Peripheral Vascular Assessment

Vascular System

System that transports blood throughout the body

Lymphatic System

System involved in immune function and fluid balance

Two circulatory-related systems

Vascular system and lymphatic system

Arteries

Blood vessels that carry blood away from the heart

Artery pressure

High pressure

Artery walls

Thick walls

Veins

Blood vessels that carry blood toward the heart

Vein pressure and walls

low pressure and thin walls

Lymphatic system is important in

immune system

What does the lymphatic system work in collaboration with?

the PV system in removing fluid from the interstitial spaces

Interstitial space

lies between blood vessels and cells

What happens to excess interstitial fluid?

Absorbed into lymphatic vessels and carried to lymph nodes

Extra fluid in interstitial space=

edema

What are the three major arteries in the arms?

brachial, ulnar, and radial artery

What are the major arteries in the legs?

femoral, popliteal, anterior and posterior tibial artery, dorsalis pedis

Femoral artery

passes under inguinal ligament

Anterior and posterior tibial artery

behind the medial malleolus (big ankle bone)

Lymph nodes in infants & children

Often can be felt and are normal

Normal lymph nodes in children feel like

Small, firm, movable, and not painful

Edema in pregnancy

Swelling in both legs, worse at end of day

When is pregnancy edema common?

Late pregnancy (third trimester)

Varicose veins common when in pregnancy

Common in third trimester

Pulses in older adults and arterial insufficiency

Harder to feel

Subjective date (leg pain or cramps)

may indicate circulation problems (intermittent claudication)

Subjective date (skin changes on arms or legs)

this is your skin assessment; example- raynaud’s disease

Subjective date (edema)

bilateral or unilateral

Subjective data

leg pain or cramps, skin changes on arms/legs, edema, lymph node enlargement, medications, smoking history (damages our arteries)

Objective data and order of assessment

preparation (check temp of room, ensure pt is comfortable); inspection, palpation, no percussion or auscultation

Inspection of the arms (looking at)

color, clubbing of fingernails, symmetry

Palpation of the arms

cap refill, temp, check pulses (radial and brachial)

Grade the pulse

+4 bounding, +3 full, +2 moderate (normal), +1 weak, 0 absent

Capillary refill <2 seconds=

normal

Capillary refill >2 seconds=

poor perfusion

Assess for clubbing of the fingernails (clubbing=)

>160 degrees (indicates chronic hypoxia)

Patients with clubbing

lung disease, heart disease

Nail polish present

check capillary refill on side of finger

Negative modified allen test results

if the hand flushes within five to fifteen seconds, this shows that the hand has good blood flow

Positive modified allen test results

if the hand doesn’t flush within five to fifteen seconds, the circulation of the ulnar artery is not sufficient (in this case, the radial artery should not be punctured)

Inspection of the legs (looking at)

color, clubbing of the toenails, symmetry, ulcers, varicose veins, and edema

Palpation of the legs

cap refill, temp, check pulses (femoral, popliteal, posterior tibial, dorsalis pedis)

Location of venous ulcers

near medial malleolus

Margin of venous ulcers

irregularly shaped

Drainage and tissue of venous ulcers

drainage- moderate to large; tissue- yellow

Location of arterial ulcers

tips of toes, foot, or lateral malleolus

Margins of arterial ulcers

rounded, smooth, looks like a hole punch

Drainage and tissue of arterial ulcers

drainage- minimal; tissue- black eschar

What is a varicose vein?

swollen, twisted vein that lie just under the skin (from whenever blood pressure increases inside your veins)

Patient population of varicose veins

pregnancy, obesity, older adults

How to check for edema

depress skin over tibia or medial malleolus for 5 seconds and release

Clinical tip for palpation of femoral and popliteal arteries

for the popliteal pulse, have patient lie in the prone position- brings artery to the surface

What can you use if you cannot feel a pulse?

use a doppler device

What is a doppler?

tool used to detect blood flow

What does a doppler show?

shows whether a pulse is present and whether there is blood flow to the limb

What can a doppler help diagnose or manage?

