Integ. Unit 4 Vascular Wounds Flashcards
What is the Normal Flow of the Arterial System?
Begins in the Ascending Aorta and travels to the distal limbs
Patients with Peripheral Arterial Disease are at risk for what?
- Arterial Insufficiency
- Slowing of blood flow
- Claudication
-Heavy legs
-Cramping pain during exertion that dissipates at rest - Resting pain
-Foot pain taht occurs consistently against gravity
-Relieved with the dependent position
What is the endstage Sx of Arterial Compromise?
Tissue Loss
What are the Risk Factors for Arterial Wounds?
- Arterio/Atherosclerosis
- Smoking
- Obesity
- Diabetes Mellius (DM)
- Hypertension (HTN)
- Hypercholesterolemia
- Family Hx
- Nutrition
With Arterial Evaluation/Screening, what are different Non-Invasive Techniques used?
- Ankle Brachial Index (ABI):
- Segmental Plethysmography: Expansion of ABI, requires pressures to be taken at various points along the limb to better localize ischemia
- Arterial Duplex Scanning: Combines ABI and Segmental Pleth. and uses an ultrasound to show the details of a specific vessle that may be occluded
- Transcutaneous Oxygen Measurement: Allows for measurement of O2 delivery to the site to be measured which mimics that blood delivery specifically, this shows the extent of ischemia
- Magnetic Resonance Angiography (MRA): can accuratly visucaly the vessels
- Computer Tomography (CT) Angiography: Multiple images taken with contrast to reconstruct a 3D image
- Rubor of Dependency (Screen)
With Arterial Evaluation/Screening, what are is an Invasive Technique used?
Contrast Angiography
What is the Ankle Brachial Index? What is the Procedure for this?
The ratio of ankle systolic pressure to brachial systolic pressure
- This is indicative of peripheral artery disease (PAD) in the LE
Procedure:
- Syphygmomanometer is placed above the ankle and inflated
- A doppler measure the systolic pressure of the Posterior Tibialis/Dorsalis Pedis by listening for the return of pulse after the cuff is slowly deflated
- Syphygmomanometer is then placed above the elbow and inflated
- Doppler measures the systolic of brachial artery
- The Highest value when testing all extremities is the value that is used for calculation
- If there is a LE wound, THAT IS THE LEG that is used for the calculation
What are the 2 choices for calculation for ABI?
Higher of the Ankle Systolic Pressures (DP or PT x LLE or RLE) / Higher Brachial Systolic BP (L or R arm)
OR
Systolic Pressure of LE with wound (DP or PT) /
Higher Brachial Systolic BP (L or R arm)
DP = Dorsalis Pedis ; PT= Post. Tib
Do not perform if distal wound will be compressed as this will cause significant pain for the patient
With ABI, what does the value 1.00 - 1.4 mean?
Normal
- Adequate Blood supply
With ABI, what does the value > 1.4 mean?
Non-compressible arteries
This is still considered abnormal
With ABI, what does the value 0.91- 0.99 mean?
Borderline Occlusion
Abnormal
With ABI, what does the value 0.80 - 0.90 mean?
Mild Occlusion
- Compression Therapy = No greater than 30-40 mmHg
Abnormal
With ABI, what does the value 0.50 - 0.79 mean?
Moderate Occlusion
- Reduced Compression Therapy = No greater than 23-30 mmHG
Abnormal
With ABI, what does the value ≤ 0.49 mean?
Severe Occlusion
- Any compression therapy is contraindicated
- Vascular Referral
What is the Rubor of Dependency Test?
This may be used as a screen for Arterial Insuffeciency and/or ischemia
- With the screen, the patient will be in supine with the extremity elevated 30°, and observe for pallor
- Once Pallor is observed, place the extremity in the dependent position
- Normal signs is the skin turns slight pinkish in about 15 seconds
- Abnormal signs is the skin turn bright red and takes about 30 seconds or longer (Usually positive for ischemia)
-Caused by dilation of arteries in attempt to reperfuse the extremity quickly compensating for poor arterial blood flow
What are the Clinical Presentations of Arterial Insufficiency wounds?
- Round and small with smooth regular borders (“Hole Punch”)
- Lacks in granulation tissue (usually pale)
- Pink Periwound
- Usualy occurs on the distal digits first
- Painful especially with elevation
- May have hair loss
- May have muscle atrophy
- Dependent Hyperemia may be present, which may be seen during the Rubor of Dependency Test
With Aterial Insufficiency Treatment, what can be done for Protection?
- The application of PRAFO (Protection, Relief, Ankle, Foot, Orthosis)
- Heel Cushions
- Pressure relief
- Clean/Sterile bandaging
With Aterial Insufficiency Treatment, (other than protectio) what are other treatment options for the patient?
- Infrared Light
- Debridement (stable eschar is NOT to be debrided!)
With Arterial Insufficiency, what are different Surgical Options?
- Revascularization surgery
- Endovascular inteventions (Stent surgery)
- Surgical Debridement
What is the Normal Venous Flow?
- Interstitual spaces -> Venous capillaries -> Superficial veins -> Deep veins
- Valves prevent retrograde
- Return of blood flow is facilitated by muscle pump
What do Venous wounds result from?
Ultimately result from chronic venous insufficiency (CVI) as a consequence of other co-morbidity such as DVT or family Hx
- Abnormal vessel valves allow for retrograde flow of some venous blood causing pooling in the distal LE
- Varicose veins may be found as a result of those “leaky” valves
- Then a dark brownish staining to the lower leg (Hemosiderin Staining/deposits, these are tyically on the Lower leg
With Venous Wound, what is the difference between having edema below the lower leg and having edema extending to the thigh?
Edema below the lower leg = Venous Insufficiency
Edema extending to the thigh = Lymphedema
What takes place during the Venous Insufficiency Assessment?
When performing an eval. the patient is usually standing to determine increased venus distention (Can be done in supine tho)
- Venus Duplex Ultrasound can be administered to evaluate the integrity of the veins and is a good clinical measure to assess the visualization of the vein, compressibility of the walls and ability to increase flow
- Photoplethsmography measure refill time of the veins by performing multiple ankle pumps using a light emitting diode
- Phlebography/Venography, these are more invasive procedure that use IV contrast dye to distinguish reflux in the veins of the Lower leg
What are the Clinical S/S of Venous Insufficiency?
{Location, onset, appearance, pain, etc}
- Location: Above Malleoli (Gaiter area)
- Onet: Insidious
- Appearance: Uneven edges, shallow, little eschar
- Periwound: Increased thickness, hemosidian staining
- Moderate to Copious serous, purulent drainage (usually this happens if there is no arterial insufficiency)
- Pain: minimal
What is the Gold Standard Treatment for Venous Insufficiency?
Compression
- Not for use with active CHF or excessive PAD (Severe arterial insufficiency), CONTRAINDICATION!!!!
- Spiral
-50% stretch and 50% overlap
-Use for patients who are bed bound or do not require a lot of compression - Figure 8
-50% stretch and 50% overlap
-Provides 2x as much compression as spiral
-Used for patients who are regularl ambulatory and have good ABI values
With Venous Wound Treatment, what is the technique for the 4 Layer Wrapping Technique?
This is a non-invasive technique
1st layer: Soft cotton padding wrapped in spiral
2nd layer: Non-elastic layer wrapped in spiral
3rd layer: Long-stretch layer wrapped in Figure 8
4th layer: Self adhering bandage (Coban)
- Changed every 3-7 days depending on drainage
