing Masters Module

Great opportunities for

Career Progression

Visit us for a Guided Tour

Email [email protected]

for more information

BCUHB Glan Clwyd Hospital

Sarn Lane Bodelwyddan North Wales

LL18 5UJ

01745 583910

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NEWVASCULAR NURSING

COURSELondon South Bank University and Imperial College Healthcare NHS Trust are excited to announce NEW DATES for their Vascular Nursing Course, ‘Care of the Vascular Patient’, taught at level 6 and level 7. The module is due to start on 6th February 2018.

The module spans over 12 weeks, with 6 taught days at London South Bank University, and St. Mary’s Hospital, Paddington. The inter-professional modules are taught by expert clinicians and focus on multiple aspects of the holistic care of the vascular patient, from both a surgical and medical perspective. The module will encourage participants to develop their knowledge, skills and competence in providing evidence-based care for the vascular patient in the acute care setting. Participants will also develop their skills in critical thinking and service innovation, contributing to an enhanced understanding of the quality of care within vascular services.

To apply and obtain further information please go to: www.applycpd.com/lsbu/

Alternatively to express your interest please contact:Louise Allen Vascular Nurse Specialist Imperial College Healthcare NHS Trust [email protected] 0203 312 6246

Claire Nadaf Associate Professor London South Bank University [email protected] 0207 8158321


James Purdie Abstract PresentationsThe James Purdie abstract presentations are named after Mr James Purdie, a patient with vascular disease, who left a legacy to the Circulation Foundation. The legacy is used for the James Purdie prize, which is £500, awarded to the best presentation by an SVN member. The award is decided by members of the SVN committee, as well as two delegates in the audience. Presenters in the abstract session have historically been nurses, however over the last few years allied healthcare professions are choosing to present at our meeting and to our audience. This gives our audience a variety of topics and an opportunity for those new to presenting, to present in a supportive environment.

No. 1Improving abdominal aortic aneurysm (AAA) screening uptake through patient engagement

Mehtab Ahmad, Vascular Registrar, Heart Of England NHS Foundation Trust

Objective:To identify potential reasons and potential areas of health inequality that may adversely affect patient engagement with the National AAA Screening Programme (NAAASP).

Method:Prospective study of 390 men who failed to attend their screening invitation between 1st April 2015 and 31st March 2016. Non-attendees were contacted by post and telephone. Patients were analysed according to ethnicity, working status and Index of Multiple Deprivation quintile.

Results:The SMaRT system used by NAAASP is 97% accurate in holding patient contact details and non-attenders are four times more likely to respond when contacted by telephone. Reasons for failing to attend initial screening invitations include not wishing to be screened, challenges in travel arrangements to local screening centres and forgetting appointment dates. Patient-suggested means to improve uptake include more information about AAA and engagement with primary care providers to promote attendance. The incidence of AAA in the non-attendee group was 3.5 times that of our general (attending) population. Afro-Caribbean men were disproportionately less likely to attend for screening.

Conclusion:A variety of external factors affect AAA screening uptake. It is important to identify, contact and encourage initial non-responders to attend, as the non-attending population may well be those men most at risk of developing AAA.

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No. 2Challenges In The Recruitment Of Patients To Chronic Venous Ulcer Studies

Layla Bolton, Research Nurse, Imperial College London

Objective:Forty-five percent of clinical study delays are related to poor recruitment, a challenge faced by many research nurses. Studies involving patients with chronic venous ulceration (CVU) are often difficult to recruit for due to stringent inclusion criteria, participant preference and logistics. This project aimed to identify reasons for reduced enrolment of CVU patients to a single centre and explored possible interventions to improve recruitment rates.

Method:CVU patients were identified in outpatient departments and prospectively recruited via an informed consent process to the MOJITO study, a study investigating biomarkers in individuals with CVU.

Results:Over eleven months the MOJITO study had a recruitment rate of 25%, (44/175). 111 were male, 64 were female, and the mean age was 67. Of 98 documented reasons for exclusion to the study, non-attendance to clinical appointments occurred in 24%. Ulcer healing before the follow up appointment occurred in 26%. Ulcers of mixed aetiology occurred in 22%, making patients non-eligible for participation. Amongst the patients who were deemed eligible but who declined to participate in the study, the main reasons for doing so included traveling difficulties, and concerns regarding pain experienced during dressing removal.

Conclusion:Recruitment of CVU patients to research studies remains an important challenge and hence the generalizability of the results. A possible, measure to increase recruitment rates includes recruitment of participants from primary care, which may reduce the effects of non-attendance to hospital and identifying patients prior to healing, as well as reducing the burden of excess travel on patients.



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No. 3A Review of themes in falls amongst amputee patients during their acute hospital stay

Matthew Fuller, Physiotherapist, Guys And St Thomas NHS Foundation Trust

Objective:Falls are associated with prolonged hospital stay and in lower limb amputees have serious consequences including stump trauma and stump revision, impacting prosthetic rehabilitation and possible limb use. To gain understanding of the causes of falls in amputee patients, identify trends within history of falling and provide targets for further intervention.

Method:Incident reports for all falls on vascular wards were retrospectively analysed from Jan-2016 to Jan-2017. Data collected included: Amputation date, level, incident date, time of fall, location, cause of fall and days post-surgery. Reasons for falls were themed to identify cause, time and location of falls.

Results:One hundred and seven amputees were admitted to the vascular wards, 33 falls were recorded in 26 amputees accounting for nearly one third of all falls and fallers (n=104/80).Above knee fallers 8, below knee fallers 19 and through-knee 3.Most amputee falls were recorded 7-13 days post amputation (29%). The peak time to fall was between 14:00-15:59 (33%). The majority of falls occurred in the ward bays (63.6%). Below knee amputees accounted for 65% of fallers. Falls occurred during transfers for almost half of those reported (45.5%) followed by cognition impairment (21.2%).

Conclusion:One quarter of all amputees on these wards experienced a fall over the year. Transfers account highly for the falls in amputees, similar to previous studies, but the location and time of day of falls was of interest. Further interventions have now been recommended to reduce falls incidence, specifically investigation of activities at high risk times.




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No. 4To what extent are the NCEPOD (2014) and VSBGI (2016) perioperative amputation recommendations being followed in a central London vascular hub site?

Talia Lea, Vascular Clinical Nurse Specialist, Guy’s & St Thomas’ NHS Foundation Trust

Objective:Determine compliance with the NCEPOD (2014) and VSGBI (2016) major amputation recommendations, at a London vascular hub unit. Objectives were to identify areas of good practice, identify shortfalls in service provision, and to provide a baseline from which future improvements can be measured.

