NUTRITIONAL INTERVENTION FOR VASCULAR PAIN AND WOUND HEALING IN PATIENTS WITH PERIPHERAL ARTERIAL DISEASE: A NURSE-NUTRITIONIST CO-MANAGEMENT PROTOCOL

G. Fedelfranco¹, F. Germini², M. Di Masi³, N. Misceo⁴ | ¹Social Health Local District, ASL Bari, U.O. Door of Unique Access(PUA)/Multidimensional Evaluetion Unit(UVM), University of Bari "Aldo Moro", Bari, Italy; ²Director Health Profession, Social Health Local District N.10 ASL Bari, Italy; ³Educational Director of Professional Training Activities for the Nursing Course in IRCCS Castellana Grotte, University of Studies Bari "Aldo Moro", Italy; ⁴Ministry of Health, SASN Bari, Italy

Background & Aims. Peripheral arterial disease (PAD) and chronic venous insufficiency (CVI) generate ischaemic and nociceptive pain directly modulated by nutritional status, endothelial function, and inflammatory milieu. Malnutrition, protein deficiency, vitamin C and zinc insufficiency, and dyslipidaemia are prevalent in Italian elderly patients with vascular pain and directly impair wound healing, analgesic efficacy, and functional recovery. Despite this evidence, no Italian community nurse-nutritionist co-management protocol addresses the vascular pain-nutrition interface. This study aims to: (1) assess nutritional status (NRS-2002, serum protein, Zn, vitamin C, lipid profile) in ADI patients with PAD/CVI-related pain; (2) implement a Vascular Nutrition Protocol (VNP) with personalised hypercaloric/hyperproteic diet and targeted micronutrient supplementation; (3) evaluate VNP impact on wound healing (PUSH score) and vascular pain NRS using PDSA-guided change management.
Methods. Design: Prospective cohort study with embedded PDSA quality improvement. Setting: Social Health Local District Bari and IRCCS + ADI wound care + community nutritionist referral, 2025–2026 (N=80 PAD/CVI patients with active wound and pain NRS ≥3). VNP components: hypercaloric diet (35 kcal/kg/day), protein 1.5–2g/kg/day, vitamin C 1g/day, zinc 25mg/day, omega-3 2g/day; arginine-based oral nutritional supplement (ArginAid/equivalent). Process instruments: PUSH score (Thomas et al. Adv Wound Care 1997, PMID:9256967), NRS, NCP SIAP module, wound care diary. Change management: CFIR + PDSA + 3h ECM vascular nutrition workshop. Statistics: Wilcoxon (NRS, PUSH change), Pearson (albumin vs PUSH improvement).
Results. (Prelim.) Preliminary data (N=42): NRS-2002 ≥3 in 52.4% (N=22). Serum albumin <3.5 g/dL in 45.2% (N=19). Vitamin C deficiency (<23 µmol/L) in 61.9% (N=26). VNP 6-week pilot (N=24): PUSH score improved in 79.2% (mean: 12.4→8.1, p<0.001). NRS reduction 1.9 points (95%CI 1.1–2.7, p<0.001). Albumin improvement: 3.2→3.7 g/dL (p=0.001). PDSA cycle 1: VNP adherence 83.3%; CFIR dominant facilitator: nurse-nutritionist weekly shared case review.
Conclusions. Nutritional deficiencies are highly prevalent in Italian PAD/CVI patients with vascular pain and directly correlate with wound healing impairment. The VNP co-management protocol improves wound healing, reduces pain intensity, and corrects micronutrient deficiencies through a structured, CFIR-guided nurse-nutritionist partnership. These findings support the integration of nutrition assessment within ADI vascular care protocols.