Varicose Vein Group 4Fanny

AishwarriyaJaneNaga

Munirah

ANATOMICAL REVIEW

What is varicose vein?

• Dilated, swelled leg veins with back flow of blood caused by incompetent valveclosure, which results in venous congestion and vein enlargement

• Usually affects the saphenous vein and its branches

TYPE OF VaRICOSE VEIN Type of varicose vein:-

1.) Greater saphenous varicose veins

2.) Lesser saphenous varicose veins

3.) Genital area varicose vein

4.) Reticular type and Web type (spider veins) varicose vein

1.) Greater Saphenous Vericose Vein

• Greater saphenous vein is the superficial vein that goes up from inside of ankle and is connected to femoral vein at the inguinal region

• The area of outset of varicose vein is lower legs, inside of thigh, outside of lower extremities and the back of thigh

2.) Lesser saphenous Varicose Veins

• next to greater saphenous varicose vein

• Lesser saphenous vein runs up from the outside of Achilles tendon and is connected to deep vein at the back of the knees

• The area of outset of lesser saphenous varicose vein is at the back of ankle or knees

3.) Genital area Varicose Vein • Varicose vein that occurs due to the blood

that backflows from the vein around ovary and womb

• Genital area varicose vein is suspected when bumpy blood vessel meanders diagonally from the groin at the back of femur and spreads through lower extremity

• Become worsens when the flow of the blood into ovary and womb increases during menstrual period

4.) Reticular type and Web type (spider Vein) Varicose Vein

• Reticular type varicose vein swollen fine subcutaneous veins in the size of 2-3mm in diameter that spread like a mesh

• Web type (spider vein) varicose vein is dilated capillary veins that are finer than reticular type in the size of less than 1mm in diameter that exist just below the skin

• Web type varicose veins are not bumpy like saphenous varicose veins

Causes / Factors1) Long time standing - nurses have higher risk of getting varicose veins due to prolong standing during shift time

2) Pregnancy- Pregnant woman having pressure at lower limb part

3) Heavy physical activity- Such as gym and boxing

4) Lifting heavy object frequently- Lifting heavy object would give pressure to both

arms and hands

PathophysiologyAny risk factor /causes

Increased venous pressure

Dilation of veins

Valves stretched

Incompetent valve

Reverse blood flow

Calf muscles fail to pump blood

Venous distension

Clinical Manifestation

• Enlarged veins that are visible on skin • Mild swelling of ankles and feet• Pain, achy or “heavy” legs• Throbbing or cramping in legs• Itchy legs, especially in the lower leg and ankle• Discolouration of skin surrounding the varicose veins

ASSESSMENT • History

- Complaints of leg pain, aching , heaviness or fatigue; ankle swelling; history of venous thrombosis

• Physical examination

- Visible, dilated, tortous superficial veins in lower extremities

• Investigation

- Duplex Ultrasound

-Trendelenburg test

A) Duplex Ultrasound

- A non-invasive evaluation of blood flow through your arteries & veins

- Provide a quantitative measure of severity of valvular reflux

- Painless and easy. It tooks 30 mins to finished

B) Trendelenburg test

- To determine the underlying cause of superficial venous insufficiency

TREATMENT

Surgical management

• Ligation and stripping

• Radiofrequency ablation

• Sclerotherapy

1.) Ligation and stripping • Ligation means the surgical tying of veins

through a small incision in the skin to prevent pooling of blood

• The saphenous vein is ligated and divided at high in the groin ( saphenous vein meet femoral vein) and at the calf vein

2.) Radiofrequency ablation

• Radiofrequency ablation involves heating the wall of your varicose vein using radiofrequency energy. The vein is accessed through a small cut made just above or below the knee

• A narrow tube called a catheter is guided into the vein using an ultrasound scan. A probe is inserted into the catheter that sends out radiofrequency energy

• This heats the vein until its walls collapse, closing it and sealing it shut. Once the vein has been sealed shut, your blood will naturally be redirected to one of your healthy veins

3.) Sclerotherapy

• Medical procedure used to eliminate varicose veins and spider veins

• Involves an injection of a solution (generally salt solution) directly into the vein

• The solution irritates the lining of the blood vessel and causing it to collapse and stick together and the blood to clot

Conservative management

• Elevation of the legs

• Avoid prolonged standing

• Avoid cross-leg while sitting

• Compression stockings

• Exercise

• Lose weight

COMPLICATION

LipodermatosclerosisSuperficial thrombophlebitis

venous ulceration venous eczema

Nursing diagnosis: Impaired blood circulation related to venous insufficiency

Goal: Improve venous return from peripheral tissue

1) Assess peripheral pulses, capillary refill, skin colour, and temperature every 4 hourly

Rationale: To obtain baseline data and further treatment can be carry out

2) Assess pain in extremities by asking the pain score using numerical pain scale

Rationale: to evaluate the severity of the pain to plan for pain management

3) Teach application and use of properly fitted elastic graduated compression stockings

Rationale: Elastic compression stockings compress the veins, and promoting venous return from the lower extremities

4) Instruct patient to perform regular exercise, such as walking for 20-30 minutes several times a day

Rationale: exercises help to maintain muscle tone, joint mobility, venous return as it promotes to stimulates circulation and promotes blood flow through the vascular system

5) Advice patient to elevate the legs for 15 to 20 minutes several times a day and to sleep with the legs elevated above the level of the heart

Rationale: To promotes venous return, reducing tissue congestion and improving arterial circulation

6) Encourage patient to wear socks during night time to keep extremities warmRationale: to maintain vasodilatation as it can increase blood supply

7) Advice patient to avoid crossing legs when sittingRationale: to prevent impairment of blood flow to distal tissues

8) Advice patient to reduce weight Rationale: as obesity can cause pressure to lower limbs

9) Educate patient about sign & symptom of cellulitis such as severe redness, pain & increased swelling in an extremities.Rationale: so further treatment can be carry out

Evaluation: Venous return from peripheral tissue as evidenced by normal capillary refill, pinkish and warm skin

SUMMARYVaricose veins are gnarled and enlarged

veins. Any vein may become varicose, but the veins most commonly affected those legs and feet. That's because

standing and walking upright increases the pressure in the veins of your lower

body

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References

• http://www.varixlaser.com/english/treatment-of-typical-varicose-veins/

• https://www.slideshare.net/diliprajpal/endovenous-laser-ablation

• Medical-Surgical Nursing Critical Thinking in patient care Lemone Burke Bauldoff 5th Edition

• Medical-Surgical nursing patient-centeredcollaborative Care Ignatavicius Workman 8th

Edition • Nursing diagnosis handbook – Betty J. Ackley &

Gail B. Ladwig