Peripheral Vascular System

Peripheral Vascular System
Presentation by:Joyce Smith RN, BSN

Following topics are covered in this presentation
Peripheral Vascular Disease
Patho
Data Collection for PVD
Diagnosis

* Arteriography – (not widely used), inject dye onto arterial system
* Segmental systolic B/P measurements – noninvasive, inexpensive method which uses measurements of B/P at intermittent segments of the lower extremities
* Doppler ultrasound – sound waves to identify changes in the walls of the blood vessels
* Plethsmography – used to determine venous thrombus and blood flow through the veins
Interventions

* Non-surgical
* Elastic stockings/intermittent pneumatic compression
* Teach client to avoid tissue trauma – wear shoes, inspect feet, trim nail straight across
* Exercise
* Positioning
* Promoting vasodilation
* Drug therapy
* PCTA
* Laser assisted angioplasty
* Anthrectomy
* Surgical
* Arterial revascularization – surgically bypassing the occlusion with a saphenous vein or synthetic material
* Pre-op care
+ NPO, vitals, pulses, IV, Foley, A-line, etc
* Post-op care
+ Watch circulation and B/P
+ May need anticoagulation
+ No crossing legs, no ROM of limb, may be on bed rest
+ No dependent position for extended period
+ May elevate extremity
+ Pain RX, may need vasodilators, nitroglycerine, NSAIDS

Arterial Embolism

* More common in the lower extremity
* Life threatening
* May break loose and travel, causing other occlusions
* 6 P’s or S/S
* Pain
* Pallor
* Pulselessness
* Paresthesia
* Paralysis
* Poikilothermia (coolness)
* Immediate treatment to prevent permanent damage or loss of extremity
* 1st intervention is Heparin
* May need embolectomy
* Can be done with arthroscopy
* May need to open and remove embolus
* Post-op care involves watching for color changes and signs of occlusion
* May have spasms and swelling
* Also may develop compartment syndrome

Raynaud’s Disease

* Caused by vasospasms of the arterioles and arteries of the upper and lower extremities
* Affects hands but can be on toes and tip of nose
* S/S – chronic, intermittent, numbness, coldness, pain and pallor
* Women 16-40 years of age
* Cause is unknown
* After spasm the skin becomes reddened and hyperemic
* Diagnosis is based on symptoms
* Treatment involves relieving the vasospasms and prevent pain
* Vasodilators
* Topical nitroglycerine
* Calcium channel blockers
* ACE inhibitors
* Nursing care
* Pain control
* Teach client to avoid stimuli which may trigger episode (stress, cold air temp, smoking)
* Keep extremity warm
* Use hair dryer, warm H2O, etc
* Protect area from trauma

Buerger’s Disease
(Thromboangiitis Obliterans)

* Uncommon occlusive disease of the medium and small arteries and veins
* The distal upper and lower limbs are most frequently affected
* In young adult men who smoke
* May result in fibrosis and scarring of the perivascular system
* Pain in the arch of the foot is the first clinical indicator
* Pain may be ischemic in nature
* Clients have increased sensation to cold
* Pulses may be diminished in the distal extremities and are cool and red or cyanotic
* Ulcerations and gangrene may occur
* Treatment is same as with Raynaud’s

Aneurysms

* Permanent localized dilation of an artery
* Area stretches and weakens, and balloons out
* As it enlarges the risk of rupture increases
* Can be acquired or congenital
* Acquired are caused by trauma, arteriosclerosis, or infection
* Abdominal aorta is most prevalent site –(AAA are about 75%)
* S/S
* Most are asymptomatic
* May be discovered on routine exam
* Pain may be caused by the pressure on organs surrounding the aneurysm
* May notice a pulsation in the upper abdomine or by hearing a bruit
* Clients with a rupturing AAA are critically ill
* Will go into hemorrhagic shock (hypovolemic)
* Hypotension
* Diaphoresis, mental confusion, oliguria, dysrhythemias
* Retroperitioneal hemorrhage produces flank bruising
* Abdominal distention may occur
* Shortness of breath, hoarseness, and difficulty swallowing may be signs of a thoracic aneurysm
* Diagnosis
* Abdominal or lateral of the spine
* CT scan
* Ultrasound
* Interventions
* Nonsurgical
+ Monitor growth
+ Maintain B/P
+ Frequent CT scans
* Surgical
* Elective mortality = 2-5%
* Emergency = 50%
* AAA resection with graph
* Preop – as described for vascular surgery
* Postop –client in ICU
+ Monitor vitals, A-line, EKG, etc.
+ Watch for
# MI, graph occlusion, hypovolemia, renal failure, respiratory distress, paralytic ilius
* Symptom
* Pain which is a tearing, ripping, stabbing that tends to move from the point of origin
* Pain may be in the anterior chest, back, neck, throat, jaw or teeth
* Emergency care
* Elimination of pain
* Control B/P – 100 to 120 systolic or lower
* If uncomplicated may be conservative treatment
* If dissection is in the proximal aorta, require CPB

Aortic Dissection

* Not a rupturing aneurysm
* Dissecting hematoma or aortic dissection
* Caused by a sudden tear in the aortic intima
* Hypertension is a contributing factor
* Relatively common - 2000/year in the US
* Ascending aorta and the descending thoracic aorta are the most common sites

Varicose Veins

* Dilated, tortuous leg veins with back flow of blood caused by incompetent valve closure, which results in venous congestion and vein enlargement
* Usually affects the saphenous vein and its branches
* Causes
* Unknown but may be R/T congenital weakness of valve
* Thrombophlebitis
* Venous stasis – pregnancy, prolonged standing
* Familial tendency
* Data Collection
* Subjective
+ Aching
+ Cramping and pain
+ Feeling of heaviness
* Objective
+ Palpable nodules
+ Ankle edema
+ Dilated veins
+ Pigmentation of calves and ankles
* Diagnosis
* History and physical
* Venogram
* Trendelburg’s test –demonstrates the backward flow of the blood in the venous system
* Treatment
* Conservative
* Avoid standing or sitting for long periods of time
* Weight reduction
* Support hose
* No restrictive clothing
* Surgical treatment
* Vein stripping, ligation or sclerosing
* Postop care
+ Pain RX
+ Elevate leg
+ Watch for bleeding
+ May need to rewrap leg q shift from toes to thigh
+ Watch for CMS

Venous Thrombosis
(plebitis, thrombophlebitis, deep vein thrombosis)
* Phlebitis is inflammation
* Thrombophlebitis is a clot in the vein
* DVT is presence of a clot in a deep vein rather than a superficial vein
* Risk factors
* Bedrest
* Surgery
* Leg trauma with cast
* Venous insufficiency
* Obesity
* Oral contraceptives
* Malginancy
* Treatment
* Anticoagulant, bedrest, elevate extremity, warm soaks, TED hose
* Nursing care
* Control pain
* Watch skin
* Help anxiety
* Assess tissue perfusion
* Watch respiratory status for embolus
* S/S
* May not have any signs
* With obstruction:
+ Edema
+ Warmth
+ Pain, tenderness
+ Positive Homans’ sogn
* Diagnosis
* Venogram
* Doppler

Peripheral Vascular System