help diagnose or help manage conditions such as peripheral arterial disease

Clinical tip for a doppler

mark the pulses with a sharpie for future assessments

Peripheral vascular disease is an umbrella term for

peripheral artery disease and peripheral venous disease

Peripheral venous disease

deoxygenated blood can’t get back to the heart (pooling of oxygenated blood in the extremities)

Peripheral artery disease

narrow artery where oxygenated blood can’t get to the distal extremities (hands and feet); ischemia and necrosis of the extremities → no blood= no O2 (pain)

Causes of peripheral venous disease and peripheral artery disease

smoking, diabetes, high cholesterol, HTN

Diagnosis of peripheral venous disease and peripheral artery disease

doppler ultrasound

What is peripheral venous disease

a problem with the circulation of blood back to the heart (pooling of blood)

Where do veins take blood

back to the heart

Peripheral venous disease (vascular insufficiency)

veins not doing their job well

Treatment for peripheral venous disease

elevate veins, medications, surgery, keep vein open

Medications for peripheral venous disease

aspirin, statins (prevents clots and reduce plaque and improve vessel health)

What does VEINY stand for?

very big pulses (bounding), edema because of the pooling of blood, irregularly shaped sores, no sharp pain (will be dull and constant), yellow ankles

Peripheral artery disease

narrow artery makes it difficult to pump O2 blood to the body (causes ischemia and necrosis, no O2= tissues dying)

Treatment for peripheral artery disease

dangle arteries, stop smoking, avoid tight clothing- vasoconstriction, medications, get blood moving!!

What medications are used for peripheral artery disease?

vasodilators and antiplatelets

What does ARTS stand for in peripheral artery disease?

absent pulses: blood is not getting to the extremities, round/red sores, toes and feet eschar= pale and dying, sharp calf pain with elevation or exercise (intermittent claudication)

Deep vein thrombosis is seen where?

lower extremities (below the knee)

Risk factors for deep vein thrombosis

obesity, oral contraceptives, prolonged immobility, surgery

S/S of deep vein thrombosis

positive D dimer, positive homan’s sign (no longer recommended), increases cal circumference, pain, redness, unilateral swelling, warm legs

Treatment and nursing priorities for deep vein thrombosis

DVT (Don’t Dislodge the clot; don’t massage, walk, or apply heat), eleVate above heart levels, anTicoagulants (enoxaparin); TED hose/SCD only used if they DON’T have a DVT

Arterial pulses

diminished or absent

Venous pulses

normal to bounding

Appearance of arterial pulses

skin- shiny, loss of hair, thick brittle toenails, elevation pallor, dependent rubor

Appearance of venous pulses

skin: brawny discoloration, stasis dermatitis and pruritus

Temp of arterial pulses

cool

Temp of venous pulses

warm

Cap refill and hardness of arterial pulses

>3 seconds, soft, thin skin

Cap refill and harness of venous pulses

<3 seconds, hardened, lethargy

Edema and sensation (pain) of arterial pulses

edema no present; intermittent claudication, painful ulcers

Edema and sensation (pain) of venous pulses

edema present; dull achy pain relieved by elevation

What are 3 ways to carry blood back to the heart

calf pump (walking), valves (prevents backflow), and inspiration (breathing)

When you breathe lowers pressure in thorastic cavity which allows

the blood to come back into the heart

Major arteries in the legs (femoral artery)

central pulse!; coding→ check femoral artery

What is a priority S/S of peripheral artery disease?

intermittent claudication

Are we more worried about bilateral or unilateral swelling?

unilateral swelling (DVT)

Subjective data; leg pain or cramps

intermittent claudication (up walking= pain; sitting down= no pain); oxygen demand is high when exercising

Venous ulcers

veins are not working; blood staying in lower extremities

Arterial ulcers

caused by peripheral arterial disease; not taking blood all the way to feet efficiently

What are the two peripheral vascular diseases?

peripherial venous disease and peripheral artery disease

Why is positive homan’s sign no longer recommended for a DVT?

dorsiflex the foot could dislodge the clot

What is a main S/S for DVT?

calf circumference (measuring the calf)