Chronic Venous Insufficiency Flashcards
Chronic Venous Insufficiency
a condition that occurs when the vein wall and/or valves in the leg veins do not work effectively, which impairs the ability for blood to return to the heart from the legs, resulting in venous-stasis
Venous network in LE 3 parts
- Superficial, (lesser and greater saphenous)
- Deep, (anterior and posterior tibial, peroneal, popliteal, deep femoral, superficial femoral, and iliac veins)
- Perforating or communicating veins
CVI may result from?
Vein wall degeneration, post-thrombotic valvular damage, chronic venous obstruction, or dysfunction of the muscular pumps.
Edema
a clinically apparent increase in the interstitial fluid volume
- Develops when Starling forces are altered so that there is increased flow of fluid from the vascular system into the interstitium.
- Due to Increase in capillary pressure usually results from an elevation of venous pressure caused by obstruction to venous and/or lymphatic drainage.
Generalized Edema
Due to
•Heart failure, Hypo-albumenia, nephrotic syndrome, Cirrhosis, sepsis
Localized Edema
Due to
•Musculoskeletal Injury, DVT
Pitting edema
1+ Barely detectable impression when finger is pressed into skin
2+ Slight indentation. 15 secs to rebound
3+ Deeper indentation. 30 secs to rebound
4+ >30 secs to rebound
PT Implications for CVI
- Exercise increases muscle pump for venous return and kidney function to clear fluid
- Short walks with occupations involving prolonged sitting, weight shift in standing
- Elastic pressure stockings - effective up to knee-don’t need to go above the knee
- Compression pump - below DBP, 90 sec on: 30 sec off (Generally)
- Unna boot - Semirigid dressing, layered application from 1st metatarsal to below tibial tubercle. - Cast dries 1h, wear 7 days. Muscle contracts and presses against rigid Unna boot to force fluid proximally
- Edema massage helps prevent pitting edema, which increases likelihood of wounds - contraindications include uncompensated CHF, untreated infection or cellulitis, active cancer (check with MD), renal failure, and severe pulmonary problems