clinical aspects of vein
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Clinical aspects of vein
Presented by:
ANKITA MISHRA
16
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Clinical anatomy of vein
DEEP VEINS
POSTERIOR TIBIAL
ANTERIOR TIBIAL
PERONEAL
SOLEAL
GASTROC NEMIUS
POPLITEAL
FEMORAL
ILIAC
SUPERFICIAL VEINS
LONG SAPHENOUS (LSV)
SHORT SAPHENOUS (SSV)
Anatomy of the venous system of the leg
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PHYSIOLOGY OF VENOUS BLOOD FLOW
Arterial pressure
Calf musculovenous pump
Gravity
Thoracic pump
Vis a tergo of adjoining muscles
Valves in veins
VENOUS RETURN FROM LEG IS GOVERNED BY:
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Foot and calf muscles act to squeeze blood out of deep veins.
One way valve allow only upward and inward flow.
During muscle relaxation blood is drawn inward thru perforating veins.
MUSCULOVENOUS PUMP
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VALVE LEAFLETS ALLOW UNIDIRECTIONAL FLOW UPWARD OR INWARD.
“NONREFLUXING OF VALVES”
MAJOR VALVES-OSTIAL VALVE
PRETERMINAL VALVE
VENOUS VALVULAR FUNCTION
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PATHOPHYSIOLOGY
Primary muscle pump failure
Venous obstruction
Venous valvular incompetance:
1.perforator incompetence-hydrodynamic reflux
2.sup.vein incompetence- hydrostatic reflux
3.deep vein incompetence- isolated/2°
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Vein Disorders
Venous Thrombosis (Superficial and Deep Vein Thrombosis),
Thrombophlebitis
Chronic Venous Insufficiency
Varicose Veins
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Chronic Venous Insufficiency
Results from obstruction of venous valves in legs or reflux of blood back through valves
Venous ulceration is serious complication
Pharmacological therapy is antibiotics for infections
Debridement to promote healing
Topical Therapy may be used with cleansing and debridement
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Stages of chronic venous insufficiency
0 - no symptoms;
1 - heavy feet syndrome;
2 - intermittent edema;
3 - persistent edema, hyper- or hypopigmentation, lipodermatosclerosis, eczema;
4 - venous ulcer.
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Causes
Primary
Theories of Aetiology:• Weak wall theory• Congenital valvular incompetence
Aggravating factors:• Female sex• High parity • Occupation requiring prolonged standing• Marked obesity• Constricting clothes• Estrogen intake• Deep venous thrombosis
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SecondaryAnything that raises intra-abdominal pressure or raises
pressure in superficial/deep venous system
so…:
•Pregnancy
•Abdominal/pelvic mass
•Ascites
•obesity
•constipation
•thrombosis of leg veins (DVT)
•AV fistula
•Vena cava thrombose
•Large liver cysts
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Varicose disease
Varicose disease of subcutaneous veins is
their irreversible dilation and elongation occurring due to crude pathological change of
venous walls and valvular apparatus.
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ANY RISK FACTOR INCREASED VENOUS PRESSURE
DILATION OF VEIN WALLS
STRECHING OF VALVES-VALVULAR INCOMPETENCE
REVERSAL OF BLOOD FLOW
FAILURE OF MUSCLES TO PUMP BLOOD
VEINS DISTEND,ELONGATE,TORTOUS,POUCHED,INELASTIC AND FRIABLE
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Surgical Intervention
INDICATED OR DONE FOR PREVENTION OR RELIEF OF EDEMA, FOR RECURRENT LEG ULCERS OR PAIN OR FOR COSMETIC PURPOSES
VEIN LIGATION AND STRIPPING
THE GREAT SAPHENEOUS VEIN IS LIGATED (TIED) CLOSE TO THE FEMORAL JUNCTION
THE VEINS ARE STRIPPED OUT THROUGH SMALL INCISIONS AT THE GROIN, ABOVE & BELOW THE KNEE AND AT THE ANKLES.
