Peripheral Vasculature

¨Virchow triad

¨Blood stasis (blood does not travel back to the heart good)

¨Vessel wall damage

¨Hypercoagulable state (bosy is stressed)

VTE Risk Assessment

•Advanced age (> 75)

•Atrial fibrillation (at risk for stroke. Atria is quivering and not emptying blood out. Can form clots, can break off and cause a stroke in the brian)

•Prolonged immobility

•Obesity

•Stroke

•History of VTE

•Trauma

•Indwelling PICC

•Cigarette smoking

Peripheral Vascular Exam

•Inspection

•Palpation

•Auscultation

Amplitude (strength

•Grade 0-4+

•0= absent

•1+= diminished, weal/thready

•2+= brisk, expected

•3+= increased

•4+=Full, bounding

CAROTID PULSE

•on either side of trachea, just medial to SCM muscle on the neck

FEMORAL PULSE:

•midway between the symphysis pubis and anterosuperior iliac spine

POPLITEAL PULSE:

•behind the knee, deep in the popliteal fossa, just lateral to midline

DORSALIS PEDIS PULSE

•on top of the foot, in the first intermetatarsal space just lateral to the extensor tendon of the great toe (use 8 fingers on top of foot)

POSTERIOR TIBIAL PULSE:

•behind and below the medial malleolus of the ankles

BRACHIAL PULSE:

•in the a/c fossa above the elbow

Edema

•1+ = trace, 2mm, rapid skin response

•2+ = mild, 4mm, 10-15 sec response

•3+ = moderate, 6mm, prolonged skin response

•4+ = severe, 8mm, prolonged skin response

1+ edema

trace, 2mm, rapid skin response

2+ edema

• mild, 4mm, 10-15 sec response

3+ edema

•moderate, 6mm, prolonged skin response

4+ edema

severe, 8mm, prolonged skin response

Arterial Insufficiency

•Intermittent claudication

•Cold extremities

•Poor wound healing

•Hair loss, slow nail growth

•No pulse or weakened pulses

•Round, smooth sores typically on feet

Venous Insufficiency

•Dull, achy pain

•Warm

•Edema

•Pitting or non-pitting

•1+ to 4+

•Red, ruddy discoloration

•Varicose veins

•Sores with uneven border

•Sores typically on ankles

•Assess for DVT

•Homan's sign (could give a false negative, not tested over)

Allen Test

•Evaluates patency of radial or ulnar arteries

•Have client rest hand palm side up on bed/table and make a fist

•Examiner uses thumbs to occlude radial & ulnar arteries

•Continue pressure to keep both arteries occluded & client releases fist. Palm remains pale

•Release pressure on one artery. Color should return to palm within 3-5 seconds

•With insufficiency pallor will persist