Method:A retrospective clinical audit was undertaken, measuring compliance against identified peri-operative and nursing recommendations, using the NCEPOD (2014) data collection tool. All adult patients undergoing major amputation for peripheral arterial disease and/or diabetes in 2016 were audited. Patients requiring revisions or amputation for non-vascular/diabetes reasons were excluded.

Results:Positively, 76% of cases were performed during normal hours, and 76% within 48 hours of the decision to amputate. VTE prophylaxis was achieved in 100%. Less positively, over a third of patients had surgery performed by junior surgeons, and only 44% of cases were performed on elective lists, with consultant anaesthetist presence in 86%. Antibiotics were received on induction in 31% of cases, with 85% receiving appropriate post-operative doses. Only 61% of cases had a nutritional assessment and only 51% of cases were reviewed by the acute pain service. Peri-operative mortality was 0%, 30-day mortality 6%, and 90-day mortality 13%. Predicted percentage survival at one year post major amputation was 77%.

Conclusion:Compliance was found to be suboptimal in the audited clinical setting, Improvement measures and education have been introduced to improve performance within the existing constraints of the service, with a long-term goal of relocating services to a purpose built cardiovascular institute.



No. 5Patient perception and understanding of peripheral arterial disease; a pre and post nurse-led clinic review of practice

Sandip Nandhra, Vascular Registrar, Northern Deanery

Objective:To gain an insight into patient’s pre-clinic understanding of the aetiology, investigation and treatment of peripheral arterial disease and to review local practice with regards to patient education and advice.

Method:Patients attending the nurse-led claudication clinic were asked to complete a questionnaire on arrival and then again following their consultation. The questionnaire assessed pre-clinic perceptions with regards to symptom aetiology, risk factor modification including lifestyle changes, investigation pathway and treatment options. Patients were then re-evaluated following their consultation. Data was collected independently.

Results:Prior to consultation patients had a limited understanding of the disease aetiology, the potential benefit of lifestyle modifications and stopping smoking. Patients were uncertain as to the expected pathway of investigation and rated vascular interventions as highly influential towards the improvement of their symptoms. Following clinic the understanding of the disease and importance of lifestyle modifications improved. Patients rated stopping smoking, and increased exercise as the most influential on their disease outcome.

Conclusion:This study as demonstrated that pre-clinic patient education is limited. Careful consultation can dramatically improve patients’ perceptions and therefore potentially compliance with lifestyle modification.


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No. 6Development and Introduction of an Acute Diabetic Foot Pathway - A Multidisciplinary Approach

Niamh Williams, Clinical Nurse Specialist, St Vincent’s University Hospital, Dublin

Objective:A lower limb is lost to Diabetes Mellitus every 20 seconds worldwide. The estimated cost to the Irish health service for treating patients admitted for diabetic foot complications in 2015 was over €71 million. The number of admissions for diabetic foot complications and associated length of stay increased dramatically from 2012-2015; median length of stay for ulceration was comparable to the length of stay for a below knee amputation The aim of the project was to: 1. Streamline and improve patient care. 2. Improve access to diagnostics. 3. Reduce out of hours surgical procedures. 4. Reduce patient length of stay. 5. Education of staff on urgency of vascular referral.

Method:A Multidisciplinary Task Force was established rationalise management of these patients. In accordance with international standards a unique management process was developed: including the following core initiatives: • Two protected beds on the Vascular Surgery Ward • Acute Diabetic Foot Pathway Booklet and Algorithm • Education • Outpatient Antibacterial Therapy (OPAT).

Results:Over a 12-month period 78 patients were admitted via the pathway. A comparison study of similar patients from 2013-2014 was conducted: • Reduction of major limb amputations • Reduction in readmission rate • Cost savings in excess €1 million.

Conclusion:This initiative has had a positive impact on both the patient and the hospital including: 1. Improved patient satisfaction. 2. Improved patient outcomes. 3. Patients re-engaging with the diabetes service. 4. Length of hospital stay has reduced.




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SVN Conference Programme08:40-08:48 Welcome, Nikki Fenwick, SVN President

08:48-10:00 James Purdie Abstract Presentations Chairs: Louise Allen and Nikki Fenwick

10:00-10:30 Coffee

Symposium 1: Intervention of the Lower Limb Chairs: Kate Rowlands and Jayne Burns

10:30-10:45 Overview of lower limb disease Ayoola Awopetu, Clinical Fellow, Cambridge University Hospitals NHS Trust

10:45-11:00 Surgical Intervention Ayoola Awopetu, Clinical Fellow, Cambridge University Hospitals NHS Trust

11:00-11:15 Endovascular Intervention Dr Owen Rees, Consultant Interventional Radiologist, Betsi Cadwaladr University Health Board

11:15-11:30 MDT audience discussion – with Ayoola & Owen

Symposium 2: Vascular Pharmacology Chairs: Sue Ward and Kate Rowlands

11:30-11:45 Caring for the Iloprost Patient Jason Clark, Vascular Nurse Specialist, Royal Sussex County Hospital

11:45-12:00 Pharmacological Issues in Chronic Oedema Aisling Roberts, Vascular Nurse Specialist, The Great Western Hospital, Swindon

12:00-12:15 Opioid Intolerance and Acute Pain Dr Jepegnanam, Consultant Anaesthetist, Manchester Royal Infirmary

12:15-12:30 Managing Neuropathic Pain TBC Specialist Pain Nurse, Manchester Royal Infirmary

12:30-13:00 Lunch

13:15-13:30 AGM (SVN members only)

Symposium 3: Wound Symposium Chairs: Leanne Atkin and Jane Todhunter

13:30-13:40 Financial and Service Impact of Chronic Wounds Dr Leanne Atkin, Consultant Vascular Nurse Specialist/Lecturer, Mid Yorks NHS Trust/University of Huddersfield

13:40-13:55 Are we failing patients with Venous Leg Ulcers Jane Todhuter, Vascular Nurse Practitioner, Cumberland Infirmary.


