Varicose Veins (Circulatory Pathologies) Flashcards
What are Varicose Veins?
“Varicose” means distended or dilated
Varicose veins are the abnormally large and bulging veins that are caused by the impaired function of the venous valves
Varicose veins develop when there is an increase in venous pressure
The result is prolonged venous dilation that causes the valves to become incompetent
The valves are unable to prevent back-flow which leads to impaired circulation and regurgitation of blood
The veins stretch and dilate further and a vicious cycle is created
Once the veins experience repeated periods of increase venous pressure, they become permanently stretched
Little can be done to return the venous tone and valvular competence
Standing aggravates the condition as the full weight of the venous blood is in the legs
Should not be confused with spider veins which are chronically dilated capillaries near the skin surface, they are harmless
Causes of Varicose Veins
Habits that impair circulation and increase venous pressure (prolonged sitting or standing in one position)
Increase pressure on pelvic veins from excess weight, heavy lifting, chronic constipation or pregnancy
Secondary to impaired or blocked blood flow from DVT, congenital venous malformation, heart failure, liver dysfunction, abdominal tumours
Vitamin C deficiency which can weaken the collagen structure of the veins
Two primary concerns are, the increased risk of developing superficial venous thrombosis and second, the ongoing edema and imparied circulation resulting in poor tissue health
Symptom Picture
Most common in people between 40-50 years of age, affecting more women than men
Familial tendency
Varicosities result in enlarged and bulging veins that are often bluish and lumpy
The affected veins can be asymptomatic, but in others, full, achy pain is experienced with swelling around the ankles. A feeling of heaviness and fatigue in the legs is reported
Leg cramps often occur at night
Contraindications
Deep, specific techniques are CI’d over varicosities and on any local tissue that appears dystrophic
If the varicosities are painful and sensitive to the touch, local massage may be CI’d
Massage is CI’d over esophageal varicosities
Local massage is CI’d for 24 hours after the medical treatment of saline injections in the affected veins, after surgery, local massage is CI’d until approved by the physician
Massage to the affected legs is CI’d if there is no previous diagnosis of varicosities or thrombophlebitis but the client presents with DVT symptoms
Assessment
Symptoms associated with varicose veins are similar to thrombophlebitis, therefore, a thorough assessment of the possibility of DVT is carried out and referral to a physician is suggested for a diagnosis
- Health History Questions (similar with Thrombophlebitis:
Is there a history of a recent surgery, accident, injury to blood vessels, heart disease, DVT or PE?
Have you been immobilized for a prolonged period?
Are you pregnant or postpartum?
Do you take oral contraceptives?
What is the location of the pain or cramping?
What aggravates the pain?
If the DVT is diagnosed, has massage been approved?
- Observation:
May reveal signs of inflammation
Edema may be present distal to a partial or complete obstruction
Leg pallor may be noted
- Palpation:
With deep palpation, there can be local tenderness when a thrombus is present
A diminished or absent dorsalis pedis pulse may be palpated
- Testing:
Ramirez’s test and Homan’s sign may be positive
About half of those with a DVT experience pain as a symptom, so a negative result will not necessarily rule out the presence of a thrombus
Massage
The client is positioned with the legs elevated
The pressure of the techniques applied on the affected leg should be modified. A lighter pressure is used and its purpose is promoting lymphatic and venous return. The direction of pressure is towards the core of the body with care taken not to direct the pressure towards the feet
Lymphatic drainage techniques are generally beneficial
Passive movement of the joints in the leg is interspersed throughout the massage
Self-Care
Support stockings are worn to support the veins and prevent swelling
Clothing that is restrictive at the waist or legs should be avoided
Prolonged periods of standing or sitting or crossed legs and heavy lifting are minimized or avoided
Care is taken not to scratch or injure the skin over varicosities
Standing in a bathtub of cold water and walking on the spot can improve circulation
Foot and ankle exercises are encouraged as a ADL
Encouraged to take regular breaks to sit and elevate the legs above the heart
The end of the client’s bed can be raised slightly to encourage venous drainage during sleep
Self-massage to the legs is encouraged
