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Venous leg ulcer

Emergency department referrals

All urgent cases must be discussed with the on call Registrar to obtain appropriate prioritisation and treatment. Contact through:

  • Caboolture Hospital (07) 5433 8888
  • Redcliffe Hospital (07) 3883 7777
  • Royal Brisbane and Women's Hospital (07) 3646 8111
  • The Prince Charles Hospital (07) 3139 4000

Urgent cases accepted via phone must be accompanied with a written referral and a copy faxed immediately to the Central Patient Intake Unit: 1300 364 952.

If any of the following are present or suspected, refer the patient to the emergency department (via ambulance if necessary) or seek emergent medical advice if in a remote region.

  • Systemic Inflammatory Response Symptoms (SIRS) or clinically unwell (see Sepsis Clinical Tools)
  • Worsening pain and/or pain not in keeping with progression of the wound/ulcer
  • Progressive cellulitis despite treatment – rapidly spreading cellulitis with peri-wound redness or erythema (colour change, warmth, tight oedema, or pain in pigmented skin tones) for > 2cm
  • Uncontrollable bleeding from ulcer.

 

Does your patient wish to be referred?

Minimum referral criteria

Does your patient meet the minimum referral criteria?

Category 1

Appointment within 30 days is desirable

  • If 2 weeks of 24/7 firm graduated toes to knee compression (20-30mmHg) over an occlusive dressing does not produce 25% reduction in wound surface area
  • If above pressure dressing unachievable
  • Aetiologic complexity – venous disease + other comorbidity
  • Patients fit for surgery should be referred as per Vascular CPC for Venous Disease

Category 2

Appointment within 90 days is desirable

  • No category 2 criteria

Category 3

Appointment within 365 days is desirable

  • No category 3 criteria

If your patient does not meet the minimum referral criteria

Consider other treatment pathways or an alternative diagnosis.

If you still need to refer your patient:

  • Please explain why (e.g. warning signs or symptoms, clinical modifiers, uncertain about diagnosis, etc.)
  • Please note that your referral may not be accepted or may be redirected to another service

Other important information for referring practitioners

Not an exhaustive list

  • Typical Venous Leg Ulcer
    • Located on lower third of lower leg and above ankle bones (malleoli)
    • Ulcer is irregular shape, shallow with sloping edges and high exudate
    • Surrounding skin has chronic venous insufficiency changes of combinations of brown haemosiderin staining, weeping or crusted venous stasis eczema, lipodermatosclerosis (inflamed lower leg with ‘inverted champagne bottle’ shape)

Suggestions for interim patient care while waiting specialist appointment:

Mild compression (< 20mmHg) – not enough compression for treatment of VLU’s

  • <10mmHg – TED anti-embolic (white) stocking, Tubifast type retention sleeves (Blue and Yellow line size
  • 10 -14 mmHg – light compression sleeves per layer e.g. Tubigrip/Versagrip/ Tubulaform etc
  • 14 -17mmHg CCl I hoiseryhosiery
  • <15mmHg – Light crepe bandage, slight extension
  • 15 – 20 mmHg – Class I hosiery

Medium compression (20 mmHg to <40mmHg) – beneficial in treatment of VLU’s

  • 18-24 mmHg – Profore lite, Coban 2 Lite, Compri 2 lite etc
  • 20 -25 mmHg – Class II hosiery
  • 30 -35 mmHg – Short stretch inelastic bandage
    e.g. Comprilan, Putterbinde; Long stretch bandage
    e.g. Setopress, Surpress, Class III hosiery

Strong compression (>40mmHg)  – Gold Standard treatment of VLU’s

  • 35 -40 mmHg – multi layer elasticised bandage e.g. Profore bandage, Coban 2, Compri 2, Urgo K etc

Referral requirements

A referral may be rejected without the following information.

Essential referral information

  • Co-morbidities, past medical history
  • Wound history e.g. duration, description, and size, wound initiating event
  • Signs of lower limb venous system disease – varicosities, oedema, haemosiderin staining, lipodermatosclerosis
  • Peripheral arterial perfusion basic assessment – leg pulses, recumbent capillary return time
  • Investigations (if performed) e.g.
    • wound biopsies
    • arterial studies / Ankle Brachial Pressure Index
    • venous incompetence studies (note NOT venous ultrasound for acute DVT)
  • Details of all treatments offered, and efficacy to date e.g. specific current and past types of wound dressings and leg compression used, date of commencement of any antibiotics with dose prescribed.
  • Service provider (i.e. GP, practice nurse or domiciliary nursing service)

Additional Referral Information (Useful for processing the referral)

  • Recent wound swabs, latest blood tests (ELFT’s, FBC)
  • Residential status (lives alone, support networks, etc)
  • My Aged Care or NDIS participation
  • Smoking status
  • Nutritional status / dietary intake / serum albumin
  • HbA1c / blood sugar control (if patient has diabetes)

Out of catchment

Metro North Health is responsible for providing public health services to the people who reside within its boundaries. Special consideration is made for patients requiring tertiary care or services that are not provided by their local Hospital and Health Service. If your patient lives outside the Metro North Health area and you wish to refer them to one of our services, inclusion of information regarding their particular medical and social factors will assist with the triaging of your referral.

  • Impact on employment
  • Impact on education
  • Impact on home
  • Impact on activities of daily living
  • Impact on ability to care for others
  • Impact on personal frailty or safety
  • Identifies as Aboriginal and/or Torres Strait Islander

  • To establish a diagnosis
  • For treatment or intervention
  • For advice and management
  • For specialist to take over management
  • Reassurance for GP/second opinion
  • For a specified test/investigation the GP can’t order, or the patient can’t afford or access
  • Reassurance for the patient/family
  • For other reason (e.g. rapidly accelerating disease progression)
  • Clinical judgement indicates a referral for specialist review is necessary

  • Presenting symptoms (evolution and duration)
  • Physical findings
  • Details of previous treatment (including systemic and topical medications prescribed) including the course and outcome of the treatment
  • Body mass index (BMI)
  • Details of any associated medical conditions which may affect the condition or its treatment (e.g. diabetes), noting these must be stable and controlled prior to referral
  • Current medications and dosages
  • Drug allergies
  • Alcohol, tobacco and other drugs use

  • Full name (including aliases)
  • Date of birth
  • Residential and postal address
  • Telephone contact number/s – home, mobile and alternative
  • Medicare number (where eligible)
  • Name of the parent or caregiver (if appropriate)
  • Preferred language and interpreter requirements
  • Identifies as Aboriginal and/or Torres Strait Islander

  • Full name
  • Full address
  • Contact details – telephone, fax, email
  • Provider number
  • Date of referral
  • Signature

  • Willingness to have surgery (where surgery is a likely intervention)
  • Choice to be treated as a public or private patient
  • Compensable status (e.g. DVA, Work Cover, Motor Vehicle Insurance, etc.)
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