Peripheral Venous System Examination Flashcards
Inspects for evidence of venous insufficiency in the lower limbs: warmer than normal skin, skin pigmentation changes, prominent veins, ulcers, swelling, etc.
“First, I will inspect for any signs of venous insufficiency, in the lower limbs, I do not see any changes in skin pigmentation (hyper pigmentation could indicate stasis) (explain findings), prominent veins (explain findings), ulcers (explain findings). Their skin isn’t warmer than normal, and there is no visible swelling.”
Can add extra findings here.
Explain significance of findings.
Palpates for temperature, pitting edema, venous tenderness or cords, calf tenderness
“I will now check the temperature of your lower limbs by placing the dorsum (back) of my fingers on your skin. I’m noting that the temperature of your skin is normal and there is no change in temperature that could be indicative of (explain findings).”
“Next, I will assess for pitting edema in the lower limbs. I will apply some pressure with a fingertip above the medial malleolus for a few seconds and then remove to see if an indentation has been left behind; bony prominence of the tibial bone (always ask patient if they’re in any pain (e.g.) pitting edema. I’m noting no sign of pitting edema bilaterally.” Continue to move upwards along the leg, repeating this process until you establish at what level edema extends to.
Pitting edema is commonly caused by heart failure and can impact the integrity of the skin if sever (as the skin becomes stretched and easily damaged). Edema is one of the first signs of complicated varicose veins. Tenderness or cords/normally palpated on the varicose veins or visible vein
Measures the calf bilaterally. Comment on findings
“Additionally, with a tape measurer, I will measure the calf bilaterally. The right calf measures […] and the left calf measures […]. While there can be normal physiologic differences in calf size, the differences should be +/- 3cm.” 10 cm down from the inferior pole of tibial tuberosity
Normal is +/- 3cm
Demonstrate the Trendelenburg test and explain its significance.
“Next, I will perform the Trendelenburg test, which is used to locate the site of incompetent venous valves.”
“I will be assessing one leg at a time. Can you please relax for me?” Assess one leg at a time, position the patient lying flat on the examination table. Lift the patient’s leg up 90 degrees and wrap hands around leg to occlude the great saphenous vein (there should be no blood moving from the GSV) (As far as the patient is comfortable with) and empty the superficial veins by “milking” the leg towards the groin (SFJ).
“Can you please stand for me? I’m observing for the filling of veins.” Ask the patient to stand and observe for filling of the veins; keep hands wrapped around until patient is completely standing: At this point if the veins have not filled and remain collapsed, it indicates the incompetent venous valve(s) was at the level of the SFJ. If the veins have filled up again, it indicates the incompetent valve(s) are inferior to the SFJ (i.e. perforator veins-veins that drain venous blood from the superficial to deep veins within the muscle).
Repeat the test with the patient lying, place tourniquet 3cm lower than the previous position, ask the patient to stand and observe venous filling.
Compare and contrast at least 3 different findings on physical exam between arterial insufficiency and venous insufficiency, i.e. trophic changes, color, temp, edema.
“Upon palpation of the pulses, I’ve found that there are no signs of peripheral or venous insufficiency in the lower extremities. However, if there was arterial insufficiency, there would have been a decreased or absent pulse, mild/absent edema, pale skin on elevation, and cool skin which would be thin, shiny and atrophic. However, if there was venous insufficiency, there would be normal/warm skin temperature, and the skin would be thick, dull, and scaly.”
