Reading Part B45

B45. The section of the guidelines establishes:

Doppler Assessments

Only appropriately trained and competent nurses should carry out leg ulcer assessments as poor assessment can lead to inappropriate treatment and patient harm. Leg ulcers are classified as venous, mixed or arterial and some patients may have both venous and arterial disease. To determine whether the patient has any significant arterial disease, a full ankle brachial pressure index (ABPI) measurement using a hand-held Doppler device is necessary. If the Doppler assessment indicates no significant arterial disease, then the patient is treated as having venous ulceration. Clinical guidance advocates that compression bandaging is the best treatment for healing. Under no circumstances should any form of compression be applied to the patient with significant arterial disease and referral to vascular services is required. In some areas of the community, it is possible for tissue viability teams to perform a more in-depth Doppler assessment called a 'waveform analysis'. Practice and community nurses can discuss this with their local tissue viability nurse to see if it is an option for their patients. This assessment is useful when nurses are not able to carry out a traditional Doppler assessment for clinical reasons, for example, if the patient cannot lie flat for the time required.