assessment of peripheral vascular system and lymphatic system

8/10/2019 Assessment of Peripheral Vascular System and Lymphatic System

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Peripheral VascularSystem and Lymphatic

System


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Lecture objectives:

Structure and function of vascular system: Arteries VeinsLymphatics

Taking clients complaints and history. Assessment techniques:

Inspection and palpation of the neck vesselsInspection and palpation of the arms (radial pulse, lymph nodes)Inspection and palpation of the legs (edema, Homans sign; femoral,popliteal, dorsalis pedis pulses, manual compression test

Additional techniques: Trendelenburg test, colour changes, dopplerultrasonic stethoscope.

Abnormal findings: Variations in arterial pulseRaynaulds syndrome Lymphedema

Arteriosclerosis

Superficial varicose veinsPeripheral artery disease: occlusions, aneurysms


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Structure And Function

The vascular system consists of the vessels ofthe body.

Vessels are tubes for transporting fluid, such asthe blood or lymph.Function - transporting the blood or lymph :

Delivery of oxygen to the tissuesDelivery of nutrients to the tissuesElimination of carbon dioxide from cellsElimination of waste products from cellular metabolism


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Arteries.

Carry freshly oxygenated blood to tissuesHigh-pressure system

Walls are strong, tough, and tense with elastic fibers stretch with systole, recoil with diastole with muscle fibers (VSM) control the amount of blooddelivered to the tissues and the rate of blood flow

Pulse is a pressure wave created by each heartbeat,palpable at body sites where the artery lies close to theskin and over a bone.


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Arteries accessible to examination

Temporal artery (review chapter 13)Carotid artery

Arteries in the arm:BrachialRadialUlnar

Arteries in the leg:Femoral arteryPopliteal

Anterior tibial dorsalis pedisPosterior tibial plantar arteries

I s c h e m i a is adeficient supply of

oxygenated arterialblood to a body part,due to constriction orobstruction of a blood

vessel


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Arteries accessible to examination


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Arteriesaccessible to

examination


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Veins accessible to examination

Jugular veins Veins in the arm:

Superficial in the subQ tissue, responsible for most of the

venous returnDeep Veins in the leg:

Deep veins: femoral, popliteal; responsible for most of the

venous returnSuperficial: great and small saphenousPerforators: connecting veins that join the two sets. Theyhave one-way valves blood into the deep veins.


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Veins accessibleto examination


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Lymphatics.

A completely separate vascular system.It retrieves excess fluid from the tissue spaces andreturns it to the blood stream.


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Lymphaticducts anddrainage

patterns


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Functions of the lymphatic system:

To converse fluid and plasma proteins that leakout of the capillaries.

To form the major part of the immune systemthat defends body against infection.

To absorb lipids from the intestinal tract.


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Structure of the lymphatic system

Microscopic open-ended tubes (capillaries)

Vessels, like veins, have valves

Lymphatic ducts

Subclavian veins


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Lymphoid tissue:

Lymph nodes:Filter the fluid before it comes back to the bloodstreamFilter out microorganisms

Tonsils:Pharyngeal (adenoid)PalatineLingual

SpleenPeyers patches (Lymphoid tissue in intestines)

Tymus glandBone marrow


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Groups of peripheral lymph nodes:

1. Auricular: anterior and posterior2. Sublingual.3. Submandibular.

4. Cervical: anterior and posterior.5. Supra- and subclavian.6. Axillary.7. Epithrochlear.8. Inguinal.9. Popliteal.

Assesment:Inspection and palpation

Amount in each groupSizeShapeConsistencyMovable/connected withsurrounding tissues

Pain/tendernessSigns of inflammation:swelling and rednessabove the node


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Taking clients complaints and history.

Ask: Any leg pain (cramps)? Where?

Detail: pain type, onset (gradual/sudden), aggravating/relieving factors (activity, walking, dangling, rubbing),associated signs (skin changes, sexual malfunction),relation to time of day, claudication distance.

