I was recently talking to a young nursing student who told me she had had a terrible week and cried when she had to do wound care for a patient. When asked what the problem was she reported that her patient was an elderly man near death who had severe peripheral vascular disease with gangrene on both feet. He had severe pain whenever touched and she was instructed to wrap his legs with gauze and ace wraps.

The Physiology of Peripheral Vascular Disease

In some of her previous work with a wound care specialist she knew that wraps were contraindicated with peripheral vascular disease (PVD), so she asked why ace wraps were being used. She was told the wife wanted the legs wrapped, yet there was no order to do this. She argued for betadine swabbing, but was told no. She cried as she did the wrapping, knowing she was causing the patient pain. She put the gauze on, then said she made the most billowy ace wrap she could to minimize pressure.

What kind of training is this for our nursing students? The physiology of peripheral vascular disease should be known and taught. If a patient does not have adequate arterial blood flow to the legs, as evidenced by gangrene, why would the leg be wrapped, increasing pressure to cut off blood supply? This is a prime teaching point to avoid damage to the patient. It is also a prime teaching point for education for the patient and family.

Teaching Assessment

Critical limb ischemia resulting from PVD is common – Critical limb ischemia affects 1% of everyone older than 50 and 1 out of every 4 individuals with diabetes will have critical limb ischemia.

Teaching nursing students to recognize this condition and to understand the physiology is essential in providing proper treatment of wounds caused by PVD. Following are factors to address in assessing a patient for ischemia:

• History of heart attack or stroke
• Visualization of the limbs: Look at the color of feet and legs, assess the limb temperature, hair distribution and pulses
• Ankle-brachial index: Assess patient for ABI. Anything less than 0.8 is ischemic

For more information on recognizing and assessing patients for ischemia, click here.

It is important for medical professionals who understand PVD and related wound conditions to advocate for their patients, but it should not be the students who have to advocate. Students are supposed to be trained, but it is very sad that the training can be woefully inadequate for peripheral vascular disease.

About The Author
Aletha Tippett MD is a family medicine and wound care expert, founder and president of the Hope of Healing Foundation®, family physician, and international speaker on wound care.