PERIPHERAL CIRCULATION EXAM (VENOUS)

Question 1

How would you start any examination?

Answer 1

WIPER QQ
Wash hands
Introduce yourself
Ask permission
Expose the patient
Reposition the patient

Ask if they are in any pain or discomfort

Question 2

How exposed should the patient be for a peripheral venous circulation examination?

Answer 2

The patient’s legs should be exposed

Question 3

How should the patient be positioned for the peripheral venous circulation examination?

Answer 3

The should initially be standing

Question 4

What might you look for during general inspection of the patient in a peripheral venous circulation examination?

Answer 4

Whether patient looked stable
Breathlessness - PE
Any obvious swelling in either leg - DVT
Any obvious varicose veins
Any medicines around the bed

Question 5

Whilst the patient is standing at the beginning of the peripheral venous circulation examination, what would you look at?

Answer 5

Any obvious swelling in either leg - DVT
Any obvious varicose veins
Gait

Question 6

Having inspected their gait as part of the peripheral venous circulation examination, what would you do next?

Answer 6

Get the patient to lie down and inspect their legs again.

Question 7

Whilst the patient is lying on the bed as part of the peripheral venous circulation examination, what would you look for?

Answer 7

Swelling in either leg - DVT, HF 
Varicose veins 
Venous eczma
Skin colour changes
Haemosiderin deposits
Lipodermatosclerosis - inflammation of subcut fat (woody hard skin, pigmentation, swelling, redness, inverted champagne bottle leg)
Venous ulcers/Atrophy blanche

Question 8

If you notice varicose veins as part of the peripheral venous circulation examination, what aspects about them should you comment on?

Answer 8

Distribution
Colour
Prominence

Question 9

Having inspected the leg with the patient lying down as part of the peripheral venous circulation examination, what would you palpate?

Answer 9

Palpate varicosities for tenderness and hardness (phlebitis)
Palpate saphenofemoral junction - check cough impulse
Palpate for any calf tenderness

Question 10

Having palpated the leg as part of the peripheral venous circulation examination, what should you do next?

Answer 10

Elevate limb to 15 degrees and note rate of emptying

Perform Tredelenburg test if varicose veins present

Question 11

How do you perform Tredelenburg’s test?

Answer 11

F