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13:55 -14:10 Innovation in Wound Healing Gail Curran, Vascular Research Nurse, Cambridge University Hospitals NHS Trust

14:10-14:25 Innovation in Oedema Management Tracy Green, Clinical Advisor, Sigvaris

14:25-14:45 Living with a Chronic Wound Tracy Goodwin, Patient

14:50-15:20 Coffee

Symposium 4: New Horizons on Vascular Services Chairs: Aisling Roberts and Sue Ward

15:20-15:30 National Survey for Vascular Research Rouleaux Club and VERN

15:30-15:45 NHS England – Vascular Indicators Nikki Fenwick, SVN President, Vascular Specialist Nurse, Sheffield Teaching Hospitals NHS Trust

15:45-16:00 Provision of services update Kevin Varty, Consultant Vascular Surgeon, Cambridge University Hospitals NHS Trust

16:00-16:30 Joint debate with Rouleaux Club: Chair: Nikki Fenwick Should Claudicants join the Gym rather than meet the Radiologist? For Leanne Atkin, Vascular Nurse Specialist/Lecturer, Mid Yorks NHS Trust/University of Huddersfield Shiva Dindyal, Consultant Vascular and Endovascular Surgeon, Basildon and Thurrock University Hospitals Foundation NHS Trust Against Phillip Stather, Vascular Registrar, Cambridge University Hospitals NHS Trust Gail Curran, Vascular Research Nurse, Cambridge University Hospitals NHS Trust

16:30-17:00 Award presentations James Purdie Bursaries Life-time Achievement

17:00 Close of Meeting, Nikki Fenwick, SVN President

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Society Vascular Nurse

Annual Conference 2017

In conjunction with the Vascular Society of Great Britain and Ireland,

Society of Vascular Nurses, and the Society of Vascular technology of

Great Britain and Ireland.

Manchester

22nd to 24th November 2017

2017 22nd - 24th November

Annual Scientific Meetingin conjunction with the Vascular Society of Great Britain and Ireland, the Society of Vascular Nurses, and the Society for Vascular Technology of Great Britain and Ireland.

2017



Annual General Meeting Agenda.Thursday 23rd November 2017

13:15Manchester Central

The SVN committee propose to discuss the following items:

1. Financial report

2. Presidents report

3. Election of Secretary for the Society of Vascular Nurses

4. Election of Treasurer for the Society of Vascular Nurses

5. Election of temporary members to the SVN committee.

6. Should the SVN have a special membership category for Student Nurses?

7. Amend the constitution to allow payments on behalf of the Society of Vascular Nurses using PayPal

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TREASURER’S REPORTApril 2016 - March 2017

The Society of Vascular Nurses membership includes individual members and ward memberships. Membership is nationwide, as well as some overseas members, and includes allied health professionals. The annual membership fees remain at £20 for individual membership (£25 for overseas membership) and £100 for ward membership. The total income from membership in 16/17 was £3,185.

The SVN committee allocated £2,000 for individual bursaries in this year, of up to £500 each. These can be used for any purpose that enhances vascular nursing practice and development. This year the committee awarded six bursaries totaling £1,543 (with one agreed 16/17 bursary still to be claimed). If requested, the SVN can also provide funding up to £150 for regional meetings organized by a member but no such funding was requested in 2016/2017.

The SVN website is useful and informative to members and enables online membership subscription. The website expenses for this financial year were £648.

The SVN committee continues to produce an A5 quarterly journal with the conference booklet being incorporated into quarter four’s issue. A good income was obtained through the inclusion of advertisements from relevant companies. The newsletter therefore gave us a profit of £5,439.

The committee meets on four occasions throughout the year. In the year 16/17 the meetings were mainly held at Queen Mary’s Hospital, Paddington, where we were able to have free use of a meeting room. Committee members are reimbursed for reasonable travel expenses to attend the meetings and for any other designated duties on behalf of the society. Committee expenses in the year 16/17 were £2,946. The SVN committee undertake all administration for the society themselves to avoid additional costs. Administration and stationary expenses in 16/17 were £1,452, including newsletter postage.

The 23rd annual conference in November 2016 was held in Manchester at the Manchester Central Conference Centre. 2016 was the second year the SVN had the chance to collaborate with the Vascular Society, with joint conference registration via their website. SVN committee were able to claim their conference expenses directly from the VS, in lieu of a grant as in earlier years, and our delegate registration fees were collected by the VS to offset our expenses. Our conference expenses are reflective of this collaboration at £313.

As in previous years the SVN held a free evening symposium the night before our conference. This is an opportunity for members to network as well as meet industries related to vascular disease, with the highlight of the evening being a guest speaker. After the venue and catering expenses had been paid, we received an income of £2,343, obtained through company sponsorship of stands.

In this financial year the SVN donated £350 to affiliated charities.

The Society of Vascular Nurses accounts for the year ending March 2017 are audited by an independent accountant. At the end of the financial year the SVN had assets of £25,815.

Jayne Burns, Treasurer, May 2017

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Bursary Award Winner - Feedback Patient Quality InitiativeBernie Hannon – Vascular CNS (Venous Disease)

St James Hospital – Dublin

In 2013 I was appointed as the nursing lead to set up an out-patient ambulatory care facility for the management of patients with varicose veins. This began as a pilot project , as management were sceptical that surgery could be performed safely in the out-patient setting. Initially surgeons planned to only do endovenous laser or radio-frequency ablation and less than 10 avulsions. However very quickly it became clear that full avulsions could also be done under local anaesthetic. All patients are now considered suitable for out-patient treatment. To date we have successfully completed over 1,000 cases.

Patients can have a light breakfast and are admitted 30 minutes before their procedure. Following their admission and signing of the informed consent patients receive Diazepam 5mg orally and prophylactic low molecular weight heparin sub-cutaneously. We have had some patients who decline sedation. The patient then walks to the procedure room which is located next door to our pre and post op patient area. The service is staffed by 2 nurses, one in the procedure room with the patient and one in the pre/post op area to complete admissions and discharges. Verbal anaesthesia is key to navigating the patient through surgery whilst awake and a playlist of appropriate music during the case further adds to the positive experience and a calm environment. The procedure takes approximately one hour. Once dressings and compression socks are applied the patient walks back to the post op area accompanied by one of the nursing staff. The patient is monitored closely for any adverse events, particularly for possible bleeding. The patient takes 3 short walks 15 minutes apart. Refreshments are provided, post op instructions given and the patient is discharged approximately one hour post procedure in the care of a responsible adult.

The results of surgery to date have been excellent with minimum adverse events. Many patients voice concerns prior to surgery in this out-patient setting that they will not get through the procedure awake and become quite anxious and nervous. Following reassurance and support they are surprised at how well they cope and feel post op. Our vascular team are keen to evaluate the patient journey, despite positive feedback to date. It is important that the service is evaluated formally and changes made if deemed necessary.

