peripheral vascular

PERIPHERAL VASCULAR

ASSESSMENT

Prepared by: Angelo P. Angeles, RN MAN

Anatomy and PhysiologyREVIEW OF STRUCTURES AND FUNCTIONS

ARTERIES ARTERIES

Carry oxygenated blood

Receives high pressure from the LV of the heart

Major Arteries of the ARM and LEGS

Brachial Artery Radial artery Ulnar artery

Femoral Artery Popliteal

Anterior branch– Dorsalis Pedis a.

Posterior branch - Posterior Tibial a.

VEINS Carry

deoxygenated blood, and wastes

SVC: head, arms, upper trunk, head and neck

IVC: lower trunk and legs

Larger and can expand in diameter

VEINS

VeinsDeep veins Femoral vein Popliteal vein

Superficial veins Great saphenous

(longest) Small saphenous

Perforator veins

VeinsMechanisms that

propel blood back to the heart:

1. Presence of One-way Valves

2. Muscular contraction

3. Creation of pressure gradient (though breathing)

Lymphatic System Composed of lymphatic capillaries,

lymphatic vessels, and lymph nodes Functions:1. It drains excess fluid and plasma

proteins from body tissues and return them to venous system

2. Aids in defending the body against MO3. Absorbs fat from the small intestine into

the bloodstream

Lymphatic System (Ducts)

Superficial lymph nodes of the arms and legs Epitrochlear lymph

nodes

Inguinal lymph nodes Horizontal Vertical

Capillaries and Fluid Exchange

COLLECTING SUBJECTIVE DATANURSING HEALTH HISTORY

COLLECTING SUBJECTIVE DATA Change in Skin color, temperature or

texture ARTERIAL INSUFFICIENCY – cold, pale, clammy

skin; thin shiny skin with loss of hair VENOUS INSUFFICIENCY – warm skin, brown

pigmentation around the ankles Leg Pains or Cramps

Intermittent Claudication – cramping in the calves, thighs, or buttocks and weakness upon activity (ARTERIAL disease)

Heaviness and aching sensation aggravated by standing or sitting for longer periods (VENOUS disease)

Leg pain at night (CHRONIC ARTERIAL dse) Numbness (NEUROPATHY)

COLLECTING SUBJECTIVE DATA Varicose veins

Hereditary Venous pressure and venous pooling

Leg Ulcers Arterial – painful Venous – painless

Edema (with/without pain) Obstruction of lymphatic flow, incompetent

valves, osmotic pressure, DVT Swollen lymph nodes

Infection Male clients: Change in sexual activity

Leriche’s syndrome Impotence/Erectile Dysfunction

COLLECTING SUBJECTIVE DATAPAST HEALTH HISTORY

History of Peripheral Vascular Diseases History of Cardiovascular surgeries

FAMILY HISTORY DM, HPN, Coronary Heart Disease,

Hypercholestrolemia

COLLECTING SUBJECTIVE DATALIFESTYLE AND HEALTH PRACTICES

Cigarette smoking

Exercise

Female clients: Intake of Oral/ transdermal contraceptives

Stress

Wearing of supportive hose

COLLECTING OBJECTIVE DATAP H Y S I C A L E X A M I N A T I O N

COLLECTING OBJECTIVE DATA Preparation

Have client wear examination gown Upright position Adjust room temperature Explain exposure of parts to be assessed Explain position changes

Equipment Centimeter tape Stethoscope Doppler UTZ device Conductivity gel Gauze/tissue Water proof pen Blood pressure cuff

PHYSICAL ASSESSMENT OF THE ARMSProcedure Normal Findings Abnormal Findings

Observe for the arm size and venous pattern; look also for edema

Arms are bilaterally symmetric; no edema or prominent venous patterning

Lymphedema (blocked lymphatic circulation)

PHYSICAL ASSESSMENT OF THE ARMSProcedure Normal Findings Abnormal Findings

Observe for coloration of the hands and arms

Color varies depending on client’s skin tone

Rapid changes in color (pallor, cyanosis, redness) – Raynaud’s disease

PHYSICAL ASSESSMENT OF THE ARMSProcedure Normal Findings Abnormal Findings

Palpate for client’s fingers, hands and arms. Note temp.

