Peripheral vessels

• Arterial Branches of the aortic arch

  Brachiocephalic trunk

  Left common carotid artery

  Left Subclavian artery

  Axillary artery

  Brachial artery

  Radial and ulnar arteries
• Arterial branches of the abdominal aorta

  Celiac trunk

  Superior mesenteric artery

  Renal arteries

  Gonadal arteries

  Lumbar arteries

  Inferior mesenteric artery

  Common iliac arteries
• Arteries of pelvis and lower extremities

  common iliac

  internal iliac

  external iliac
• Common iliac artery


  supplies pelvis and lower limb
• At the level of the lumbosacral joint the common iliac divides into


  internal iliac artery

  external iliac artery
• Internal iliac artery


  supplies urinary bladder, pelvis, external genitalia and medial side of thigh
• External iliac artery 


  supplies lower limb; penetrates abdominal wall and becomes the femoral artery
• deep femoral artery


  supplies the muscles of the thigh branches off the femoral artery
• popliteal artery


  The femoral artery continues on the back side of the femur and becomes the _ after it pierces through the adductor magnus and crosses the popliteal fossa
• anterior tibial artery and posterior tibial artery


  The popliteal artery divides into the?
• Veins draining into the superior vena cava

  Radial and ulnar veins

  cephalic vein

  basilic vein

  median cubital vein

  subclavian vein

  vertebral vein

  internal jugular vein

  brachiocephalic vein

  Azygos vein
• Veins draining into the inferior vena cava

  Tibial veins

  Great saphenous veins

  Common iliac vein

  Gonadal vein

  Renal veins

  Hepatic portal vein

  Hepatic veins
• Lymphatic system function


  to drain excess fluid and plasma proteins from bodily tissues and return them to the venous system

  major part of the immune system defending the body against microorganisms

  to absorb fats from the small intestine into the bloodstream
• Lymphatic drainage and superficial lymph nodes of upper and lower extremities

  Right lymphatic duct

  Thoracic duct

  Inguinal nodes

  Axillary nodes

  Epitrochlear nodes
• PVD

  Peripheral Vascular disease
• Arterial:

  Cool to the touch

  Thin, dry/scaly skin

  Hairless

  Thick toenails

  Dangle legs = Rubor

  Elevate legs = Pale
• Venous:

  Warm to the touch

  Thick, tough skin

  Brownish colored
• Deep Vein Thrombosis


  People with this might have:

  been in bed for long periods

  been inactive, such as during a long flight

  had major surgery recently

  had an injury, such as a fracture

  had a major illness such as cancer, heart failure or a serious infection

  been taking the oral contraceptive pill or hormone replacement therapy
• Equipment for assessing the peripheral vascular system

  centimeter tape

  stethoscope

  doppler ultrasound device

  conductivity gel

  tourniquet

  gauze or tissue

  waterproof pen

  blood pressure cuff
• CRT

  capillary refill time
• What is the grade if the pulse amplitude is absent

  0
• What is the grade if the pulse amplitude is weak, diminished (easy to obliterate)

  1+
• What is the grade if the pulse amplitude is normal (obliterate with moderate pressure)

  2+
• What is the grade if the pulse amplitude is bounding? (unable to obliterate or requires firm pressure)

  3+
• Stages of Lymphedema: Stage 0 


  No obvious signs or symptoms. Impaired lymph drainage is subclinical. Lymphedema may be present for months to years before progressing to later stages. Edema is not evident
• Stages of Lymphedema: Stage 1 (spontaneously reversible)


  Swelling is present. Affected area pits with pressure. Elevation relieves swelling. Skin texture is smooth
• Stages of Lymphedema: Stage 2 (spontaneously irreversible)


  Skin tissue is firmer. Skin may look tight, shiny, and tissue may have a spongy feel. Pitting may or may not be present as tissue fibrosis begins to develop. Elevation does not completely alleviate the swelling. Hair loss or nail changes may be experienced in affected extremity.
• Stages of Lymphedema: Stage 3 (irreversible)


  LE has progressed to the lymphostatic elephantiasis stage, at which the limb is very large. Affected area is nonpitting, often with permanent eczema. Skin is firm and thick, with hard underlying tissue having an unresponsive feel. Affected limb may ooze fluid. Elevation will not alleviate symptoms.
• Allen test


  To perform this test:

  Occlude the radial and ulnar arteries while client makes a fist.

  Continue occluding arteries while client releases fist

  Remove pressure on ulnar artery while observing the color return to palm.
• Why do we take a measurement in centimeters from the patella to the location to be measured?

  To aid in getting the exact location on both legs
• If you cannot detect a pulse, what position should you try palpating the client?

  Prone position
• If it is difficult or impossible to palpate a pulse, what device can be used?

  Doppler ultrasound
• Test for arterial insufficiency

  position change test
• It is the ratio of the ankle systolic blood pressure to the arm systolic blood pressure. It is considered an accurate objective assessment for determining the degree of peripheral arterial disease.

  Ankle-brachial index
• Ankle brachial index: 1.0-1.2


  normal- no arterial insufficiency
• Ankle brachial index: 0.8-1.0


  Mild insufficiency
• Ankle brachial index: 0.5-0.8


  moderate insufficiency
• Ankle brachial index: <0.5


  severe insufficiency
• Ankle brachial index: <0.3


  Limb threatening
• Measuring ABI

  Have the client rest in a supine position for at least 5 minutes.

  Apply the blood pressure cuff to first one arm and then the other to determine the brachial impulse using the doppler.

  First palpate the pulse and use the Doppler to hear the pulse. The "whooshing" sound indicates the brachial pulse.

  Pressures in both arms are assessed because symptomatic stenosis in the subclavian artery can produce an abnormally low reading and should not be used in the calculations.

  Record the higher reading.