I now plan to carry out a patient quality study to this end. I, in association with the nursing research team in Trinity College Dublin developed a questionnaire which was piloted over a 3 month period. It was evaluated by patients and the vascular team and changes were made based on feedback. Following validation of the questionnaire, ethics approval was sought and approval was granted in early March 2017. All post op patients will be invited to complete the questionnaire and return it to the Vascular Department using a stamped addressed envelope. I am very grateful to SVN for providing a bursary to help fund this project.

It is hoped that this service will become the blueprint for the future management of varicose veins and I look forward to presenting my study results in due course.

If you have a project idea but require some funding to initiate it consider applying for a SVN bursary – see http://www.svn.org.uk/membership/bursary-information/ for more information

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Bursary Award Winner - FeedbackVenous Forum Summer MeetingMichelle Britton, Vascular Clinical Nurse Specialist, Bristol

The SVN have a long history of supporting practice and service development so I applied for a Bursary to enable me to attend the Venous Forum in London. I am in the midst of planning a development of my role to include a specialist nurse led superficial venous incompetency treatment service for patients with chronic venous disease. I was very keen to attend the forum to gather information, expert advice and to ensure I am as up to date as possible with current research and practices within this field. I was thrilled when the SVN agreed to support this with a bursary so that I could attend.

I have not had the opportunity to attend the Venous Forum before and found it a great meeting. The venue was the Royal Society of Medicine in London which has excellent facilities for conferences. My colleague and I caught a very early train and set off to London on the Tuesday morning so we could get there in time for the early start. We attended the Venous Forum on the Tuesday and Wednesday.

The sessions over the 2 days covered a myriad of topics relating to venous disease, its management and treatment. I particularly enjoyed the debate sessions where the audience could participate by electronically voting before and after the speakers (for and against) to see if opinion had been swayed by the debate. Sessions ranged from presentations on compression therapy, venous severity grading systems through to national guidelines and their impact on current practice. There were approx. 40 presentations throughout the 2 days on various aspects and issues of venous disease. It was evident there is a great deal of good work being done to tackle venous disease in a secondary care setting but also in primary care.

We are all aware of the extraneous cost that leg ulcers cause the NHS every year and the major impact they can have on patients’ lives. Finding ways to treat these patients swiftly with increased benefit to the patient and decreased risk of recurrence is essential to these patients and was an important message from the forum.

There is concern that many patients with leg ulcers are not being referred quickly enough for specialist assessment and new pathways to streamline and encourage this were presented and discussed at the meeting. This was followed by a call to provide better access to services for patients by delivering services as close as possible to where the patient lives.

Thanks to this opportunity to attend, I was able to network with people and discuss the proposed setup of our new planned service and gained some valuable advice and inspiration. In summary I found this an extremely useful forum to attend and plan to apply what I have learned to my ongoing practice. It was invaluable as a resource for planning our service development allowing me to network with other professionals in other trusts that have already developed a specialist nurse led veins service.

The use of Farrow Wrap with lymphovenous oedema and active ulcerationJane Todhunter, Vascular Nurse Practitioner, Cumberland Infirmary

IntroductionChronic oedema is a soft tissue swelling present for at least 3 months, most commonly caused by venous and lymphatic impairment. Chronic oedema has a huge impact on quality of life and over time may cause social deprivation. The mainstay of treatment is compression therapy and treatment of the underlying cause. Comfort and acceptability of the compression system is essential. Clinicians need to work with patients to ensure they are included in treatment decisions and empowered to take charge of their condition.

Key words: Chronic oedema: Lymphovenous oedema: Leg Ulceration: empowerment: Concordence

Chronic oedemaChronic lower limb oedema is a persistent, abnormal swelling of the leg caused by an increase in fluid in the tissue. In the microcirculation of a normal limb, fluid containing oxygen, proteins and nutrients is released by the capillaries into the interstitial space and is reabsorbed into either the bloodstream or the lymphatic system to maintain fluid balance. When an imbalance occurs due to underlying venous and / or lymphatic disease, the drainage of fluid is impaired, resulting in oedema (EWMA, 2003).

Prevalence Chronic oedema is a common undiagnosed condition. Prevalence statistics and current demographic trends indicate that is a major and growing health care problem. A prevalence rate of 1.33 per 1000 is cited in the literature (Moffatt, Franks, Doherty et al 2003) however, these figures are thought to be much higher. A recent single centre population study demonstrated a crude prevalence of 3.93 per 1000, but higher among those aged 85 and above (5.37 per 1000) and higher among women than men. Unsurprisingly, 40% of those with chronic oedema also had concurrent leg ulceration (Moffatt et al 2016). It is well documented that venous ulceration is the most common type of leg ulcer, affecting approximately 1% of the population and 3% of people over 80 years (SIGN 2010). Like chronic oedema the prevalence increases with age and the global prevalence is predicted to escalate as people are living longer often with multiple co-morbidities.

Lymphovenous oedema Lymphovenous oedema is the result of a combination of venous and lymphatic insufficiency. Venous hypertension results from valvular incompetence in the superficial, deep or perforator veins. Increased venous pressure transcends the venules to impede flow within the capillaries. This causes increased capillary filtration that overloads the lymphatic system resulting in oedema. In clinical practice the leg oedema will be accompanied by one or more of the classical sig ns of venous disease; haemosiderin staining, varicose eczema, atrophie blanche, lipodermatosclerosis or ulceration.

Burden of lymphovenous oedemaLymphovenous oedema represents a significant burden to patients and the NHS. At any one time, there are between 70,000 and 190,000 individuals with a venous leg ulcer in


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the UK. The impact on quality of life is well documented and is similar to that of other common chronic conditions such as renal failure, heart failure and diabetes (Hopman et al 2016). The associated symptoms include pain, odour and exudate, and are frequently accompanied by loss of mobility, lack of sleep and social isolation (Franks & Morgan 2003). The cost to the NHS of treating venous ulceration is at least £168-198m per year (Posnett & Franks 2008).

Management of lymphovenous oedemaThe best practice management of lymphovenous oedema is a holistic, multidisciplinary approach that includes: • Swelling reduction and ulcer healing using compression

• Skin care to optimise the condition of the skin and treat any venous eczema

• Exercise/movement to enhance lymphatic and venous flow

• Treatment of the underlying venous disease to reduce risk of recurrence and / or long term compression maintenance

There is evidence to suggest the management of the condition is often sub optimal. Chamanga (2014) highlights the poorer outcomes associated with wrongly applied bandages. In clinical practice the frequency and correct application of compression bandaging is often compromised by staff shortages, inadequately trained staff and lack of continuity of care. Inappropriate management may lead to increased exudate levels, wound deterioration and have a negative impact on patient quality of life.