C l au d i c a t i o n d i s t a n c e is the numberof blocks walked or stairs climbed

to produce pain.Note sudden dencrease in

claudication distance, or painsuddenly not relieved by rest.


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Taking clients complaints and history. Edema is bilateral when

caused by a systemicproblem (heart failure),

orunilateral

when due toa local obstruction orinflammation.


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Objective dataPreparation:

EnvironmentShould be warm (about 22C) and draftlessto prevent vasodilatation or

vasoconstriction.

PrivacyMake sure the females breasts and clientsgenitals remain draped.

Order of examBegin with observations peripherally and

move toward the heart.1. Pulse and blood pressure2. Extremities peripheral vascular

assessment3. Neck vessels4. Precordium (portion of body over heart

and thorax)

Equipment needed: Tourniquet or bloodpressure cuffStethoscopePaper tape measure

Doppler ultrasonicstethoscope


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Assessing Neck Vessels

Carotid ArteryPalpate the carotid artery

Avoid excessive pressure.Excessive vagal stimulationcould slow down heart rate.Carotid arteries should besame bilaterally

Auscultation

Listen for bruits blowing,swishing sounds indicatingblood flow turbulence.Caused by atheroscleroticnarrowing (one half or two

thirds of artery).


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Jugular VeinsCan be used to assess central venous pressure (CVP) and cardiacefficiency

Distended external jugular veins signify increased CVP, as with heart failure

Position the patient at 30-45 degree angle, wherever pulsations canbe seen best. Remove pillow to avoid flexion of head.

The higher the CVP, the higher the position you will need

Turn the pts head away from examiners side Distinguish from carotid artery pulsations. Internal jugular pulseis lower, varies with respiration, not palpable, and disappears asperson is sitting.


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Jugular Venous Pressure EstimateUsed to assess heart failurePosition the patient at 30-45 degree angle. Place one ruler verticallyat the manubriosternal angle. Place a second ruler perpendicular to

the first and record the height of pulsation of the internal jugular vein.Normal pulsation is 2 cm or less above sternal angle

Pulsations 3 or more cm above sternal angle while at 45 degrees occur withheart failure

Record height of pulsations and degrees of elevation


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Question

The examiner has estimated the jugular venouspressure. Identify the finding that is abnormal.

1. Patient elevated to 30 degrees, internal jugular vein

pulsation at 1 cm above sternal angle.2. Patient elevated to 30 degrees, internal jugular vein

pulsation at 2 cm above sternal angle3. Patient elevated to 40 degrees, internal jugular vein

pulsation at 1 cm above sternal angle4. Patient elevated to 45 degrees, internal jugular vein

pulsation at 4 cm above sternal angle


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Inspection and palpation of the arms

Palpate both radial pulses:Symmetricity (equal force), rhythm, rate, elasticity.Grade the force (amplitude) on a fore-point grade:

0 absent1+, weak2+, normal3+, increased

4+, boundingFor ulnar pulse palpate along the medial site ofthe inner forearm. Not palpable in healthyperson.


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Inspection and palpation of the arms

Palpate the brachial pulses.Palpate the epitrochlear lymph nodeModified Allen test: Normal 2 to 5 seconds


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Inspection and palpation of the legs

Inspect for:Color of skin and nailbeds

Temperature, texture andturgor of skin

Any lesions, edemaCapillary refill

Hair distributionSize (swelling or atrophy)


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Palpate the inguinal lymph nodesPalpate these peripheral arteries in both legs:

femoralpoplitealdorsalis pedisposterior tibial

Grade the force on a fore-point grade


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Check for pretibial edemaIs pitting edema is present, grade it:

1+ Mild pitting, slide indentation, no perceptibleswelling on the leg2+ Moderate pitting, indentation subsides rapidly3+ Deep pitting, indentation remains for a shorttime, leg looks swollen4+ Very deep pitting, indentation lasts a long time,leg is very swollen


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Assess venous system. Noteany visible, dilated, andtortuous veinsPerform Manualcompression testPerform Trendelenburg test


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assessment of peripheral vascular system and lymphatic system

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