Peripheral Vascular & Lymphatic Assessment

spring 2012 1

Major Arteries Accessible to Examination:

– Temporal – Carotid– Brachial– Radial– Femoral – Popiteal– Posterior Tibial– Dorsalis Pedis

spring 2012 2

Major Veins•Internal jugular•External jugular

Health History• Current Symptoms

– Leg pain or cramps– Skin changes in the arms or legs– Swelling arms or legs– Open wounds– Lymph node enlargement

• Medication History• Personal History• Family History

spring 2012 3

Examination: Upper Extremity

• Inspect for Edema / Color Changes / Lesions

• Palpate Pulses

• Perform the Allen Test

• Palpate the Epitrochlear Lymph Nodes

spring 2012 4

Pulse Grading Scale

• 0 = Absent• 1+ = Weak• 2+ = Normal• 3+ = Increased Normal• 4+ = Bounding

spring 2012 5

Palpate Epitrochlear node

• Support client’s hand with your hand

• With other hand reach behind the elbow and place finger pad in groove between biceps and triceps muscle above the medial conyle of the humerus

• Feel for node

spring 2012 6

Examination: Lower Extremity

• Inspect for Color

• Inspect for Lesions

• Inspect for Edema

• Palpate Peripheral Arteries

spring 2012 7

Additional Assessments

• Manual Compression Test

• Trendelenburg Test

spring 2012 8

Abnormal Findings

• Variations in Arterial Pulse– Weak, Thready– Full, Bounding– Water Hammer– Pulsus Paradoxus

spring 2012 9

Arterial Insufficiency

• Deep Muscle Pain• Claudication • Rest Pain • Dependent Rubor• Diminished Pulses• Skin Changes

• Pain

• Pallor

• Pulselessness

• Paresthesia

• Poikilothermia

• Paralysis

spring 2012 10

Arterial Insufficiency Ulcers

• Ulcer Location

• Ulcer Margin

• Ulcer Drainage

• Peri-ulcer Area

spring 2012 11

Venous Insufficiency• Aching

• Worsens with Prolonged Standing, Sitting

• Brawny Edema

• Coarse Thickened Skin

• Dermatitis, Pruritisspring 2012 12

Venous Insufficiency Ulcers

• Ulcer Location

• Ulcer Margin

• Ulcer Tissue

• Drainage

spring 2012 13

Arterial Risk Factors

• Age• Smoking• Diabetes mellitus• Hypertension• Increased Lipid Levels• Male

• Obesity• High Fat Diet• Heavy Alcohol Use• Coagulation

Abnormalities• Physical Inactivity

spring 2012 14

Venous Risk Factors

• Pregnancy• Prolonged sitting, standing• Limited physical activity• Age• Obesity• Use of constrictive clothing

spring 2012 15

Developmental Considerations

• Aging Adult

• Peripheral Blood Vessels Rigid

• Increased Risk of DVT

• Decreased Lymphatic Tissue

• Decreased # of Lymph Nodes

spring 2012 16

Health Promotion

• Smoking Cessation

• Regular Exercise

• Healthy Diet

spring 2012 17

Nursing Diagnoses

• Altered Tissue Perfusion• Sensory Perceptual Alterations• Impaired Ambulation• Pain • Sleep Pattern Disturbance

spring 2012 18