To address these issues, it is important to recognise that different compression options may be suitable for different patients depending on the clinical challenges presented (WUK BPS 2016). Self-Adjustable Velcro Compression Devices may represent an effective alternative to either bandages or hosiery. In addition, they may aid self- management with related significant cost savings (Blecken et al 2005). This article looks at the use of farrow wrap garments as an alternative to compression bandaging in the presence of lymphovenous disease combined with tissue loss.

empowermentInvolving the patient as a key decision maker in the management of their lymphovenous oedema may improve outcomes (DH 2001). Ribu and Wahl (2004), demonstrated that patients can become experts in their own leg ulcer management. Enabling patients to take control of their chronic condition can improve their self-esteem (Sneddon & Lewis 2007) and is consistent with the NHS Five -Year Forward View which makes patient empowerment and involvement a priority (NHS 2014). Indeed, the expert patient is likely to reduce demands on acute services as they manage their long-term condition more effectively. The issue of empowerment was pivotal in the following case studies.

JoBsT farrowwrap Jobst FarrowWrap is a wrap compression system that consists of a liner and an outer wrap piece and is indicated for both lymphatic and venous disorders. It has the advantage of short stretch or inelastic technology. Inelastic compression is favoured for chronic lymphovenous oedema as the fabric does not yield to expansion related to the oedema (WUK BPS 2016). The stiff fabric provides superior augmentation of the calf’s natural muscle pump action and delivers a low resting pressure and high working pressure which aid venous and lymphatic return. The simplicity of Velcro fastening allows maximum


29

patient independence enabling the patient to control their own care while the range of styles, sizes and the availability of two compression classes provide the variation required in clinical practice.

Case study oneMs B is a 63-year-old lady. She was referred to the Vascular Nurse clinic from dermatology. She had a long history of lesions to her left leg. With a background of extensive sun damage and multiple non melanotic skin cancer she had been referred for a dermatology opinion. Dermatology felt the skin lesions were of a different aetiology and warranted a vascular opinion. Upon referral Ms B had leg oedema and copious exudate from the lesions. She was managing her leg herself with multiple pads and loose crepe bandages but her preference was to keep the lesions dry and crusty if possible. She described emollient as ‘melting her skin’ and so this was not part of her skin routine. The main issue on referral was the leg oedema causing the exudate. Her expectation was not one of healing her skin completely but keeping it manageable.

Following a vascular assessment evidence of superficial venous reflux was noted. Her ankle brachial pressure index (ABPI) was normal. For people with leg ulcers the arterial supply to the leg should be assessed to support the safety of compression bandaging (SIGN 2010). Ms B was reluctant to try compression bandaging but after a lengthy discussion weighing up the pros and cons agreed to give it a go. It was felt that compression was the answer to reduce the leg oedema. Ms B had a very active life style and had no time to sit with her legs elevated. A short stretch cohesive 2 layer system was applied with a non-adherent wound contact layer. Inelastic bandaging is most appropriate for chronic oedema due to the massaging effect on the lymphovenous system. If a cohesive inelastic bandage is used, this can help overcome bandage slippage. Compression can also contribute to ulcer healing and help to prevent further deterioration of the skin (EWMA, 2003).

It was anticipated that she would be reviewed in one week but 3 days later she asked to be seen urgently due to increased discomfort and malodour. Upon removal of the bandages there was extensive skin loss and evidence of pseudomonas. Ms B felt this was due in part to her leg ‘being encased in the compression bandages’ and no longer being showered daily. Her leg was washed with potassium permanganate, cutimed Sorbact was applied as the primary dressing to reduce the bacterial bioburden and the 2 layer full compression bandages reapplied after a lengthy debate. There was no sign of clinical infection. In people with chronic leg ulcers systemic antibiotics should only be used if there is evidence of clinical infection (SIGN 2010)

At review 4 days later her exudate levels had decreased, there was less pseudomonas and the leg oedema was reducing. However, Ms B was shortly going to Italy and was unhappy with the regime of compression bandages. She felt disempowered by not being able to look after her leg herself, and the trips to clinic were interfering with her usual daily activities. The vascular nurse was aware of the potential loss of Ms B’s trust and engagement. The farrow wrap garment was discussed as an alternative and Ms B could see the potential of taking control of her care once more. She was measured and fitted with Farrow Wrap strong providing her with 40 mmHg of compression but with a soft conformable garment. Cutimed Siltec was used as the primary dressing due to its softness, conformability, absorbency and ease of application. She became self-managing.


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4 months after her initial visit Ms B presented at a follow up appointment. Her skin had improved with fewer lesions evident, there was no exudate and she was wearing the farrow wrap as she felt necessary. She was delighted with the outcome and extolled the virtues of a Velcro leg device as an alternative to bandaging. She felt it was not necessary to attend any further appointments and was discharged. She declined any intervention for her venous disease.

Initial visit Application of Final visit farrow wrap strong 4 months later

discussion There is some evidence to suggest that practitioners sometimes focus more on the wound’s progress than on what the patient wants and a mismatch in expectations may lead to disillusionment with care and poor concordance (Persoon et al, 2004; Briggs and Flemming, 2007). Patients were concerned about the socially inhibiting consequences of their complex wound, but wound care services often did not focus on the psychological or social impacts (Callum et al 2016). Ms B merely wanted the exudate reduced and to be left to continue the management of her skin lesions and carry on with her busy life. It is important to view the situation in a holistic manner with a good understanding of the quality of life issues relevant for the patient.

The farrow wrap can be used successfully with open skin lesions in conjunction suitable absorbent primary dressings.

Case study TwoMrs H is a 92-year-old lady with a long history of bilateral leg oedema and intermittent ulceration following bilateral DVT. She lives alone with input from a carer who applies bandages when her legs leak. Over the years, Mrs H has been reluctant to wear compression hosiery, finds bandages uncomfortable and her leg oedema has become chronic and recalcitrant. She is normally very sociable and loves to lunch out accompanied by her carer and another elderly friend however her ‘heavy legs’ are becoming a problem. She is finding it increasingly difficult to get her legs into bed and has taken to sleeping in a chair at night. Her legs have become ‘leaky’ with substantial skin loss. She is finding it difficult to get out and about, is becoming self-conscious about the odour of her ulcer and the wet dressings on her legs. She is missing the social interaction of her regular lunches


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out and is feeling a ‘bit down’. Mrs H does not want to become a burden on the NHS and values her independence and freedom from clinic appointments. She was referred to the vascular nurse clinic by the practice nurse who was at a loss how to proceed.

