Assessment of the Peripheral Vascular System and Lymphatic System

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Assessment of the Peripheral Vascular System and
Lymphatic System

• Week 6

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Arteries

• Carry oxygenated blood usually, and nutrients
• High pressure system
• Walls are strong, tough elastic
• Contains muscle fibres that constrict dilate
  artery
• Heart beat generates a pulse wave that carrys
  throughout artery but only felt where arteries
  are more superificial pass over bone.

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Arteries in the Arm
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Arteries in the Leg
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Veins

• Parallel course of arteries
• Body has more veins than arteries, closer to
  surface
• Carry deoxygenated blood waste back to heart
• Low pressure system walls thinner larger
  diameter
• More distensible expands to hold more blood when
  volume ? ? stress on heart capacitance
  vessels
• No smooth muscle in vein wall just stretchy
• Mechanisms needed to keep blood moving.

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Vein Anatomy

• The vein consists of three layers
• Tunica adventitia
• Tunica media
• Tunica intima
• Veins are in 2 sets deep superficial.

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Superficial Veins of the Right Upper Limb
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Veins of the Hand
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Veins in the Legs
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Venous Mechanisms to Keep Blood Moving

• Contracting skeletal muscle
• Pressure gradient caused by breathing
• Intraluminal valves.

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Mechanisms of Venous Flow
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Lymphatic System

• Completely separate vessels from blood vessels
• Lymphatic capillaries start as open ended
  microscopic tubes that siphon interstitial fluid
  from tissue spaces return it to blood stream
• Lymphatic vessels drain into 2 main trunks that
  empty into subclavian veins
• Have valves similar to veins to prevent back flow
• Speed of flow is slow compared to blood vessels,
  mechanisms similar to veins skeletal muscle
  contraction, pressure changes during respiration,
  valves.

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Functions of Lymphatic System

• To conserve fluid plasma proteins that leak out
  of capillaries
• To form a major part of the immune system
• To absorb lipids from the intestinal tract.

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Lymphatic Ducts Drainage Patterns
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Lymphatic Drainage Pathways

• http//www.coursewareobjects.com/objects/hao/anim/
  08-001ap.htm

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Related Organs in the Immune System
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Developmental Considerations Older Adults

• Vessels more rigid with age arteriosclerosis
  (not atherosclerosis deposition of fatty
  plaques on intima of arteries)
• Rise in systolic BP - ? pulse pressure
• Progressive enlargement of intramuscular calf
  veins
• Immobility ? risk of DVT pulmonary embolism
• Loss of lymphatic tissue ? fewer s of lymph
  nodes ? in size of remaining ones.

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Subjective Assessment

• Leg pain or cramps PVD Intermittent
  claudication
• Skin changes on arms or legs colour, temp.,
  arterial/venous ulcers nailbeds
• Edema/swelling
• Lymph node enlargement
• Medications.

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Objective DataThe Physical Exam
Chapter 20
Peripheral Vascular System and Lymphatic System

• Preparation
• Equipment needed (occasionally)
• Paper tape measure
• Tourniquet or blood pressure cuff
• Stethoscope
• Doppler ultrasonic stethoscope

Slide 20-6
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Objective DataThe Physical Exam, cont.
Chapter 20
Peripheral Vascular System and Lymphatic System

• ArmsInspect and Palpate
• Skin
• Profile sign
• Capillary refill
• Symmetry
• Radial pulse

• Ulnar pulse
• Brachial pulse
• Epitrochlear lymph node
• Modified Allen test

Slide 20-7
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Objective DataThe Physical Exam, cont.
Chapter 20
Peripheral Vascular System and Lymphatic System

• LegsInspect and Palpate
• Skin and hair
• Symmetry
• Temperature
• Calf muscle
• Inguinal lymph nodes
• Femoral pulse

• Popliteal pulse
• Posterior tibial pulse
• Dorsalis pedis pulse
• Pretibial edema (Fig 20-20)
• Leg veins
• Assess while patient stands
• Manual compression test

Slide 20-8
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Pitting Edema (Page 546)

• Measurement Scale
• 1 Mild pitting, slight indentation no
  perceptible swelling of leg
• 2 Moderate pitting, indentation subsides rapidly
• 3 Deep pitting, indentation remains for a short
  time leg looks swollen
• 4 Very deep pitting indentation lasts a long
  time leg is very swollen

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Manual Compression Test Trendelenburg Test
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Palpate the Radial Pulse
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Palpate the Brachial Pulse
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Pulse Variations

• http//www.coursewareobjects.com/objects/hao/anim/
  14-001ap.htm

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Pulse Quality

• http//www.coursewareobjects.com/objects/hao/anim/
  14-002ap.htm

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Blood Flow

• http//www.coursewareobjects.com/objects/hao/anim/
  14-003ap.htm

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Inspection Palpation Pulses Capillary
Refill Upper Extremities

• http//www.coursewareobjects.com/objects/hao/video
  /14-0021vp.htm

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Measure Calf Circumference
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Palpate Legs for Temperature
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Femoral Arteries
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Popliteal Pulse
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Posterior Tibial Pulse
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Dorsalis Pedis Pulse
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Abnormal Findings Peripheral Vascular Disease
Chapter 20
Peripheral Vascular System and Lymphatic System

• Arms
• Raynauds syndrome
• Lymphedema
• Legs
• Arteriosclerosisischemic ulcer
• Venous (stasis) ulcer
• Superficial varicose veins
• Deep vein thrombophlebitis
• Occlusions
• Aneurysms

Slide 20-11
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Lymphedema
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Arteriosclerosis Ischemic Ulcer
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Venous Stasis Ulcer
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Superficial Varicose Veins
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Deep Vein Thrombophlebitis
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Peripheral Artery Disease