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Peripheral Vascular Disorder: Venous Thrombosis & Varicose Veins -…
Peripheral Vascular Disorder: Venous Thrombosis & Varicose Veins
Venous Thrombosis (Thrombophlebitis)
Condition in which blood clot (thrombus) forms on the wall of a vein, accompanied by inflammation of the vein wall and some degree of obstructed venous blood flow
Incidences
Venous thrombi more common than arterial thrombi because of lower pressures and flow within the venous system
Usually develops in the deep veins of the calf (80%)
Deep vein thrombosis common complication of hospitalisation, surgery and immobilisation
Higher risk in orthopaedic and obstetric procedures; may develop in > 50% of orthopaedic cases especially hip and knee surgeries
Pathophysiology
Etiology
Malignancy
Blood Disorders - Polycytemia
Operations
Road Traffic Accidents
Orthopaedic Surgery, Old age
Hormone - OCP
Serious Illness
Trauma
Immobilisation
Spleenectomy
Most common locations of DVT
DVT extending from calf to the iliac veins
Superficial venous thrombosis
The most common sites of DVT
Clinical Manifestations
Complications
Chronic Venous Insufficiency
Pulmonary Embolism
Diagnostic Investigation
Plethysmography
To measure changes in blood flow through vein: non-invasive test
Magnetic resonance imaging (MRI)
To detect DVT especially when thrombosis of the vena cave or pelvic veins suspected; non-invasive test
Duplex venous ultrasonography
To visualise vein and measure velocity of blood flow in veins; non-invasive test
Ascending contrast venography
To confirm DVT, its location and extent of venous thrombosis; The most accurate diagnostic tool which uses an injected contrast medium; invasive, expensive and uncomfortable procedure → gold standard
Medical Management
Administer analgesics to minimise pain
Encourage early ambulation while wearing anti embolism stockings (TEDS)
Application of warm, moist compress to the affected area
Perform leg exercises such as ankle flexion and extension to assist venous flow by muscle compression
Elevation of affected arm or leg above level of heart with knee slightly flexed (15 to 20 degrees) to promote venous return and discourage venous pooling
Intermittent pneumatic compression devices applied to legs to stimulate
Bed rest with duration typically determined by the extent of leg oedema
Avoid crossing of legs or tight-fitting garments or stockings that bind
Surgical Management
Insertion of filter
Greenfield filter
Filter inserted into the vena cava to capture emboli from the pelvis and lower extremities to prevent pulmonary embolism; only if venous thrombosis is recurrent and anti-coagulant is contraindicated
Ligation and division of saphenous vein
Only if there is extensive thrombosis of the saphenous vein to prevent clot extension into deep venous system
Venous thrombectomy
To remove thrombi to prevent pulmonary embolism or gangrene
Nursing Intervention
Health Teaching
Nursing Diagnoses
Ineffective peripheral tissue perfusion
Impaired physical mobility
Pain
Risk of ineffective cardiopulmonary tissue perfusion
Varicose Vein
Definition
Irregular, tortuous veins with incompetent valves; usually affect the veins of the lower extremities especially long saphenous vein
Classification
Primary
Without involvement of deep veins
Secondary
Resulting from obstruction of deep veins
Pathophysiology
Clinical Manifestation
Itching of the affected leg (static dermatitis)
Feeling of warmth in the leg
Leg fatigue and heaviness
Visibly dilated veins
Severe aching pain in the leg
Thin, discoloured skin above the ankles
Stasis ulcers
Risk Factors
Pregnancy
↑ blood volume →sustained pressure on abdominal veins
Family history
Majority for those with primary varicose veins
Gender
Female > male as female hormone tend to relax vein walls
Obesity
Additional weight put pressure on veins
Age
↑ with age due to wear and tear on valves of the veins; common > 35 years old
Standing or sitting for long periods of time
Effects of gravity - Occupation hazard that involved long periods of standing
Diagnosis
Trendelenburg Test
Doppler Ultrasound
Medical Management
Avoid prolonged sitting and standing
Leg elevation above level of heart
Regular daily walking
Weight reduction
Use of properly fitted compression stockings
No crossing of legs at thighs
Surgical Management
Post-Operative Care
Health Teaching
Nursing Diagnoses
Ineffective peripheral tissue perfusion
Risk of impaired skin integrity
Chronic pain
Risk for peripheral neurovascular dysfunction