Peripheral venous assessment

Question 1

Risk factors for developing venous congestion in the lower legs

Answer 1

Obesity

Familial

Age

Pregnancy

Standing for long periods of time

Increased abdominal pressure

Question 2

Complications of venous congestion in the lower limbs

Answer 2

Varicose veins

Thrombophlebitis

Varicose eczema

Venous ulcers

Question 3

Blood supply to the leg

Answer 3

Superficial: Great and short saphenous veins

Deep: Femoral vein

Question 4

Characteristics of a venous ulcer

Answer 4

Superficial

Itchy

Large

Medial malleolus

High exudate level (slough)

Minimal pain

Question 5

Characteristics of an arterial ulcer

Answer 5

Deep

Small and punched out

Lateral aspect of the leg

Absent pulses

Question 6

1. What is this
2. What is it caused by
3. Presenting features
4. What is the increased colour of the skin due to

Answer 6

1. Varicose eczema
2. Increased pressure in the venous drainage system of the leg
3. Itchiness, appearance, breakage of the skin, oedema, venous ulcer
4. Haemosiderin deposit

Question 7

Why is this a venous ulcer?

Answer 7

Shallow, large, medial aspect of the leg, slough at the base, haemosiderin deposit, thickened skin, surrounded by eczematous skin

Question 8

What are you looking for in the well’s score?

Answer 8

• Paralysis, paresis or recent orthopedic casting of lower extremity (1 point)
• Recently bedridden (more than 3 days) or major surgery within past 4 weeks (1 point)
• Localized tenderness in deep vein system (1 point)
• Swelling of entire leg (1 point)
• Calf swelling 3 cm greater than other leg (measured 10 cm below the tibial tuberosity) (1 point)
• Pitting edema greater in the symptomatic leg (1 point)
• Collateral non varicose superficial veins (1 point)
• Active cancer or cancer treated within 6 months (1 point)
• Alternative diagnosis more likely than DVT (Baker’s cyst, cellulitis, muscle damage, superficial venous thrombosis, post phlebitic syndrome, inguinal lymphadenopathy, external venous compression) (2 points)

DVT Risk Score Interpretation:

3-8 Points:High probability of DVT

1-2 Points:Moderate probability

0-2 Points:Low Probability

Question 9

Risk factors for DVT

Answer 9

Age, being in hospital, bedridden, Oestrogen containing contraceptive therapy, HRT, thrombophilias, pregnancy, varicose veins with phlebitis, significant comorbodities, obesity.

NOT: varicose veins per se, admission to hospital (unless critical care)