Peripheral Vascular System Flashcards
Inspection, Upper Extremity
(7 components)
- Size
- Symmetry
- Swelling
- Venous pattern
- Color
- Texture
- Nail beds
Inspection, Lower Extremity
(12 components)
- Size
- Symmetry
- Swelling
- Rashes
- Ulcerations
- Texture
- Venous enlargement
- Unusual pigmentation
- Hair distribution
- Scars
- Color
- Nail beds
Palpable Pulses
(8)
- Carotid
- Brachial
- Radial
- Ulnar
- Femoral
- Popliteal
- Dorsalis pedis
- Posterior tibialis
Peripheral Vascular Competencies
(8)
- Upper extrem inspection
- Lower extrem inspection
- Palpate pulses
- Use technique to assess for edema
- Detect and describe varicosities
- Perform Allen test
- Assess BP
- Assess cap refill
Upper Extrem Pulse Obtainability
- Arterial pulses are palpable when artery lies close to body surface
- In upper extremity the ulnar pulse may be obscured by overlying tissues
Veins
(two relative locations, descriptions)
- Deep veins - carry 99% of venous return from lower body, well supported by surrounding tissues
- Superficial veins - subcutaneous and poorly supported by surrounding tissues
Blood Movement in Veins
- All veins (deep, communicating, superficial) have one way valves
- Blood flows from superficial → deep toward the heart
- Muscle pumps sqeeze blood against gravity
- Competent valves prevent backflow
Lymph Node Shapes
(3)
Vary in size
- Round
- Oval
- Bean-shaped
Superficial Lymph Nodes Accessable on Exam
(4 groups)
- Cervical
- Axillary
- Epitrochlear - medial arm, ~3 cm superior to elbow
- Inguinal - normally between 1 and 2 cm
- Horizontal group - below inguinal ligament
- Vertical group - near upper part of saphenous vn
Pulse Technique
(4 aspects)
- Use fingertips, not thumbs
- Firm even pressure
- Ensure you are perceiving the pt’s pulses, not your own
- Never palpate both carotids at once
Pulse Descriptions
(5)
*Remember to compare these bilaterally and note assymetry *
- 0: absent unable to palpate
- +1: diminished, weaker than expected
- +2: brisk, expcted (avg)
- +3: increased
- +4: bounding
Widened Pulse
(definition, implicaiton)
Definition: larger diameter where pulse is palpable
Implication: aneurysm
Arterial Occlusion
(definition, clinical presentation, pt pop)
Definition - fatty plaques impede bloodflow; most common cause of arteriosclerosis
Presentation - decreased/absent pulses distal to occlusion (usually in thigh)
Pt Pop: diabetics
Symptoms of Ischemia (c arterial occlusion)
(6)
6 P’s
- Polar (cold) - typically first notable symptom
- Pain - 80% of cases; absent in remaining 20% due to prompt onset of anesthesia or paralysis
- Pallor - replaced by mottled cyanosis in a few hours
- Paresthesia - loss of light touch followed by other sensory modalities
- Paralysis/Power - indicative of severity
- Pulselessness
Carotid Pulse Procedure
(3 steps)
- Inspect neck for pulsations just medial to SCM
- Place 2nd and 3rd fingers on lower 1/3 of neck
- Press posteriously and feel for pulse
Brachial Pulse Procedure
(4 steps)
- Patient’s arm should rest c elbow etended palm up
- Use 2nd and 3rd digits of opposite hand
- Cup hand under pt’s elbows
- Feel for pulse just medial to biceps tendon
Radial Pulse Procedure
(2 steps)
- Use pads of fingers on the flexor surface of the lateral wrist
- Partially flexing pt’s wrist may help
Ulnar Pulse Procedure
Using the pads of your fingers, feel for the pulse deeply on the flexor surface of teh wrist medially
Femoral Pulse Procedure
Press deeply below the inguinal ligament and about midway between teh anterior superior iliac spine and the symphysis pubis
Popliteal Pulse Procedure
(4 steps)
- Patient should be prone
- Flex the knee to 90 degrees
- Let the leg rest against you
- Use your thumbs to press deeply into the popliteal fossa
Dorsalis Pedis Pulse Procedure
(2 steps)
- Feel the dorsum of the food just lateral to the extensor tendon of the great toe
- If no luck, try more laterally
Posterior Tibial Pulse
Curve your fingers behind and slightly below the medial malleolus of the ankle
Examination Technique for Edema
- Press firmly but gently for 5 seconds over
- Dorsum of each foot
- Behind medial malleolus of each ankle
- Over each shin
- Observe for pitting (depression caused by finger pressure)
- Bilateral edema is usually pitting
- Unilateral may not be
- Grade edema on 5 point scale (trace to +4)
- In the event of present edema, measure and compare circumference bilaterally in the following places. Difference of > 1 cm above ankle or 2 cm above calf is unusual and can suggest edema.
- Forefoot
- Above ankle
- Largest circumference of calf
- Mid-thigh (measured distance above the patella c knee extended)
Edema Scoring
- Trace = minimal edema of foot
- +1 = edema of foot
- +2 = edema to ankle
- +3 = edema halfway up shin
- +4 = edema to knees
Edema Causes
(4)
- Recent DVT
- Chronic venous insufficiency
- Incompetent venous valves
- Lymphedema
Varicosity Examination
(3 steps)
You can map the course of varicosities by transmitting pressure waves in filled veins
- Stand pt
- Place fingers gently on vein
- Compress sharply
Lower Extremity Fluid Pathology
(3)
- Superficial thrombophlebitis - local swelling, reddness, warmth, and palpable cord
- Venous insufficiency - brownish color or ulcers just above the ankle
- Lymphedema - thickened skin
Allen Test
(purpose, indication, procedure)
Purpose: Evaluate arterial blood supply to the hand
Indication: Assess ulnar artery patency before puncturing radial artery for blood draws or line placement
Procedure:
- Position pt’s hands c palms up
- Occlude radial and ulnar arteries
- Instruct pt to tighten fist
- Instruct pt to release fist
- Observe palor of hand
- Open one artery
- Circulation is intact if hand turns pink
Capillary Refill
(Function, Normal, Procedure)
Function: assess ability of capillaries to refill c blood when emptied
Normal: < 3 sec
Procedure:
- Ensure clean nails - no polish, blood, or fungus
- Press on end of nail until nail bed becomes pale
- Release and assess time to turn pink
