Peripheral Vascular System assessment
Arteries
• Carry oxygenated, nutrient-rich blood
from the heart to the capillaries.
• Major arteries of arm: brachial, radial,
ulnar
• Major arteries of the leg: femoral,
popliteal, dorsalis pedis, posterior tibial
Major Arteries Of The Arms And Legs
Major Arteries Of The Arms And Legs
Veins
• Carry deoxygenated, nutrient-depleted,
waste-laden blood from the tissues back
to the heart
• Three types of veins: deep veins,
superficial veins, and perforator veins.
• Femoral, popliteal, saphenous veins
Major Veins of the Legs
Lymphatic System
• Lymphatic capillaries; lymphatic vessels;
lymph nodes
• Capillaries and fluid exchange
• Form the connection between the
arterioles and venules
• Allow the circulatory system to maintain
the vital equilibrium
Superficial Lymph Nodes Of The Arms And
Legs
Slide 20-9
Slide 20-10
Peripheral Vascular Disease
• Aortic aneurysms
• Cerebrovascular disease
• Deep vein thrombosis and pulmonary
embolism
• Peripheral arterial occlusive disease
• Varicose veins
Deep Vein Thrombosis: Risk Factors
Any condition that increases blood clotting,
including inherited conditions
Lowblood flow to deep vein(s) from surgery,
immobilization, injury, constriction
Some cancers and cancer treatments
Other vascular conditions such as varicose veins
Sitting for long periods, especially in a car or airplane
Deep Vein Thrombosis: Risk Factors (cont.)
• Pregnancy, especially the first 6 weeks after giving birth
• 60 years of age or older
• Overweight
• Birth control pills, hormone therapy, post menopausal hormone
replacement
• Having a central venous catheter in a vein
• Having more than one DVT risk factor
Deep Vein Thrombosis: Risk Reduction
• If sitting for long periods, stand up as often as
possible or at least every hour. Exercise feet and lower
leg muscles frequently.
• Get out of bed and walk as soon as possible after
surgery or illness.
• Follow physician’s orders for taking clot preventing
medicines if required for some surgeries and follow up
with physician as necessary. Report tenderness or
pain, swelling, or warmth or redness in calf or thigh.
Deep Vein Thrombosis: Risk Reduction
Traveling Long Distances
• Exercise leg muscles frequently in airport as well as on plane; curl
and press toes down to improve circulation.
• Wear compression stockings.
• Avoid socks with tight elastic bands around tops.
• Drink plenty of fluids to avoid dehydration.
• Take aspirin if advised by physician or not contraindicated by other
medical conditions.
• On long car trips, stop every two hours to get out and walk around.
Subjective Data: Current
Symptoms
• Skin changes
• Leg pain, heaviness, or aching
• Leg veins
• Leg sores or open wounds
• Swelling in legs or feet
• Men: sexual activity changes
• Swollen glands or nodules
Subjective Data: History
• Past
– Previous problems with circulation in arms or legs
– Heart or blood vessel surgeries or treatments
• Family
– Varicose veins, diabetes, hypertension, coronary heart
disease, or elevated cholesterol or triglyceride levels
Subjective Data: Lifestyle & Health
Practices
• Tobacco use
• Regular exercise
• Oral contraceptives use
• Stress
• Peripheral vascular problems interfere with ADLs
• Medications
• Support hose
Client Preparation
• Explain procedure to client
• Ask client to gown
Equipment
• Gloves
• Centimeter tape
• Stethoscope
• Doppler ultrasound probe
• Tourniquet
• Gauze
• Waterproof pen
• BP cuff
Arms: Inspection
Size,presence of edema, venous
patterning
Skin color
Fingertips for clubbing
Arms: Palpation
Fingers, hands, & arms for temperature
Capillary refill time
Radial, ulnar, & brachial pulses
Epitrochlear lymph nodes
Allen’s test
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Radial Pulse 27
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Ulnar Pulse 28
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Brachial Pulse 29
Allen’s Test
Legs: Inspection
Skin color
Distribution of hair
Lesions or ulcers
Edema
Legs: Palpation
Temperature
Superficial inguinal lymph nodes
Femoral pulse
Popliteal, dorsalis pedis, posterior tibial pulses
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Femoral Pulse 33
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Popliteal Pulse 34
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Dorsalis Pedis Pulse 35
© Pat Thomas, 2006.
Legs
• Inspect for varicosities and thrombophebitis by
asking client to stand
– Manual compression test
– Trendelenburg test
• Homan’s sign
Trendelenburg test
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Manual Compression Test 39
From Bloom A, Watkins PH, Ireland J: Color atlas of diabetes, ed 2, St. Louis, 1992, Mosby.
Arterial Insufficiency
• Pain: intermittent claudication to sharp,
unrelenting, constant
• Pulses: diminished or absent
• Skin characteristics: dependent rubor
Venous Insufficiency
Pain: aching, cramping
Pulses: present but may be
difficult to palpate through
edema