What is the patient experience of healing in a hosiery kit?

Ask the expert
In each issue of JCN we ask a clinical expert to take a look at a therapy area and examine
some everyday problems that community nurses may experience. In this issue, we look
at the management of leg ulcers with hosiery kits and ask the question...
What is the patient experience
of healing in a hosiery kit?
THE PROBLEM
Leg ulcers can be particularly difficult to
manage, with pain and exudate having
a serious effect on patients’ quality of
life, not to mention the difficulties of
treatment with compression bandaging.
We asked Ian Payne, a patient with a
history of leg ulcers, to tell us how he
found treatment with a hosiery kit. We also asked his nurse,
Karen Hutchinson, a community nurse/wound clinic nurse in
Walsall, how she approached his care.
THE SOLUTION
Although I have a clinical background,
this reflection has been written from
the perspective of my recent experience
as a lay-person rather than as a nurse.
Having developed an ulcer to my left
leg following a previous deep vein
thrombosis (DVT) in January 2014, I
was unfortunate enough to develop
another DVT in my right leg; this
consequently led to immediate severe
oedema and skin breakdown.
Following discharge from
hospital, my ulcer was managed by
the local practice nurse using wound
dressings and analgaesia. One thing
that I will never forget is how painful
the ulcer was — it was excruciating.
While I appreciate that pain is a
very personal experience and can
be difficult to assess, it had a huge
impact on my life.
After three months the wound
was deteriorating and my leg
continued to be oedematous, so I
was referred to the local leg ulcer
specialist service. The team there
decided that I would benefit from
compression therapy and this was
started in May, 2014. At this point the
ulcer was incredibly wet.
The prospect of compression
bandaging was daunting at first,
although eventually I got used to the
bandages, resigning myself to the
thought that they were something
I just had to live with. They became
almost part of me.
Despite the use of compression
bandaging, the wound continued to
progress slowly, largely due to ongoing
issues with infection, but then in
January 2015 the wound appeared to
deteriorate significantly (Figure 1).
Due to the complexity of
the problem, I was referred to a
dermatologist who prescribed a course
of prophylactic antibiotics. I remained
on the antibiotic therapy for four
months, which proved to be extremely
helpful. From then on the wound began
to improve and the oedema reduced,
aided by the combination of bandaging
and antibiotics.
HOSIERY KIT
In May 2015, my wife and I had
planned to go on holiday, which raised
the question of how I would be able
to have my compression reapplied
safely and effectively while we were
away. By this point the ulcer had
improved considerably — the leakage
had reduced along with the oedema
(Figure 2).
My specialist nurse Karen
suggested I use a hosiery kit to
overcome the issues around bandage
reapplication while on holiday. Due to
my history of oedema, an ActiLymph™
(Activa Healthcare) hosiery kit was
prescribed.
As soon as I tried on the hosiery
kit I felt relieved — not only was I able
to go on holiday and independently
care for my leg, I also continued to
wear the hosiery kit when I returned
home and, to my surprise, one month
later the ulcer was healed (Figure 3).
Being able to wear a hosiery kit
rather than bandages made me feel
so much more human; more normal
and civilised. The kit also felt more
comfortable than the compression
bandages and I could again do things
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?
Figure 2. The patient’s leg before the application of a
hosiery kit on 22 May, 2015.
Figure 1. The patient’s ulcerated leg following an exacerbation
while in bandaging on 26 January, 2015.
that I once took for granted, like
showering and wearing normal shoes.
As well as healing the ulcer, I
feel that wearing the hosiery kit has
Clinician’s reflection
Figure 3. The patient’s healed leg on 1 July, 2015.
helped me understand the rationale
behind wearing compression hosiery
and, in some way, has given me a
greater confidence in what hosiery
can achieve. I am going to continue
wearing hosiery on both legs to
prevent any further DVTs or leg
Karen Hutchinson is community nurse/wound clinic nurse, Brace Street
Wound Clinic, Walsall Healthcare NHS Trust
I feel Ian could have gone into a hosiery kit sooner but, as well as challenging
my practice, Ian had experienced so many setbacks that we were both
apprehensive about changing his treatment. However, when Ian mentioned
he was going on holiday I remembered an article which discussed the findings
of the VenUS IV study (Ashby et al, 2014) and highlighted improved quality of
life and lower recurrence rates for patients in hosiery kits.
Once he was using the hosiery kit, I was really pleased to see that Ian’s leg
continued to improve and was also surprised at how quickly the ulcer itself
healed. I was also extremely happy to see how positive Ian was — he was able
to self-manage his ulcer and had complete faith in the kit; so much so that he
was keen to remain in the kit and was completely healed within six weeks.
Since working with Ian I have used hosiery kits to manage other patients; not
only with the ‘step-down’ approach, but also as a first-line treatment initiative.
They allow patients to lead a more ‘normal’ life and are safe and cost effective.
Hosiery kits are an asset to any clinician’s toolkit when managing leg ulcers.
ulcers. Karen also informed me about
the evidence that has recently been
published on hosiery kits, so I was
pleased to find out that I was receiving
evidence-based best practice.
I hope that relating my experience
here helps clinicians to reflect on
their practice and, in particular,
consider using hosiery kits to deliver
more effective and timely care for
those with a leg ulcer. I also want to
thank the nurses, particularly Karen,
for being my advocate. I am now
looking forward to a more active
and pain-free future (in my hosiery
of course!). JCN
This piece was sponsored by
an educational grant from
Activa Healthcare.
REFERENCES
Ashby RL, Ghabe R, Ali S, et al (2014) Clinical
and cost-effectiveness of compression
hosiery versus compression bandages in
treatment of venous leg ulcers (Venous leg
Ulcer Study IV, VENUS IV): a randomised
controlled trial. Lancet 383(9920): 871–9
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