the peripheral vascular system

The peripheral vascular system
Arms
Inspection (both arms from fingertips to the shoulders).
• Size asymmetry and swelling.
• Venous pattern.
• Color: redness or cyanosis.
• Texture of the skin.
Palpation
• Temperature and pulse (radial and brachial).
• Allen test
- Ask the pt to tight his hand.
- With your thumbs compress both radial and ulnar artery.
- Ask the pt to open hand into a relaxed.
- Release your pressure over ulnar artery (the palm flushes within 3 to 4 sec).
- The same technique for radial artery.
Legs
Inspection (both legs from groin to the feet).
• Size asymmetry and swelling.
• Venous pattern.
• Color: redness or cyanosis.
• Texture, ulcer and varicose veins.
Palpation
• Temperature (feet and legs).
• Pulse: femoral, popliteal, dorsal pedis and posterior tibial.
• Pitting edema: place your thumb for 5 sec over:-
1. The dorsal each foot.
2. Behind each medial malleolus.
3. The shins.
- Normally  no pitting and the blood refill during 2 sec.
Special techniques
• Mapping for varicose veins:
1. Place your hand lateral below the knee and compress sharply.
2. Place other hand above the knee.
3. Feel for a pressure wave transmitted.
- A palpable pressure wave indicates that connect the two part of the vein  varicose veins.
• Competency of venous valves:
1. Elevated one leg to about 90º to empty it of venous blood (with the pt supine).
2. Pressure of great saphenous vein in the upper thigh by manual compression (put not deeper vein).
3. Ask the pt to stand.
4. Keep pressure of the vein (normally  the blood refill from 35 sec).
- If rabid refilling  incompetent the valves in the communicating vein  varicose veins.