At the first clinic visit she had bilateral leg oedema with shape distortion, a large circumferential ulcer to her right gaiter with a high level of exudate that was requiring daily dressings. Her ankle brachial pressure index was normal and she was known to have deep venous reflux. She made her negative feelings about compression bandages quite clear. Due to her poor tolerance of compression in the past she would only agree to try reduced compression in the form of a 2 layer short stretch system. Sorbion sachet XL was used as the primary dressing to absorb the exudate. She agreed to try and go to bed at night and elevate her legs when sitting during the day.

At her clinic visit the following week leg oedema had started to reduce and exudate levels decreased. The ulcer was smaller. She was adamant however that she didn’t want to continue with professional input on a weekly basis but wondered if her carer could be taught to apply the compression bandages. The concept of a farrow wrap garment was offered as an alternative and she was keen to give it a go. She was measured for a farrow wrap Lite due to her low tolerance for compression. This provides compression within the range of 20-30mmHg. Her carer was shown how to apply the garments and the plan was that Mrs H would be able to have her daily shower once more. She was reviewed 2 months after her initial visit. The ulcer had almost healed, there was very little exudate and her skin condition had improved. Mrs H continues to sleep in bed and is enjoying her social activities once more.

First Visit Application of 2 months after first visit Farrow wrap Lite

discussion Research has shown that the leakage and odour from leg ulcers can cause embarrassment, resulting in social isolation, low mood, depression and poor self-esteem. Interventions to improve leakage and odour have often proved to be inadequate (Green et al 2016). Providing Mrs H with a farrow wrap enabled her to shower and apply emollient daily which enhanced her feeling of well-being as well as her skin condition. Skin care is vitally important and a good daily skin care regimen should be encouraged to help maintain skin integrity and minimise the risk of infection (Lymphoedema Framework 2006).


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The farrow wrap Lite was a compromise between compression and non-concordance. She would benefit from stronger compression to improve her leg shape and reduce the risk of recurrence. Patients should be offered the strongest compression which they can tolerate to prevent ulcer recurrence (SIGN 2010). As she has found the current garments comfortable changing to a farrow wrap strong will be discussed when the time comes to renew the garments. Patients should be reviewed regularly and limbs should be re-measured every four to six months and new compression garments prescribed as appropriate (Lymphoedema Framework, 2006).

referencesBenbow, M. (2004) ‘Mixing dressings-a clinical governance issue?’, Journal of Community Nursing, 18(3) pp.26–32.

Blecken, S.R., Villavicencio, J.L. & Kao, T.C. (2005) ‘Comparison of elastic versus nonelastic compression in bilateral venous ulcers: a randomized trial’, Journal of Vascular Surgery, 42 (6) pp.1150–1155.

Briggs, M. & Flemming, K. (2007) ‘Living with leg ulceration: a synthesis of qualitative research’, Journal of Advanced Nursing, 59(4) pp.319–28.

Chamanga, E.T. (2014) ‘Understanding the impact of leg ulcer bandaging on patient quality of life’, Journal of Community Nursing, 28(1) pp. 40-47.

DH (2001) The Expert Patient: a new approach to chronic disease management for the 21st century. Department of Health: London.

European Wound Management Association (2003) Position Document: Understanding Compression Therapy. London: MEP Ltd.

Franks. P.J. & Morgan, P.A. (2003) ‘Health related quality of life with chronic leg ulceration’, Expert Review of Pharmaco-economics and Outcomes Research, 3 (5) pp.611-622.

Green, J., Jester, R., McKinley, R. & Pooler, A. (2016) The impact of chronic venous leg ulcers: a systematic review. [Online] [Cited: 22nd May 2017] http://eprints.keele.ac.uk/693/3/Julie%20Green.pdf.

Hopman, W.M., Vandenkerhof, E.G., Carley, M.E. & Harrison, M.B. (2016) ‘Health -related quality of life in individuals with chronic venous or mixed venous leg ulceration: a longitudinal assessment’, Journal of Advanced Nursing, 72(11) pp2869-2878.

Lymphoedema Framework (2006) Best Practice in the Management of Lymphoedema: International Consensus. MEP Ltd: London.

Moffatt, C.J., Franks, P.J., Doherty, D.C., Williams, A.F., Badger, C., Jeffs, E., Bosanquet, N. & Mortimer, P.S. (2003) ‘Lymphoedema: an underestimated health problem’, Quarterly Journal of Medicine, 96 (10) pp.731–8

Moffatt, C.J., Keeley, V., Franks, P.J., Rich, A. & Pinnington, L. (2016) ‘Chronic oedema: a prevalent health care problem for UK health services’, International Wound Journal DOI: 10.1111/iwj.12694

NHS (2014) Five Year Forward View. NHS England: London.

Persoon, A., Heinen, M.M., van der Vleuten, C.J.M.. de Rooij, M.J., van der Kerkhof, P.C. & van Achterberg, T. (2004) ‘Leg ulcers: a review of their impact on daily life’, Journal of Clinical Nursing, 13(3) pp.341–354.

Posnett, J. & Franks, P.J. (2008) ‘The burden of chronic wounds in the UK’, Nursing Times, 104 (3) pp. 44-45.

Ribu, L. & Wahl, A. (2004) ‘How patients with diabetes who have foot and leg ulcers perceive the nursing care they receive’, Journal of Wound Care, 13(2) pp.65–68.

SIGN (2010) Management of chronic venous leg ulcers. A national clinical guideline. SIGN: Edinburgh.

Sneddon, M.C. and Lewis, M. (2007) ‘Lymphoedema: a female health issue with implications for self care’, British Journal of Nursing, 16 (2) pp.76-81.

WUK (2016) Best Practice Statement: Holistic management of venous leg ulceration. Wounds UK: London.


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Bradford’s Vascular Educational Day

To reserve a place, please email Carly Burnett at

[email protected] or telephone 01274 36 6239

Content: • Peripheral Arterial Disease • Care of the Diabetic Foot • Amputation and Rehabilitation • Aneurysms • Vascular Access • Stroke and Carotid Intervention • Wound and Ulcer Management • Practical Demonstrations

This course has been designed to help healthcare professionals in all disciplines improve their knowledge of vascular surgery. The day will

give an insight into vascular disease and intervention and will be delivered from both a medical and nursing approach.

