Varicose Veins / Venous Disease - Adult CPC

For clinical advice, please telephone the relevant specialty service.

Central Adelaide Local Health Network

• Royal Adelaide Hospital (08) 7074 0000
• The Queen Elizabeth Hospital (08) 8222 6000

Southern Adelaide Local Health Network

• Flinders Medical Centre (08) 8204 5511

Exclusions

• cosmetic varicose veins/spider veins
• CEAP score ≤ 2 (refer to Essential referral information)
• patients with nonulcerative skin changes and body mass index (BMI) ≥ 35 not actively engaged in weight loss management
• public specialist outpatient services do not provide compression hosiery for patients unless actively treated for venous pathology CEAP score ≥ 3 (refer to ‘referral information – essential referral information’)
• patients seeking compression hosiery alone should be referred to specialist allied health lymphoedema services or private providers

Triage categories

Category 1 - appointment clinically indicated within 30 days

• haemorrhage from varicose veins
• venous ulceration with active cellulitis ≥ 2 cm erythema at wound edge; commenced on oral antibiotics and systemically well
• superficial thrombophlebitis of the great or small saphenous veins ≥ 5 cm from the Saphofemoral junction and Saphenopopliteal junction

Category 2 – appointment clinically indicated within 90 days

• venous leg ulceration unresponsive to current management +/- ≤ 2 cm erythema at wound edge

Category 3 — appointment clinically indicated within 365 days

• CEAP score ≥ 3 (refer to Essential referral information) and body mass index ≤ 35
• post thrombotic syndrome
• patients with ultrasound-confirmed venous incompetence, with one or more of the following features:
  • limb swelling
  • pitting oedema
  • current or previous ulceration

Essential referral information

Completion required before first appointment to ensure patients are ready for care. Please indicate in the referral if the patient is unable to access mandatory tests or investigations as they incur a cost or are unavailable locally.

• CEAP classification score
• venous incompetency duplex ultrasound
• body mass index (BMI)
• ulceration present
• complete past medical history
• current medication list
• pedal pulses - dorsalis pedis/posterior tibial/popliteal
• smoking/vaping status - if active, strongly consider referral for smoking/vaping cessation
• previous management prior to referral - including community nursing if relevant/use
• previous surgical procedures including where/when

Additional information to assist triage categorisation

• complete blood examination (CBE)
• urea, electrolytes and creatinine (UEC)
  
• liver function tests (LFT)
• estimated glomerular filtration rate (eGFR)
• glycated haemoglobin test (HbA1c)
• ankle brachial pressure index
• wound microscopy, culture and sensitivity (MCS) (if clinical signs of infection present)
• clinically infected wounds - swab microscopy/culture/sensitivity
• if wound present:
  • histology results (if previously completed)

CEAP classification score

Clinical management advice

Patients with body mass index (BMI) ≥ 35 should be referred initially for weight loss management +/- bariatric opinion. Patients with BMI ≥ 35 may be considered for review with documented evidence of active participation in attempts to lose weight with a documented weight loss management plan, which should be provided.

Clinical resources

• Royal Australian College of General Practitioners - Smoking Cessation

Consumer resources

• Australian and New Zealand Society for Vascular Surgery - Venous Disease and Varicose Vein Consumer Information
• Be Smoke Free SA

Reason for request

• to establish a diagnosis
• for treatment or intervention
• for advice and management
• for specialist to take over management
• for a specified test/investigation the General Practitioner cannot order
• for other reason (e.g. rapidly accelerating disease progression)
• transfer of care from another tertiary service
• clinical judgement indicates a referral for specialist review is necessary.

Patient demographic details

• 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

Clinical modifiers

• 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

Other relevant information

• 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.
• Relevant social history, including identifying if you feel your patient is from a vulnerable population, under guardianship/out-of-home care arrangements and/or requires a third party to receive correspondence on their behalf.
• Triage of a specialist outpatient referral is based on clinical decision making to allocate an appropriate urgency categorisation.
  
• Where appropriate and where available, the referral may be streamed to an associated public allied health and/or nursing service. Access to some specific services may include initial assessment and management by associated public allied health and/or nursing, which may either facilitate or negate the need to see the public medical specialist.
• A change in patient circumstance (such as condition deteriorating or pregnancy) may affect the urgency categorisation and should be communicated as soon as possible.
• All new referrals will be triaged by a consultant and appointment times scheduled according to clinical urgency.