vascular assessment.pdf

7/29/2019 Vascular Assessment.pdf

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Vascular Assessment


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Normal Physiology of theCardiovascular System (CVS)


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Heart contracts approximately every 0.8s

Divided into 2 phases

Cardiac output is about 5 litres

Myocardium has the ability to contractwithout nerve impulses. Myogenicity.


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The most important of these is the

sinoatrial (SA) node, situated in the rightatrium.

according to demands placed upon it.


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Sympathetic nerve acts on the heart via

beta-receptors.

Increasing stoke volume and heart rate.

arasympat e c vagus nerve s ows eartrate


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Overall purpose of all vessels is to deliver

blood with its nutrients etc and to removewaste products.


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Capillary Function

Exchange of substances

Pressure drop

Capacitance vessels


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Arterial, Venous and CapillaryStructure


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Assessment of the Lower Limb. In order to maintain tissue integrity and

viability, it is essential that blood flow tothe lower limbs is maintained and


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It is important that the Podiatrist is aware

of what to look for in a healthy vascularsystem, and is clear regarding what

relation to blood supply


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Beginning the assessment Initially, you will have made sure you have

collected information regarding patientdetails, including medical and surgical

, ,and also an indication of any relevantfamily history, such as ischaemic heart

disease, hypertension, diabetes, stroke, etc.


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What indications would encourage you to

perform a vascular assessment on yourpatient?

A good approach to vascular assessmentis to follow a simple structure, so that no

aspect is missed,


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One thing often forgotten whencarrying out any clinical examination isthat you should use the information

collected to make a diagnosis. Withoutthis, your examination is meaningless.Additionally, should you become

nvo ve n t gat on, t e ac o a diagnosis may impair your defence asit could be implied that you were

unable to interpret the resultsof your tests.


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A further point to note aboutassessment is that no single test resultor observation should be used to

formulate your diagnosis. Instead, youshould be able to combine the results

working diagnosis, on which you thenbase your management plan, or yourreferral to another

health professional.


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Arterial Insufficiency Pain

Pallor

Pulselessness

Paraesthesia Paralysis

Perishing cold.


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Causes Thrombosis,

Embolus,

Aneurysms,

Oedema Transient ischaemia

Chronic ischaemia


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Arterial in-sufficiency is usually associated

with pain Site

ature Duration

Aggravating Factors


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This stage can be recognised by mottling,

muscle tenderness, motor or sensorydeficit and necrosis.


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Intermittent claudication

Night cramps

Rest pain


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Observations. Skin may appear

Pink

White

Blue Red

Dusky pink.


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Tissue Viability A poor blood supply will mean that the skin

and other soft tissues will be receivinginadequate nourishment


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Clinical Tests Temperature gradient

Sub-papillary plexus filling time (CRT)

Buergers test

Allens test


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Pedal Pulses

Posterior Tibial

DorsalisPedis


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Peroneal


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Anterior Tibial


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Doppler Ultrasound Allows pulses to be heard more clearly

Sound waves bounce of objects (usuallyred blood cells)

an a so e e to a pr nter


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ABPI This was first described by Yao in the

1960s Calculated by recording the systolic

posterior tibial artery (ankle), using thefollowing method;


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Lay patient flat for 10 mins

Measure systolic brachial pressures (L+R)

Measure systolic pressures in PT

Measure systolic pressure in DP Divide the highest pressure on left foot

with highest overall

brachial pressure


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Venous Insufficiency Arises in the superficial and/or deep veins

Affects the return of blood to the heart

Pooling of blood in the ankles

Exacerbated by gravity More evident around the malleoli


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Past History Venous problems? DVT Pregnancy?

Varicose veins Familial

Telangiectases around the medial malleoli

can n cate poor ra nage Mottled cyanosis to lower third of limb


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Symptoms Varicose related pain

Ankle oedema

Alleviated by elevation

Varicosities- especially on standing Unilateral PVD

Bilateral - CHF


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Temperature In venous insufficiency the skin often feels

warm, which suggests that the arterialsupply is satisfactory. However, it should

result in inflam-mation of the veins(phlebitis) due to the presence of thethrombosis


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Varicose Veins Presence of these may be due to valvular

incompetence in the superficial division ofthe venous system in isolation, or in

created by back-pressure due to anobstruction in the veins.


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Tissue Viability Poor venous return results in the

accumulation of waste products andtherefore the viability of the surrounding

lipodermatosclerosis may develop


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Oedema Associated with venous problems

Hydrostatic pressure causes leakage into

t e t ssues


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Leg Shape Patients with chronic venous ulceration

and oedema may develop characteristic'champagne legs',

' ',this is characteristic oflipodermatosclerosis.


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Pulling all the informationtogether.

Once the vascular assessment is

complete, the next step is to decide on amanagement plan suitable for the patient.

results of the assessment may indicatethat it is better to refer the patient to aspecialist for

further investigation.


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