Welcome from Dr Bryan Gill – Medical Director, BTHFT

Friday 15th December 2017 Sovereign Lecture Theatre, Bradford Royal Infirmary

8.15am – 4pm Conference fee £20 per person (lunch, refreshments, certificate

and goody bag included)


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SVN MILESTONE 25TH ANNIVERSARY Celebratory Event The SVN will reach its Quarter Century in 2018, join us in Glasgow to celebrate this fantastic milestone. Details will be released at the earliest opportunity, so that you will be able to save the date.

SVN 25TH ANNIVERSARY

JOIN US IN GLASGOW TO

CELEBRATE

1994-2018

DETAILS WILL BE RELEASED EARLY 2018

SVN 25TH

ANNIVERSARY——

JOIN US INGLASGOW

TO CELEBRATE——

1994-2018

DETAILS WILL BE

RELEASED

EARLY 2018



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The need for a cross sectoral, collaborative, whole systems analysis of services that leads to saving legs: Introducing the Manchester Amputation Reduction Strategy (the MARS project)Naseer Ahmad, Consultant Vascular Surgeon, Manchester University Foundation Trust

The BackgroundThe prevalence of major amputation in those over 50, in England, is approximately 26/100 000.1 In relation to this national average, rates across England vary by 50% with prevalence higher in Northern England compared with the South.1 The above to below knee amputation ratio (a potential marker of poor care) is additionally higher in Northern regions (North 1.3:1, Midlands 1.2:1, South 0.9:1).2 Amputation rates are also three times higher in men compared with women1 and 70% higher in Black than white populations.3 Half of these amputations are in non diabetics - the additional main cause being peripheral arterial disease i.e. atherosclerosis1,4. Fortunately, over the last ten years (2003-2013), major amputation rates have fallen by 18%, however, regional and gender inequalities remain.5 Additionally, minor amputation rates i.e. those below the ankle have risen with this rise attributable to non diabetic men.5 The cost of diabetic foot disease to the NHS is estimated at £600m annually7, this can easily be doubled to include peripheral arterial disease.

Figure 1Proportional percentage prevalence (relative to national average; England=100) of lower limb major

amputation (upper value) and revascularisation (lower value);men and women aged 50-84: England 2003-2009

Figure1

NorthEast

Yorkshire&Humber

EastMidlands

EastofEngland

London

SouthEast

SouthWest

WestMidlands

NorthWest

89;86-93

105;100-109

85;81-88

132;126-138

121;117-124

86;83-8992;89-96

94;91-98

114;110-118

89;89;86 9399;98-101

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27.7

22 .9

29 .9

35.2

10.0

15.0

20.0

25.0

30.0

35.0

40.0

2003/4 2004/5 2005/6 2006/7 2007/8 2008/9 2009/10 2010/11 2011/12 2012/13

Year

Prev

alen

ce p

er 1

00 0

00

Majo rM ino r

Figure2

94.8

99.1

58.1

51.5

69.0

85.2 65.1

100.9

97.8

141.5

113.1

154.0

Fig. 2.Age adjusted lower limb major (solid circle) and minor (solid square) amputation rates;

men and women aged 50-84: England 2004-2013

The Greater Manchester ProblemThe population of Greater Manchester is 2.8 million and covers 493 square miles. Its population rose by three times the national average between 2001 and 2011 (national rise 7.1%; manchester 19%)6 and over the last fi ve years (2010-2015), the population has risen by a further 50 000.6

Figure 3Proportional Prevalence of major amputation (England=100) within each Clinical Commisioning

Group of Greater Manchester; men and women combined aged 50-84; 2010-2015

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Appointmentoffirstsub-specialitysurgeon

Firstmulti-disciplinaryfootwardround

Firstcomplexultra-distalbypass

Firstcomplexultra-distalangioplasty Firstcomplexfootsurgery

FirstuseofthenewHybridSuite Appointmentofsecondsub-specialitysurgeon

Firstlowerlimbsurgicalfellowship

AK:BK1.1:1

AK:BK1:1.3

AK:BK1:1.5

The national inequalities surrounding amputation highlighted earlier are also evident within Greater Manchester. Data sourced regionally from the limb reconstruction service (which records all major amputations in the Greater Manchester area) show overall prevalence of major amputation for those aged 50-84 to be 36% above the current national average (22.9 vs 31.5/100 000) with rates over three times higher in men than women (men 48.9, women 15.0). Whilst the overall prevalence in Greater Manchester is above the national average, within each Clinical Commisioning Group rates vary widely. The proportional prevalence relative to the national rate in each area is shown in the map below. The centre of Greater Manchester has rates well above the national average, the East has rates in line with the of the national average with Western and Southern rates below the national average.

The reasons for the variation across Greater Manchester are not clear and are the subject of current research. However, areas of expert treatment have been identifi ed such as at Central Manchester Foundation Trust. Here, the amputation numbers have reduced dramatically and brought about by vascular surgeons sub-specialising in complex lower limb disease.

Figure 4Number of Major Amputations and changing practice at Manchester Royal Infi rmary 2010-2016

Similar expertise has also been identifi ed in primary care as shown in fi gure 3. Such examples have highlighted the need for pockets of expertise to be identifi ed and replicated across Greater Manchester.

The Manchester Amputation Reduction Strategy (MARS) –an introduction (fi g 5 and 6)The main causes of lower limb amputation addressed by MARS are those due to diabetes, peripheral arterial disease, venous disease and lymphoedema. It does not directly address those caused by trauma and cancer.

39


GeneralPractitioner

DistrictNurse

Specialist TVNClinic

MDT

DistrictNurse

Specialist Podiatry

MDT

Vascular Outpatient

HospitalAdmission

Leg AssessmentClinic

Exercise Class

AE AE AE

GeneralPractitioner

DistrictNurse DistrictNurseLegAssessmentClinic

ExerciseClass

SpecialistTVNClinicSpecialist

Podiatry

VascularOutpatient

HospitalAdmission

MDTMDT

AE

Footulcers Legulcers

The project is built on three principles; prevention, collaboration and building on best practice. The strategy began by collecting examples of best practice across primary and secondary care and augmented these with best evidence guidelines. It then identifi ed key stakeholders in the management of these conditions and through collaboration developed one treatment algorithm which was then tailored to individual regions through a locality plan. The strategy integrates prevention by ensuring those at high risk are identifi ed early, offered lifestyle and risk factor modifi cation, and, if required, treated for ulceration quickly and correctly.

