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LETTEI S TO THE EDITOR Changes in Enterostomal Therapy
Compression Therapy for Venous Ulceration
To the Editor: I was extremely impressed by Phyllis Bonham's eloquence in describing the challenges and changes that have occurred throughout the history of enterostomal therapy (J WOCN 1999;26:5-6). Ms. Bonham has most definitely touched on the "sore spot" with many of the ET nurses who have been in practice for more than 10 or even 15 years, although I do support the inclusion of nurses who choose to specialize in only 1 aspect of ET nursing. I applaud Ms. Bonham for having the courage to put into written word what many, including myself, have felt with the changes that have occurred in the organization during the 1990s. However, I agree that the organization, board and members alike need to reconsider our goals and how we define ourselves. I support Ms. Bonham's suggestion of changing our byline to "WOCN, An Association of ET, Wound, Ostomy and Continence Nurses." I, for one, do not want to lose either the history or identity as an ET nurse. Sharon A. Aronovitch, PhD, RN, CETN Nurse Educator, Regents College 7 Columbia Circle Albany, New York Delmar, NY
To the Editor: The article by Lisa Reichardt entitled, "Venous Ulceration: Compression as the Mainstay of Therapy" (J WOCN 1999;26: 39-47), provides a thorough review of venous pathophysiology and how it contributes to venous ulceration. I completely agree with her position that the use of gradient compression therapy is a central component of treatment and prevention for recurrence of venous ulcerations. However, I believe that the use of compression therapy for all patients with venous pathology can be misguided and even dangerous. Before compression therapy is used, a complete history and physical examination including the patient's overall cardiovascular status should be completed. This is in addition to an assessment of lower extremity arterial perfusion. As the elderly population increases, the risk for and incidence of congestive heart failure increases, along with the risk for and incidence of venous pathologic conditions. Compression therapy, especially highlevel compression, can be dangerous for patients with congestive heart failure that is not adequately compensated. Clinicians need to be aware of the effect of compression on the patient's general cardiovascular condition. Improvement in lower extremity edema is not a logical trade-off with decompensated congestive heart failure. This complication of compression therapy should be included whenever venous pathology and compression therapy are discussed. Karen Heavner, ARNP, CWOCN Enterostomal Therapy Consultant Baptist~St. Vincent' s Health System Jacksonville, FL
21/8/99414
Thank You To the Editor: The family of Norma Gill-Thompson wishes to express our gratitude to the authors of the lovely memorials in your January issue (J WOCN 1999;26:2-4). We have heard from patients with ostomies, colleagues, and ET nurses from all over the world, and it certainly has helped us work through our grief. It is most comforting to know that her work touched so many, and that there are so many wonderful people continuing her legacy. Sally J. Thompson, ET Herbert G. Thompson David E. Gill Marilyn A. Gill 21/8/99415
2118199416
To the Editor: Reichardt is to be commended for a thorough review of venous ulcer etiology, diagnosis, and treatment. 1 However, I would like to point out that the list of compression stocking manufacturers included Coloplast/Sween. This corporation does not manufacture stockings. It does market the CircAid Thera-Boot and CircPlus, which are nonelastic, adjust-
J WOCN 1999;26:171-2. Copyright © by the Wound, Ostorny and Continence Nurses Society, 1071-5754/99/$8.00 + 0
171
Compression Therapy for Venous Ulceration
To the Editor: I was extremely impressed by Phyllis Bonham's eloquence in describing the challenges and changes that have occurred throughout the history of enterostomal therapy (J WOCN 1999;26:5-6). Ms. Bonham has most definitely touched on the "sore spot" with many of the ET nurses who have been in practice for more than 10 or even 15 years, although I do support the inclusion of nurses who choose to specialize in only 1 aspect of ET nursing. I applaud Ms. Bonham for having the courage to put into written word what many, including myself, have felt with the changes that have occurred in the organization during the 1990s. However, I agree that the organization, board and members alike need to reconsider our goals and how we define ourselves. I support Ms. Bonham's suggestion of changing our byline to "WOCN, An Association of ET, Wound, Ostomy and Continence Nurses." I, for one, do not want to lose either the history or identity as an ET nurse. Sharon A. Aronovitch, PhD, RN, CETN Nurse Educator, Regents College 7 Columbia Circle Albany, New York Delmar, NY
To the Editor: The article by Lisa Reichardt entitled, "Venous Ulceration: Compression as the Mainstay of Therapy" (J WOCN 1999;26: 39-47), provides a thorough review of venous pathophysiology and how it contributes to venous ulceration. I completely agree with her position that the use of gradient compression therapy is a central component of treatment and prevention for recurrence of venous ulcerations. However, I believe that the use of compression therapy for all patients with venous pathology can be misguided and even dangerous. Before compression therapy is used, a complete history and physical examination including the patient's overall cardiovascular status should be completed. This is in addition to an assessment of lower extremity arterial perfusion. As the elderly population increases, the risk for and incidence of congestive heart failure increases, along with the risk for and incidence of venous pathologic conditions. Compression therapy, especially highlevel compression, can be dangerous for patients with congestive heart failure that is not adequately compensated. Clinicians need to be aware of the effect of compression on the patient's general cardiovascular condition. Improvement in lower extremity edema is not a logical trade-off with decompensated congestive heart failure. This complication of compression therapy should be included whenever venous pathology and compression therapy are discussed. Karen Heavner, ARNP, CWOCN Enterostomal Therapy Consultant Baptist~St. Vincent' s Health System Jacksonville, FL
21/8/99414
Thank You To the Editor: The family of Norma Gill-Thompson wishes to express our gratitude to the authors of the lovely memorials in your January issue (J WOCN 1999;26:2-4). We have heard from patients with ostomies, colleagues, and ET nurses from all over the world, and it certainly has helped us work through our grief. It is most comforting to know that her work touched so many, and that there are so many wonderful people continuing her legacy. Sally J. Thompson, ET Herbert G. Thompson David E. Gill Marilyn A. Gill 21/8/99415
2118199416
To the Editor: Reichardt is to be commended for a thorough review of venous ulcer etiology, diagnosis, and treatment. 1 However, I would like to point out that the list of compression stocking manufacturers included Coloplast/Sween. This corporation does not manufacture stockings. It does market the CircAid Thera-Boot and CircPlus, which are nonelastic, adjust-
J WOCN 1999;26:171-2. Copyright © by the Wound, Ostorny and Continence Nurses Society, 1071-5754/99/$8.00 + 0
171