Peripheral Vascular HA Exam #3

pump O2 rich blood to all body tissues
pressure wave -- "pulse"

Temporal
Carotid
Brachial
Femoral
Popliteal
Dorsalis Pedis
Posterior Tibial

arteries are closer to the skin
more superficial

high pressure system with thicker vessel walls

absorb CO2 and waste products from periphery and carry them back to the heart

Jugular Vein
Veins in arms and legs

low pressure system with thinner walls that allow for venous pooling

veins can pool

intraluminal valves = one way valves that prevents regurgitation

skeletal muscle contractions help blood go back to the heart
alternate contraction and relaxation

preload on the heart

Intermittent claudication
Claudication distance

pain with walking that usually resolves with 2 minutes of rest
usually in calves, thighs and butt
early sign of peripheral arterial disease (PAD)

number of blocks walked or stairs climbed to produce pain

claudication distance gets shorter

check bilaterally -> skin temp
color/ good perfusion
coolness = arterial issues
heat and inflammation = venous issues (not pulling trash out)
Varicose veins

genetics
pregnancy
obesity

start smoking at 16 or younger double risk of PAD

bilateral edema -> symptom of heart failure, usually swelling lower extremities often hands and if really bad in face
unilateral edema -> embolism or clot that causes an obstruction

node filters the infection and becomes irritated and swollen

retrieves excess fluid and plasma proteins from interstitial space and returns it to the bloodstream

Hormone Replacement Therapy (HRT)
Oral Contraceptive Pills (OCP)

- examine arms with vital signs and person is sitting
- examine legs while person is still supinel then stand person up to evaluate leg veins (should NOT see ropes)
- room temperature should be about 22ºC ans free of drafts to prevent vasodilation or constriction
- use inspection THEN palpation
- compare with opposite extremity

Skin: color, cap refill (<2 seconds)
Profile sign: view finger to detect clubbing
- Vasoconstriction
- Hypovolemia
- Early Congestive Heart Failure

look at dorsal part of great toe
look for signs of hair growth
no hair due to laser hair removal just document that or well shaved

GREATER (>) THAN 2 SECONDS IS ABNORMAL

investigate

palpate pulses, note rhythm, elasticity of vessel walls, and equal force

brachial
radial
ulnar

furrows of the biceps
in between triceps and biceps

thumb side of wrist
note rate--can complete with vital signs

pinkie side
hard to palpate, can phone a friend or use a doppler

ask someone else to palpate it

3+ increased, full, bounding (someone who just worked out, anemia, has a fever)
2+ normal
1+ weak (elderly, someone in shock)
0+ absent

used to evaluate collateral circulation prior to radial artery puncture
suggests adequate circulation
used in ABG collection
crude/ subject to error

have to use 11 lbs of pressure
blood flow should return 7 seconds or less

doppler

Skin
Hair distribution
Venous pattern (should be flat and barely visible
Size-any swelling or atrophy (muscles getting smaller)
Skin discoloration, skin ulcers or gangrene (document size/measure in cm or mm and exactly where it is)

standing because gravity is pulling it down

tape measure at widest part of calf on unaffected and affected leg in the SAME SPOT
> 1 cm is pertinent
2 cm or great = DVT

medial malleolus
(where they start)

ball on the outside
arterial ulcers

arteries not perfusing

Femoral
Popliteal
Posterior Tibial
Dorsalis pedis

Palpate pulses, note rhythm,elasticity of vessel walls, and equal force

sit frog leg and palpate near the groin
will palpate mainly on children

behind the knee
very difficult to find

between medial malleolus and achilles

top of foot
big tow, halfway up, move laterally
one finger usually sufficient

the doppler

audible pulsatile sounds

if you can't find it, it is the same since it is still present
2+ for dorsalis pedis, 2+ for popliteal

in front of the tibia swelling

firmly depress skin over tibia or medial malleolus for 5 seconds and release
normally your finger should leave no indentation
pit is commonly seen if person has been standing all day or during pregnancy

venous issue
only use compression socks if there are NO arterial issues

1+ mild pitting, slight indentation, no perceptible swelling of leg
2+ moderate pitting, indentation subsides rapidly
3+ deep pitting, indentation remains for short time, leg swollen
4+ very deep pitting, indentation lasts a long time, leg VERY swollen
SCALE IS SUBJECTIVE

Note any visible, dilated and tortuous veins (old fraying rope)
If present, varicose veins cause pain, swelling, fatigue, and cramping

thickening and loss of elasticity of arterial walls

chronic incompetent valves in deep veins or clot
risk of infection

arterial--pale, cyanotic, mottled
venous--may be reddish-blue

arterial--cool to cold
venous--warm

arterial--thin, shiny skin, dependent rubor, elevation pallor of foot
venous--firm, brawny, brownish pigmentation in area between medial and lateral malleolus, skin thickened and tough, cyanosis when dependent

arterial--thickened and ridged
venous--not thickened

arterial--loss of hair over toes and dorsum of foot
venous--present

arterial--none or minimal, lift leg up and doesn't drain/help
venous--moderate to severe; pitting; ankle, foot, lower leg, lift leg up and swelling goes down

arterial--decreased or absent
venous--present but may be difficult to palpate through edema

arterial--intermittent claudication (relieved by rest)
venous--aching, cramping, feeling of fullness, relieved by elevation

arterial--between toes or tips of toes, heels, lateral malleolus, well-defined edges, deep, circular ulcer base-black or gangrene; non-bleeding
venous--medial malleolus and lower leg; uneven edges, superficial, ulcer base-granulation tissue-beefy red to yellow; bleeding; may or may not be painful

arterial--usually cleaner cut
venous--rigid and more nasty

measures probability for DVT
3 points for high probability

way of measuring, determining or screening for PAD
ankle pressure and brachial pressure

get cold and hands turn blue

breast mastectomy in left arm = don't take BP in left arm