Referral to emergency

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

  • venous leg ulceration with active cellulitis non responsive to antibiotics and systemically unwell
  • superficial thrombophlebitis of the great or small saphenous veins < 5 cm from the Saphofemoral junction or Saphenopopliteal junction
  • axillary vein thrombosis,  please contact on call registrar to discuss clinical concerns
  • - iliofemoral +/_ inferior vena cava thrombosis, see “Contacts for clinical advice’

It is strongly advised that after hours presentations attend the Royal Adelaide Hospital or Flinders Medical Centre emergency departments.

For clinical advice, please telephone the relevant metropolitan Local Health Network switchboard and ask to speak to the relevant specialty service.

Central Adelaide Local Health Network

Southern Adelaide Local Health Network


  • 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

For information on referral forms and how to import them, please view general referral information.

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.

  • identifies as Aboriginal and/or Torres Strait Islander
  • relevant social history, including identifying if you feel your patient is from a vulnerable population and/or requires a third party to receive correspondence on their behalf
  • interpreter requirements
  • 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

CEAP classification system
Classification Description
C0 no visible signs of venous disease on examination
C1 reticular veins or telangiectasias (spider veins)
C2 varicose veins
C2r recurrent varicose veins
C3 edema
C4 changes in skin and subcutaneous tissue as a result of chronic venous disease
C4a hyperpigmentation or venous eczema
C4b lipodermatosclerosis or atrophie blanche
C4c corona phlebectatica (venous flare at ankle)
C5 healed venous ulcer
C6 active venous ulcer
C6r recurrent active venous ulcer

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

Consumer resources