peripheral vascular system

• Arteries


  • Carry oxygenated, nutrient-rich blood from the heart to the capillaries
  • Major arteries of arm: brachial, radial, ulnar
  • Major arteries of the leg: femoral, popliteal, dorsalis pedis, posterior tibial
• Veins


  • Carry deoxygenated, nutrient-depleted, waste-laden blood from the tissues back to the heart
  • Three types of veins: deep veins, superficial veins, and perforator veins
  • Femoral, popliteal, saphenous veins
• Lymphatic System


  • Lymphatic capillaries
  • Lymphatic vessels
  • Lymph nodes
  • Capillaries and fluid exchange
  • Form the connection between the arterioles and venules
  • Allow the circulatory system to maintain the vital equilibrium
• Peripheral Vascular Disease


  • Aortic aneurysms
  • Cerebrovascular disease
  • Deep vein thrombosis and pulmonary embolism
  • Peripheral arterial occlusive disease
  • Varicose veins
• Deep Vein Thrombosis: Risk Factors


  • Any condition that increases blood clotting, including inherited conditions
  • Low blood flow to deep vein(s) from surgery, immobilization, injury, constriction
  • Some cancers and cancer treatments
  • Other vascular conditions such as varicose veins
  • Sitting for long periods, especially in a car or airplane
  • Pregnancy, especially the first 6 weeks after giving birth
  • 60 years of age or older
  • Overweight
  • Birth control pills, hormone therapy, post menopausal hormone replacement
  • Having a central venous catheter in a vein
  • Having more than one DVT risk factor
• Deep Vein Thrombosis: Risk Reduction


  1. If sitting for long periods, stand up as often as possible or at least every hour. Exercise feet and lower leg muscles frequently.

  2. Get out of bed and walk as soon as possible after surgery or illness.

  3. Follow physician's orders for taking clot preventing medicines if required for some surgeries and follow up with physician as necessary. Report tenderness or pain, swelling, or warmth or redness in calf or thigh.
• Deep Vein Thrombosis: Risk Reduction Traveling Long Distances


  1. Exercise leg muscles frequently in airport as well as on plane; curl and press toes down to improve circulation.

  2. Wear compression stockings.

  3. Avoid socks with tight elastic bands around tops.

  4. Drink plenty of fluids to avoid dehydration.

  5. Take aspirin if advised by physician or not contraindicated by other medical conditions.

  6. On long car trips, stop every two hours to get out and walk around.
• Subjective Data: Current Symptoms

  • Skin changes
  • Leg pain, heaviness, or aching
  • Leg veins
  • Leg sores or open wounds
  • Swelling in legs or feet
  • Men: sexual activity changes
  • Swollen glands or nodules
• Subjective Data: History


  • Previous problems with circulation in arms or legs
  • Heart or blood vessel surgeries or treatments
  • Varicose veins, diabetes, hypertension, coronary heart disease, or elevated cholesterol or triglyceride levels
• Subjective Data: Lifestyle & Health Practices


  • Tobacco use
  • Regular exercise
  • Oral contraceptives use
  • Stress
  • Peripheral vascular problems interfere with ADLs
  • Medications
  • Support hose
• Client Preparation


  1. Explain procedure to client

  2. Ask client to gown
• Equipment


  • Gloves
  • Centimeter tape
  • Stethoscope
  • Doppler ultrasound probe
  • Tourniquet
  • Gauze
  • Waterproof pen
  • BP cuff
• Arms: Inspection


  • Size, presence of edema, venous patterning
  • Skin color
  • Fingertips for clubbing
• Arms: Palpation


  • Fingers, hands, & arms for temperature
  • Capillary refill time
  • Radial, ulnar, & brachial pulses
  • Epitrochlear lymph nodes
  • Allen's test
• Legs: Inspection


  • Skin color
  • Distribution of hair
  • Lesions or ulcers
  • Edema
• Legs: Palpation


  • Temperature
  • Superficial inguinal lymph nodes
  • Femoral pulse
  • Popliteal, dorsalis pedis, posterior tibial pulses
• Legs


  1. Inspect for varicosities and thrombophebitis by asking client to stand

  2. Manual compression test

  3. Trendelenburg test

  4. Homan's sign
• Arterial Insufficiency


  • Pain: intermittent claudication to sharp, unrelenting, constant
  • Pulses: diminished or absent
  • Skin characteristics: dependent rubor
• Venous Insufficiency


  • Pain: aching, cramping
  • Pulses: present but may be difficult to palpate through edema