Module 4: Venous insufficiency

what are the differences between the venous system vs arterial?

is a low pressure system, thinner, smaller amounts of smooth muscles and less connective tissue support, also have valves and relies on pumps (respiratory pump and the calf muscle pump)

what do the valves do?

prevent retrograde blood flow, thereby preventing increased venous backpressure (venous hypertension)

what is the etiology of venous insufficiency?

• sustained venous hypertension

• common causes:

  • vein dysfunction

  • calf muscle pump failure

  • combination of both

what is the most commonly involved vein in VI?

isolated greater saphenous vein incompentence

what is most VI caused by?

reflux or venous hypertension may occur due to obstruction to venous outflow (stenosis or thrombosis). tissue damage and skin breakdown is hypoxia due to venous hypertension

what are teh risk factors to VI ulcers?

• vein dysfunction (incompetent superficial and perforating veins)

• valve damage

• calf muscle pump failure

• trauma

• previous VI ulcer (recurrence as high as 81%)

• advanced age

• obesity

• DM

what might be some reasons for calf muscle pump failure?

• calf weakness/paralysis

• decreased dorsiflexion

• prolonged standing (not walking)

• incompetent valves

when does venous hypertension occur?

when bicupsid valves fail to close

what might valve damage be caused by?

thrombosis or clot, distended vessel diameter, varicose veins

what are the PT tests and measures for DVT?

• gold standard is a venogram (but is expensive, invasive, and uses potential allergen dye),

• ultrasonagraphy (very specific and sensitive)

• homan’s sign (this is unreliable and insufficient tho)

• clinical assessment guideline for DVT (well’s criteria)

what are the PT tests and measures for VI?

• ABI

• trendelenburg test to ID vein incompetence

• doppler ultrasound

• venous filling time

what is the homer’s sign?

is a clinical test for deep vein thrombosis (DVT), where pain is elicited in the calf upon dorsiflexion of the foot. However, it is considered unreliable and insufficient for accurately diagnosing DVT.

what is the 5 PT method?

• pain '

• position

• presentation

• periwound

• pulses

• temperature

compare venous and arterial insufficiency ulcers

see image

what is hemosiderin deposition/staining

the accumulation of hemosiderin, an iron-storage complex, in tissues, typically resulting from chronic venous insufficiency. It often manifests as brownish staining on the skin, particularly in the lower extremities.

what is shown in the image?

hemosiderin deposition/staining

what is the average healing time for full thickness venous ulcers?

• 8 weeks average (5-7 fro smaller, 10-16 for larger ulcers)

wounds that do not show signs of healing within what amount of time require referral?

4 weeks

how does compression help?

30-60% of pts treated with compression will heal within 3 months

what are precautions for procedural interventions of AI?

• concomitant arterial disease

• allergic reactions and sensitization

• inappropriate whirlpool use

why is whirlpool use not indicated in venous insuffiency?

• exacerabtes venous insufficiency and slow venous ulcer healing due to

  • dependent positioning

  • warm temp encourages superficial vein dilation and edema

  • add moisture to already highly exudating VI wound

when should you request for further medical testing?

• pts scoring 3 or more on DVT clinical prediction guidelines

• wounds that fail to progress

• wound culture and sensitivity is suspected infection

• bone scans/x-ray is exposed capsule or bone

• wounds that do not present with typical Vi ulcer characteristics

what does local wound care look like with pts with VI?

• protect surrounding skin

• address wound bed

• enhance venous return

• edu pt/caregivers

when should compression therapy not be used?

when there is significant arterial insufficiency

what are paste bandages?

non-elastic compression bandages, are gauze cloth roll bandage impregnated with zinc oxides, calamine, glycerin, and gelatin. hardens into semi-rigid support, stays on for up to 1 week, used on ambulatory patients. disadvantages include the smell, pt can’t shower, and clinical must apply and remove

what are short stretch compression wraps?

have elastic and non elastic qualities that have low resting pressure and little distensibility, can be used with ambulatory and non-ambulatory patients. disadvantages are that they are prone to slippage, causing frequent wrapping, and patients must be trained in technique

what are multilayer compression bandage systems?

A type of bandaging that uses multiple layers to provide graduated compression to the lower extremities (incorportabte short stretch compression bandages). These systems help improve venous return and can be effective for treating venous ulcers. the inner layer absorbs excess wound drainage and provides padding, the middle layer absorbs drainage, the outer layer provides increased compression. are reusable, can accommodate unusually shaped limbs, and stays in place better and maintains compression longer than short stretch alone

what are compression garments used for?

• used for long term management, help maintain edema reduction and control venous hypertension

• requires circumferential and limb length measurements

• off-the-shelf and custom garments

• knee-high usually preferred

• wear garments at all times except while sleeping and bathing (replace every 3-6 months)

what therapeutic exercise can be used for AI?

range of motion and strengthening exercise (target ankle plantar flexors, gastrocnemius soleus stretching exercises), aerobic exercise, gait and mobility training (positive influence on calf muscle and respiratory pumps, weight loss, and blood sugar control)