STERILE DRESSING ARE PLACED OVER THE INCISIONS AND AN ELASTIC BANDAGE EXTENDING FROM THE FOOT TO THE GROIN IS FIRMLY APPLIED
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Keep pt. flat on bed for first 4 hrs. after surgery, elevate leg to promote venous return when lying or sitting
Medicate 30 mins. before ambulation and assist patient
Keep elastic bandage snug and intact, do not remove bandage
Monitor for signs of bleeding, esp. on 1st post-op day
if there is bleeding, elevate the leg, apply pressure over the wound and notify the surgeon
NURSING CARE AFTER VEIN LIGATION & STRIPPING
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Microscopic appearance
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RISK FACTORS
AgeGenderHeight
left>rightHeredity
PregnancyObesity and overweight
Posture
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25-50% of adult women 15-30% of adult men
Is it an industrialized country disease? UK: 45 000 hospital admissions per year
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Treatment complications
Major complications following VV surgery are relatively rare
Up to 20% morbidityInfection
HematomaPain
Nerve damage Saphenous nerve (LSV surgery)
Sural, peroneal nerve (SSV surgery)Lymphatic leak - Venous thrombosis - Vascular injury
Recurrence
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Deep Vein Thrombosis (DVT)
DVT: Blood clot in a vein located deep in the muscles of
the legs, thighs, pelvis or arms
DVT is the result of 3 principle factors
1. Reduce or stagnant blood flow in deep veins
2. Injury to the blood vessels wall
3. Increase clotting activity (hyper-coagulability
or thrombophilia)
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Risk of DVT
1. Immobilization2. Recent surgery or trauma
3. The use of medication4. Inherited or acquired hypercoagulability,
Note: Approximately 75-90% of DVT have at least one established
risk factor : Inherited thrombophilias can be identified
in 24-37% of patients
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SIGN AND SYMPTOMS
Leg pain or tenderness
Leg swelling
Increase wormth of one leg,change in skin color (redness)
Homans sign positive
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Medical ManagementDeep vein thrombosis
REQUIRES HOSPITALIZATIONBED REST W/ LEGS ELEVATED TO 15-20 DEGREES ABOVE HEART LEVEL ( KNEES SLIGHTLY FLEXED, TRUNK HORIZONTAL (HEAD MAY BE RAISED) TO PROMOTE VENOUS RETURN AND HELP PREVENT FURTHER EMBOLI AND PREVENT EDEMAAPPLICATION OF WARM MOIST HEAT TO REDUCE PAIN, PROMOTES VENOUS RETURNELASTIC STOCKING OR BANDAGEANTICOAGULANTS, INITIALLY WITH IV HEPARIN THEN COUMADINFIBRINOLYTIC TO RESOLVE THE THROMBUSVASODILATOR IF NEEDED TO CONTROL VESSEL SPASM AND IMPROVE CIRCULATION
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Nursing Assessmentcharacteristic of the painonset & duration of symptomshistory of thrombophlebitis or venous disorderscolor & temp. of extremityedema of calf of thigh - use a tape measure, measure both legs for comparisonIdentify areas of tenderness and any thrombosis
SURGERY if the thrombus is recurrent and extensive or if the pt. is at high risk for pulmonary embolismThrombectomy – incising the common femoral vein in the groin and extracting the clotsVena caval interruption – transvenous placement of a grid or umbrella filter in the vena cava to block the passage of emboli
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Thrombophlebitis inflammation of the veins caused by
thrombus or blood clotFactors assoc. with the devt. of
Thrombophlebitis venous stasis
damage to the vessel wall hypercoagulability of the blood – oral
contraceptive usecommon to hospitalized pts. , undergone
major surgery (pelvic or hip surgery), MIPathophysiology
develops in both the deep and superficial veins of the lower extremity
deep veins – femoral, popliteal, small calf veins
superficial veins – saphenous vein Thrombus – form in the veins from
accumulation of platelets, fibrin, WBC and RBC
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Thrombophlebitis•Thrombosis with infammation of superfiacial veins
•Occur spontaneously/due to minor trauma
•Can occur durin injection of sclerosing fluid for treatment
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Main symptoms of thrombophlebitis
Edema of the extremity The pains are localised in the
gastrocnemius muscles as a rule, along the course of vascular bundles The skin of the extremity becomes
cyanotic.
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Medical ManagementThrombophlebitis
bed rest with legs elevated apply moist heat
NSAID’s ( Non – steroidal anti-inflammatory drugs) -
aspirin
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Homans' sign
• Pains in gastrocnemius muscle upon dorsal flexing of the foot is characteristic of thrombophlebitis of profound veins of the extremity.
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Classification of functional tests
1. Test enable one to judge the condition of valvular
apparatus Trendelenburg-Trojanov's tests
Hackenbruch's 2. Test enable of insufficient
perforating veins Pratt's test II
Scheins' test Thalmann's test
3. Test enable the patency of profound veins
Delbe-Pertez test (marching test)
Pratt-I test
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Trendelenburg-Trojanov's test.
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Pratt's test II.
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Hackenbruch's test.
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Scheins' test.
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Delbe-Pertez test (marching test)
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Loevenberg's test
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Thrombectomy from femoral vein
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Edema
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Venous ulceration
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Thanks to all…..`