The strategy incorporates the treatment of all foot and leg ulcers i.e. both diabetic and non diabetic. It is an ambitious project which will involve bringing together, podiatrists, tissue viability teams, district nurses and vascular surgeons. Its aim is to spread expertise in the management of these conditions and support non experts in their treatment through effective referral pathways.

The project is primarily based in the community and fulfi ls regional and national agendas regarding prevention, the transfer of hospital services into the community and ‘get it right fi rst time’ initiatives.

Ultimately, the project is a whole systems review with the aim of creating one uniform service with common standards and referral pathways. The pathway has a ‘triage’ service which reviews the referrals and offers lifestyle and risk factor modifi cation interventions and a ‘protection service’ where those with either foot or leg ulcers are referred. Expert staff work at all levels of the protection service to ensure skills and confi dence are disseminated. The heterogeneous nature of the current pathway and the proposed new MARS pathway are shown in fi gures 5 and 6 respectively.

40


ClaudicationSuspectedPADLossofprotectionsensationFootNeuropathy Legulcers Footulcers LymphoedemaVaricoseveins ‘blue/blacktoe’ Diabeticandnondiabetic

GenericWoundclinics (DN/Pod/TVN)

SpecialistTVNclinic Specialistpodiatryclinic

FootMDT LegMDT

Hospital

TriageReferrals

Health,Lifestyleand SocialReview Reassess

Health,Lifestyle,social Intervention

Refertoprotectionservice (atappropriatelevel)

Generalpractitioners AccidentEmergency Hospitals Podiatrists Districtnurses TissueViability SelfReferral

FootandLeg TriageService

FootandLeg ProtectionService

The Next StepsThe MARS project is currently taking shape and enjoys the support of commissioners and key stakeholders through early, consistent and meaningful engagement. Once the detail regarding project has been agreed and business case submitted, the real work will begin!

References1 Ahmad N, GN Thomas, Gill P, Chan C, Torella F. Lower limb amputation in England: prevalence,

regional variation and relationship with revascularisation, deprivation and risk factors. A retrospective review of English hospital data. J R Soc Med. 2014 Dec;107(12):483-9

2 Ahmad N, GN Thomas, Gill P, Torella F. Endovascular revascularisation is associated with a lower risk of above knee amputation than surgical or combined modalities. Analysis of English hospital admissions over a six year period. Int J Angiol 2016;35:498-503

3 Ahmad N, Chan C, Thomas GN, Gill P. Ethnic differences in lower limb revascularisation and amputation rates. Implications for the aetiopathology of atherosclerosis? Atherosclerosis 2014; 233:503-507

4 Moxey PW, Hofman D, Hinchliffe RJ, Jones K, Thompson MM, Holt PJE. Epidemiological study of lower limb amputation in England between 2003 and 2008. BJS 2010; 97: 1348-1353.

5 Ahmad N, GN Thomas, Gill P, Torella F. The prevalence of major lower limb amputation in the diabetic and non diabetic population of England 2003-2013. Diab and Vasc Dis Research 2016;13(5):348-53

6 Offi ce National Statistics. Annual Population Estimates. HMSO available at http://www.ons.gov.uk/ons/guide-method/method-quality/specifi c/population-and-migration/pop-ests/faq-annual-population-estimates--uk-.html

7 Kerr M, Rayman G, Jeffcoate WJ. Cost of diabetic foot disease to the National Health Service. Diabetic Medicine 2014;32:1498-1504

41


Saving Lives

SepsisImplementing the New National Quality StandardMonday 22 January 2018 De Vere West One Conference Centre, London

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Chair and Speakers Include:

Professor Saul Faust Chair Sepsis NICE Guideline Committee & Professor of Paediatric Immunology &Infectious Diseases University of Southampton

Dr Ron Daniels Chair The UK Sepsis Trust& Consultant in Intensive CareGood Hope Hospitals NHS Foundation Trust

For a 20% Discount Quote hcuk20svn

42

svn.org.uk 4th Quarter 2017svn.org.uk 4th Quarter 2017

Exciting opportunity for Staff NursesThe SVN wish to recruit two staff nurses who work with vascular patients in any setting and who would like to join us for a year’s secondment on our national committee, as from February 2018.

This would be an excellent opportunity for educational and professional development and would involve attending 3 committee meetings in central London during the year to help contribute ideas and plan strategies for our national society. We are looking for staff nurses, Band 5 working in any acute or community setting caring for vascular patients.

Travel expenses to committee meetings would be fully met by the Society and the two secondees would also be entitled to free registration/travel to our annual conference in Glasgow in November 2018.

Each applicant needs to be either an individual SVN member or part of a ward membership.

I have attached an application form which needs to be emailed/sent to me by the 31st December 2017.

If you would like any further information please give me a call or email me.

Sue Ward, Vascular Nurse Specialist The Vascular Assessment Unit The Royal Sussex County HospitalTel: 01273 696955 bleep 8213 ext 3610Mobile: 07770 826278



BURSARY UPDATE Would you like to develop yourself in vascular nursing and benefit your patients?

Is the thought of spending some money in doing so holding you back?

The committee have made £2,000 available in this financial year for the award of bursaries overall, so why not apply if you have been an individual member for more than three months? Up to £500 can be awarded per bursary (maximum of one bursary per member every three years).

The SVN committee have received 2 applications for a bursary so far in this financial year. These were both requested to attend the Venous Forum this summer at the Royal Society of Medicine.

Have a look at the bursary section on the SVN website for further details. What have you got to lose?

Jayne Burns, Treasurer and Bursaries

43


Application for 1 year Staff Nurse Secondment to SVN CommitteeSurname: ___________________________________ First name: ____________________

Current post: ________________________________ Grade: ________________________

Employer’s Address: ___________________________________________________________

Work telephone number: ______________________

E Mail address: ______________________________

SVN Membership: Individual: Yes/No or Ward membership Yes/No

Please write a brief statement of your reasons for your application:

_____________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

Applicant’s signature: _________________________ Date: _________________________

Application supported by:

Manager’s name _____________________________ Signature: _____________________

Manager’s address: ___________________________________________________________

_____________________________________________________________________________

Please return application by 31st December 2017 to:Sue Ward, Vascular Nurse SpecialistThe Vascular Assessment Unit, The Royal Sussex County HospitalEastern Road, Brighton, BN2 5BE

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