Warm bilaterally from fingertips to upper arms

Cool extremity/ Cold fingers and hands

Assess Capillary Refill

Capillary beds refill (color returns in 1-2 seconds)

> 2 secs (vasoconstriction, CO, shock, arterial occulsion)

Palpate for the radial pulse

Equal strength bilaterally (2+)

Increased – hyperkineticDiminished or absent – occlusion

PHYSICAL ASSESSMENT OF THE ARMSProcedure Normal Findings Abnormal Findings

Palpate for the ulnar pulses

Equal strength; may not be detectable

Lack or resilience or inelasticity (arteriosclerosis)

Palpate the brachial pulse (if suspected for arterial insufficiency)

Equal strength bilaterally

Increased, diminished, absent

PHYSICAL ASSESSMENT OF THE ARMSProcedure Normal Findings Abnormal Findings

Palpate for the epitrochlear lymph node

Not palpable Enlarged/swollen

PHYSICAL ASSESSMENT OF THE ARMSProcedure Normal Findings Abnormal Findings

Perform Allen test

Pink coloration return to palms within 3-5 seconds

Pallor persists

PHYSICAL ASSESSMENT OF THE LEGSProcedure Normal Findings Abnormal FindingsObserve skin color while inspecting both legs from toes to groin

Uniform pigmentation

Pallor (elevated) & rubor (dependent) – A.I.Brownish – V.I

Inspect distribution of hair

Hair cover the skin and appears on the dorsal surface

Loss of hair (A.I)

Inspect for lesions

Legs are free of lesions/ulcers

Ulcers

PHYSICAL ASSESSMENT OF THE LEGSProcedure Normal Findings Abnormal FindingsInspect for Edema

Identical size/shape; no swelling

Bilateral edema

Palpate for Edema

No edema Pitting or non pitting edema

Grading for Pitting edema

Edema Grading:

1+ = slight pitting2+ = deeper than 1+3+ = noticeably deep

pit; looks larger 4+ = very deep pit;

gross edema in extremity

PHYSICAL ASSESSMENT OF THE LEGSProcedure Normal Findings Abnormal FindingsPalpate bilaterally for temp of feet and legs

Equally warm Generalized coolness (A.I.), Warmth (thrombophlebitis)

Palpate superficial inguinal lymph n.

Nontender, maybe movable

Swelling >2cm

PHYSICAL ASSESSMENT OF THE LEGSProcedure Normal Findings Abnormal FindingsPalpate: Femoral Popliteal P. Dorsalis Pedis P. Posterior Tibial P.

Strong and equal bilaterally

Weak or absent

PHYSICAL ASSESSMENT OF THE LEGSProcedure Normal Findings Abnormal FindingsInspect for varicosities and thrombophlebitis

Veins are flat and barely seen under the skin

Distended, nodular, bulging and tortuous veins

PHYSICAL ASSESSMENT OF THE LEGSProcedure Normal Findings Abnormal FindingsCheck for the Homans’ sign

(-) Homans’signNo pain or tenderness elicited

(+) Homans’ sign Calf pain and tenderness

SPECIAL TESTS FOR A.I. OR V.I.Procedure Normal Findings Abnormal FindingsPosition change test

Feet: pink to slightly pale in color (elevation); pinkish color returns to toes and feet in ≤ 10 secs, 15 secs for superficial veins on top of feet. (dangled)

Marked pallor

> 10 secs and > 15 secs (A.I.)

Persistent rubor

SPECIAL TESTS FOR A.I. OR V.I.Procedure Normal Findings Abnormal FindingsAnkle- brachial pressure index (ABPI) – ratio of ankle systolic BP to brachial systolic BP.

Ankle pressure is same or slightly higher than the brachial pressure (ABPI: 1)

ABPI: 0.5 to 0.95 (mild to mod A.I.)ABPI: 0.25 or lower (severe stenosis)

SPECIAL TESTS FOR A.I. OR V.I.Procedure Normal Findings Abnormal FindingsManual Compression test

No pulsation is palpated (competent valves)

Pulsation with the upper fingers (incomptent valves)

SPECIAL TESTS FOR A.I. OR V.I.Procedure Normal Findings Abnormal FindingsBrodie-Trendelenburg test

Saphenous vein fills from below in 30 seconds; no rapid filling of veins from above after removal of torniquet

Filling from above with the tourniquet in place (while client is standing) – incompetent valves