Heather Hodgson - Tissue Viability Nurse Specialist - Gartnavel General Hospital, Glasgow & Co-author Sharon Naughton - Sister, Tissue Viability Link Nurse 3C - Gartnavel General Hospital, Glasgow
Dealing with patients with ‘leaky legs’ where there is a constant flow of fluid from patients’ swollen oedematous legs is a constant challenge for nurses and compromises quality of life for patients. It is a condition that is complex to assess and manage.
Oedema results from fluid accumulation in the interstitial compartment of the extravascular space.
Oedema has many causes: venous insufficiency, lymphoedema, drug induced, endocrine disease, renal disease, hepatic disease, cardiac problems and nutritional imbalance.
A clinically relevant history and appropriate investigations must be carried out to accurately assess and treat the underlying cause. Choosing the appropriate intervention involves understanding the cause of oedema as well as the different management approaches available, problems can occur if the volume of interstitial fluid in the limb exceeds its capacity to retain it. This may be complicated if there is a breach in skin integrity or an infection. This can result in gross swelling, blistering and leakage of interstitial fluid on to the skin.
A grossly oedematous limb is physically heavy to lift, affects mobility and well-being, and has a high risk of infection. If it is leaking fluid, it will feel wet and quickly become cold. The fluid will soil clothing and bed linen, and could pose a safety problem if flooring becomes slippery.
Management of leaking fluid
Management of leaking interstitial fluid often centres on appropriate dressing selection. However, it is essential to take an interdisciplinary approach to managing patients to prevent complications, maintain skin integrity and promote independence.
There is a range of dressings and devices for dealing with wound fluid however the choice is limited when treating a grossly oedematous limb, owing to its size and leaking fluid. Dressings designed to deal with significant fluid volumes include foam, alginate, hydrofibre and composite dressings. There are anecdotal reports of absorbent disposable continence pads or nappies being used to absorb fluid but there is lack of evidence to support this practice.
However, dressings may quickly become saturated and thus extremely heavy, causing them to slip and pull on the skin and is not advisable to use adhesive dressings on grossly oedematous legs because they may tear the very fragile taut skin and will require frequent changing. Therefore finding a suitable dressing to deal with ‘leaky legs’ is challenging for nurses and patients.
According to Advancis Medical, the Eclypse Boot is a super absorbent dressing designed to manage moderate to heavily exuding wounds including:
• Leg ulcers
• Superficial wounds
• Pressure ulcers
• Arterial ulcers
• Diabetic ulcers
• Leaky legs
The dressing features being:
• Rapid absorption
• High capacity
• Fluid repellent backing
• Strength and durability
• Stay dry technology
• Thin and conforming
From the product description, this dressing seems the ideal choice to manage the fluid from ‘leaky legs’
Fig 1. Application of the Eclypse Boot
This evaluation is a comparison between conventional management of Eclypse (with the same dressing features as the Eclypse Boot) and the Eclypse Boot.
To reduce patient variables, three patients with leakage from both legs were asked to participate in the evaluation. One leg was treated conventionally using Eclypse secured with a light bandage and the other with the Eclypse Boot. Fig 2. The layers of the Eclypse dressing.
After one week the patient and the nursing staff were both asked to complete a Likert type scale to determine the overall performance of each dressing regime, the time spent on each dressing regime and cost of each dressing regime.
Compared to the conventional method of treatment, the Eclypse Boot was rated ‘excellent’ by both patients and nursing staff. The main result areas being:
• Eclypse Boot was up to eight times quicker to apply (fastest application time 20 seconds)
• Required only one nurse to apply dressing, where conventional dressing required two
• Cost savings of up to £25 per patient
• Eclypse Boot stayed in place compared to conventional regime which had a tendency to ‘slip down’
• Eclypse Boot was more comfortable to wear
• Eclypse Boot managed exudate more effectively ‘No more freezing legs at night!’
• Eclypse Boot less painful to apply
There are no easy ways to manage gross oedema and the resulting fluid leakage. It is vital to treat the underlying cause and reduce the risk of complication, such as infection and injury to wet, vulnerable skin. It is envisaged that the Eclypse Boot proved beneficial for patients in terms of comfort and quality of life, for nurses in terms of time and frequency of dressing change and budget in terms of cost effective care. In conclusion, not only did the Eclypse Boot rise to the challenge of dealing with the debilitating condition of leaky legs – it exceeded it.
Fig 2. The layers of the Eclypse Dressing