Assessing the Peripheral Vascular and Regional Lymphatic Systems

Lymphatic system structure

Spleen, thymus, bone marrow, tonsils and adenoids, appendix, parts of the liver and lungs, lymph nodes, peyer’s patches

Right lymphatic duct

Receives lymph from the right upper part of the body

Thoracic duct

Receives lymph from the rest of the body

Diagnostics

Computer tomography (CT) scan, duplex ultrasound, magnetic resonance angiography (MRA), angiogram, angioplasty, lymph node biopsy

Unilateral edema

Local or peripheral cause

Lymphedema

Swelling due to an abnormal accumulation of lymph fluid within the tissues

Rubor

Redness

Elevational pallor

Pale skin when raising up the affected extremity

Raynaud’s phenomenon

Periodic ischemic attacks affecting extremities of the body, especially fingers, toes, ears, and nose, becoming cyanotic and very painful; attacks are brought on by arterial constriction due to extreme cold or emotional stress

Atherosclerosis

Condition where fatty deposits called plaque build up on the inner walls of the arteries

Intermittent claudication

Pain in leg muscles that occurs during exercise and is relieved by rest

Varicose veins

Abnormally swollen, twisted veins with defective valves; most often seen in the legs

Diabetes

Body is unable to produce enough insulin, the hormone required for the metabolism of sugar

Peripheral arterial disease

Blockage of arteries carrying blood to the legs, arms, kidneys and other organs

Lymph node sites

Pre and postauricular, suboccipital, tonsilar, submandibular, superficial and posterior cervical, superclavicular 

Assessing lymph nodes normal findings

No nodes are palpated; if palpated, nodes are <1 cm; discrete, moveable, nontender

Assessing lymph nodes abnormal findings

Enlarged, >1cm, matted, hard, tender

Inspecting and palpating the carotid arteries normal findings

Visible symmetrical pulsations, pulse rate between 60-100 bpm, rhythm is regular, amp +2

Inspecting and palpating the carotid arteries abnormal findings

No pulsations or asymmetrical pulsatile bulge, pulse rate <60 or >100 bpm, rhythm irregular, amplitude absent, weak, or bounding

Auscultating carotid arteries normal findings

No bruit heard

Auscultating carotid arteries abnormal findings

Bruit heard

Bruit

Blowing, swooshing sound heard through a stethoscope when an artery is partially occluded

Inspecting for jugular venous distention normal findings

No visible pulsation or jugular vein distention

Inspecting for jugular venous distention abnormal findings

Visible distention

Inspecting/palpating upper extremities normal findings

Arms symmetrical, color uniform, no edema or ulcerations, fingernail beds pink, venous pattern normal, fingernails have even thickness, fingernails 160 angle of attachment, epitrochlear nodes not felt, temperature warm to touch, +2 radial and brachial pulse

Inspecting/palpating upper extremities abnormal findings

Signs of altered peripheral circulation, discoloration, change in skin texture, cool extremities, unilateral edema, enlarged epitrochlear nodes, cellulitis, edema, ulcerations

Cellulitis

Inflammation of cellular or connective tissue

Ulcerations

Blisters or open-sores

Assessing capillary refill normal findings

Pink color returns in <2 sec

Assessing capillary refill abnormal findings

Pink color returns in >2 sec

Inspecting/palpating lower extremities normal findings

Legs symmetrical, uniform color, no edema or ulceration, toenails pink with even thickness, temp warm to touch, even hair distribution, inguinal lymph nodes palpable, +2 symmetrical pulses, nondistended veins

Inspecting/palpating lower extremities abnormal findings

Discoloration, decreased texture, loss of hair, cool skin temp, thick toenails, arterial or venous insufficiency, presence of bilateral or unilateral edema, lymphedema

Pitting edema

Retains an imprint when touched

Nonpitting edema

Does not retain an imprint when touched

Edema grading

0-4+

0 edema grading

No pitting edema

1+ edema grading

Mild pitting edema, 2mm depression that disappears rapidly

2+ edema grading

Moderately pitting edema, 4mm depression that disappears in 10-15 seconds

3+ edema grading

Moderately severe pitting edema, 6mm depression that may last more than 1 minute

4+ edema grading

Severe pitting edema, 8mm depression that can last longer than 2 minutes

Deep vein thrombosis

Blood clot forms in a large vein, usually in a lower limb

Peripheral vascular disease

Disease of veins with inadequate blood flow from extremities

Peripheral arterial disease signs and symptoms

Intermittent claudication, pain, no pulse or weak pulse at affected site, black eschar, cyanosis

Peripheral vascular disease

Dull achy pain, lower leg edema, erythema, drainage, varicose veins

Risk factors for deep vein thrombosis

Birth control, surgery, smoking, sitting for long periods of time