Peripheral vascular system
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Peripheral Vascular System. Consists of a system of intertwining veins and arteries which carry blood to and from the heart and lungs Also involves the capillaries and lymph system . Peripheral Vascular Disease. Disorders which alter the normal flow of blood through the arteries and veins

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Peripheral vascular system l.jpg
Peripheral Vascular System

  • Consists of a system of intertwining veins and arteries which carry blood to and from the heart and lungs

  • Also involves the capillaries and lymph system

Peripheral vascular disease l.jpg
Peripheral Vascular Disease

  • Disorders which alter the normal flow of blood through the arteries and veins

  • Effects the lower extremities more frequently the the upper

  • A client with a diagnosis of PVD implies arterial disease rather than venous

  • Some client have both arterial and venous disease

Patho l.jpg

  • PVD is the manifestation of systemic atherosclerosis

  • Chronic condition in which partial or total occlusion deprives the lower extremities of oxygen and nutrients

  • Fatty substances accumulate at the site of vessel wall injury and alter or occlude the blood flow

  • Risk factors:

    • Hypertension, smoking, high lipids and cholesterol, diabetes, obesity and family predisposition

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Data Collection for PVD

  • Subjective symptoms

    • Aching calves

    • Numbness in legs

    • Leg cramps

    • Loss of sensation in legs

    • Pain in legs during exercise (intermittent claudicating)

    • History of diabetes, thrombophlebitis, hypertension or alcoholism

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Objective Symptoms

Cold or blue feet

Redness (rubor) of leg in dependent position (arterial)

Spares hair distribution

Dry, scaly, dusky, pale, or mottled skin


Stasis ulcers (venous-occur around ankle and foot is warm, arterial- painful,on toes and can become gangrene)

Muscle atrophy

Varicose veins

Diminished or absent pulses – use grading scale

Delay in capillary refill

Bruits heard in major arteries

Differences in the circumference of legs

Check for Homans’ sign

Data Collection for PVD, cont.

Diagnosis l.jpg

  • 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

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  • 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

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Interventions, cont.

  • 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

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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)

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Arterial Embolism, cont.

  • 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

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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

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Raynaud’s Disease, cont.

  • Diagnosis is based on symptoms

  • Treatment involves relieving the vasospasms and prevent pain

    • Vasodilators

    • Topical nitroglycerine

    • Calcium channel blockers

    • ACE inhibitors

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Raynaud’s Disease, cont.

  • 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

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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

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Buerger’s Disease(Thromboangiitis Obliterans)

  • 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

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  • 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%)

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Aneurysms, cont.

  • 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

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Aneurysms, cont.

  • 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

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Aneurysms, cont.

  • Diagnosis

    • Abdominal or lateral of the spine

    • CT scan

    • Ultrasound

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Aneurysms, cont.

  • Interventions

    • Nonsurgical

      • Monitor growth

      • Maintain B/P

      • Frequent CT scans

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Aneurysms, cont

  • 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

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Aortic Dissection, cont.

  • 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

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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

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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

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Varicose Veins, cont.

  • Data Collection

    • Subjective

      • Aching

      • Cramping and pain

      • Feeling of heaviness

    • Objective

      • Palpable nodules

      • Ankle edema

      • Dilated veins

      • Pigmentation of calves and ankles

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Varicose Veins, cont.

  • Diagnosis

    • History and physical

    • Venogram

    • Trendelburg’s test –demonstrates the backward flow of the blood in the venous system

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Varicose Veins, cont.

  • Treatment

  • Conservative

    • Avoid standing or sitting for long periods of time

    • Weight reduction

    • Support hose

    • No restrictive clothing

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Varicose Veins, cont.

  • 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

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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

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Venous Thrombosis, cont.

  • Risk factors

    • Bedrest

    • Surgery

    • Leg trauma with cast

    • Venous insufficiency

    • Obesity

    • Oral contraceptives

    • Malginancy

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Venous Thrombosis, cont.

  • 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

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Venous Thrombosis, cont.

  • S/S

    • May not have any signs

    • With obstruction:

      • Edema

      • Warmth

      • Pain, tenderness

      • Positive Homans’ sogn

  • Diagnosis

    • Venogram

    • Doppler