My nurse manager informed us that we'll soon be using leech therapy in my medical-surgical unit. Can you provide some general information about leech therapy and why it's used?-J.B., CALIF.

Richard L. Pullen, Jr., EdD, RN, replies: Leeches work by creating a puncture wound that causes prolonged localized vasodilation and bleeding while anesthetizing the application site. This results in reduced venous congestion. Leech saliva has a vasodilator similar to histamine that encourages local bleeding; a local anesthetic; hirudin, a direct thrombin inhibitor that acts as an anticoagulant; and hyaluronidase, which acts like an antibiotic and also helps transport the saliva throughout the wound.1

Leeches can be used to

* promote healing in an infected wound that's resistant to antibiotic therapy

* reduce venous congestion following skin grafting, reattachment of body parts, or transplant surgery

* relieve engorgement after plastic or reconstructive surgery of the breast.1

Before initiating leech therapy, it's important to assess your patient's nutritional status, which should be optimal for successful wound healing. In addition, assess the wound, flap, or graft for signs of infection, such as erythema and purulent drainage, and signs of poor perfusion, such as decreased capillary bed refill time. Leech therapy won't be helpful in patients with arterial insufficiency and could also lead to infection from any source, including leeches.2 Obtain baseline complete blood cell count, hemoglobin, and hematocrit levels because of the potential for excessive blood loss during leech therapy, depending on the number of leeches used and the duration of leech therapy.

Teach the patient and family why the leeches have been prescribed and explain the procedure fully. Advise them that leech therapy is medically approved, won't hurt, and generally poses little infection risk.3

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