Peripheral Venous Examination Flashcards
Introduction
Wash hands, PPE
Introduce yourself
Patient DOB
Explanation
-I’d like to examine the veins in your legs. I will look at, feel and perform some short tests on your veins. There will be a staff member acting as a chaperone throughout. You will need to remove your trousers but you can keep your underwear on. I’d also like you to stand for the first part of the exam and lie flat for the latter part. Do you have any questions? Are you happy for me to examine you today?
Do you have any pain?
General inspection
- bedside
- patient
Bedside
- compression socks, wound dressings
- mobility aids
- vital signs, prescriptions
Patient
- well/unwell
-breathless/pain/discomfort?
Leg inspection when standing
-what are you looking for
Inspect for venous disease
Surgical scars
-past venous treatments are minimally invasive => very few scars
Venous eczema - ITCHY!
- itchy red, blistery plaques on gaiter regions
- atrophie blanche
- hemosiderin deposits
- lipodermatosclerosis
Venous ulcers - mild pain
-large, shallow, irregular border in gaiter region
Varicose veins in long and short saphenous veins
-distribution, colour prominence
Swelling
- ankle - heart failure
- calves - DVT
Observation of gait
-what are you looking for?
Asymmetry, additional movements, difficulties in turning or moving
What is
- venous eczema
- atrophie blanche
- hemosiderin deposits
- lipodermatosclerosis
- venous ulcers
Venous eczema
-venous stasis => venous HTN => fluid accumulates in tissue => inflammation of tissue
Atrophie blanche
-white depressed plaques surrounded by hemosiderin
Hemosiderin deposits
-damaged capillaries leak blood => red patches
Lipodermatosclerosis - inflammation and stiffening of SC fascia
- skin hardening
- hyperpigmentation, redness
- swelling
- inverted champagne bottle
Venous ulcers - improper functioning of valves => harder for injuries to heal
- large irregular border
- shallow
- mild pain
Location of
- long saphenous
- short saphenous
What is phlebitis
Long - medial leg
Short - lateral lower leg
Phlebitis - vein inflammation often caused by trauma, infection
Palpation
- how would you do this
- what are you assessing for?
Ask patient to lie down on couch
Temperature of varicosities - high (inflammation, phlebitis?)
Palpation of varicosities - ask patient if they feel pain
- erythema and tenderness => phlebitis
- hard and tender => thrombophlebitis (thrombosis with inflammation)
Palpate 5cm below and medial to femoral pulse, patient cough
-cough impulse at saphenofemoral junction = saphena varix
Palpate calf tenderness - DVT
Palpate pitting edema
Elevate limb to 15deg - note rate of venous emptying
Percussion and auscultation
- how would you do this
- what are you assessing for
Tap distal varicosity - feel impulse proximally
Tap proximal varicosity - feel impulse distally => incompetent valvee
Auscultate over varicosity - bruit => turbulent flow from AVM
Special tests if varicosities present
-explanation of this test
Trendelenburg test
- lift 1 leg as high as comfortable
- milk leg to empty vein
- place torniquet over saphenofemoral junction
- ask patient to stand, torniquet and observe vein filling
Vein filled below torniquet => incompetent valve below SFJ
Torniquet released, vein filled where torniquet was => SFJ incompetent valve
- repeat test with patient lying down with torniquet 3cm below previous position, get patient to stand and observe venous filling again
- repeat until filling stops and location of incompetent venous valves localised
The torniquet occludes the superficial veins only
Deep veins are left unoccluded
If valves at the level of torniquet are incompetent => should only fill when torniquet released
If valves below the level of the torniquet are incompetent => valves fill with torniquet on
To complete examination
Check arterial pulses
Abdo, pelvic exam to exclude masses that could cause VC obstruction
Venous duplex scan
