Registered Nurses' Association of Ontario

Nursing Best Practice Guidelines

Venous Ulcer Care

16. Develop treatment goals mutually agreed upon by the patient and healthcare professionals, based on clinical findings, current evidence, expert opinion and patient preference.
17. Local wound bed preparation includes debridement when appropriate, moisture balance and bacterial balance.
18. Cleansing of the ulcer should be kept simple; warm tap water or saline is usually sufficient.
19. First-line and uncomplicated dressings must be simple, low adherent, acceptable to the client and should be cost-effective.
20. Avoid products that are known to cause skin sensitivity, such as those containing lanolin, phenol alcohol, or some topical antibiotic and antibacterial preparations.
21. Choose a dressing that optimizes the wound environment and patient tolerance.
22. No specific dressing has been demonstrated to encourage ulcer healing.
23. In contrast to drying out, moist wound conditions allow optimal cell migration, proliferation, differentiation and neovascularization.
24. Refer clients with suspected sensitivity reactions to a dermatologist for patch testing. Following patch testing, identified allergens must be avoided, and medical advice on treatment should be sought.
25. Venous surgery followed by graduated compression hosiery is an option for consideration in clients with superficial venous insufficiency.