VENOUS DISORDERS

Margaret Xaira R. Mercado RN

 DEEP VEIN THROMBOSIS
• Inflammation of the vessel wall with
formation of a blood clot (thrombus) which
could affect superficial or deep vein
resulting to venous insufficiency
• Frequently affects lower extremity veins
saphenous, femoral, and popliteal
• Can result damage to the surrounding
tissues, ischemia and necrosis
• Complication: life threatening pulmonary
thromboembolism
 RISK FACTORS:
VIRCHOW’S TRIAD
• Venous stasis
Surgery, obesity, pregnancy, CHF and
immobility
• Hypercoagulability
Malignant neoplasms, dehydration, blood
dyscrasias and oral contraceptive use
• Venous wall injury
Constriction due to restrictive matrial (i.e.,
garters, straps) or trauma to lower
extremities causing injury to venous walls
 PATHOPHYSIOLOGY
Platelets release
chemicals initiating Clot formation Clot grows in size
platelet aggregation

Clot may dislodge Prevention of venous

Blocks or obstruct
and travel to drainage from area
vein
circulation distal to site

May lodge to the

Pulmonary embolism
pulmonary artery
 ASSESSMENT
CARDIOVASCULAR SYSTEM
• Superficial vein: tenderness, redness, and
induration along the course of the vein
• Deep vein: swelling, venous distention of
limb, tenderness over involved vein, and
cyanosis
OTHER MANIFESTATIONS
• Positive Homan’s sign
-pain on calf muscles when client’s leg is
dorsiflexed due to the stretching of
inflammed veins
-pathognomonic sign of DVT
• Pain in the affected extremity
• Low grade fever
• Edema of the leg
HOMAN’S SIGN
 DIAGNOSTIC TESTS
1. VENOGRAPHY: increased uptake of
radioactive material
2. DOPPLER ULTRASONOGRAPHY: impaired
blood flow ahead of thrombus
3. VENOUS PRESSURE MEASURE: high in
affected limb until circulation is formed
4. CBC: elevated WBC and ESR
 NURSING INTERVENTIONS
1. Monitor and improve client’s circulatory
state
- assess vital signs every 4 hours
- measure thighs, calves, ankles, and instep
every morning
- monitor for chest pain or shortness of
breath (possible pulmonary embolism)
2. Provide bed rest, elevating lower extremity
to increase venous return and to decrease
edema
3. Apply continuous, warm, moist soaks to
decrease lymphatic congestion
4. Provide client teaching and discharge
planning
- avoid standing, sitting for long periods,
wearing constrictive clothing, leg crossing,
smoking, and oral contraceptive use
- adequate hydration to prevent
hypercoagulability
- use of elastic stockings if ambulatory
- importance of planned rest periods and
elevation of the feet
-plan for exercise/ activity
feet dorsiflexion (sitting or lying down)
swim several times weekly
gradually increase walking distance
-weight reduction if obese
5. Provide dependent and other collaborative
nursing interventions
SURGERY
• vein ligation and stripping
• venous thromboectomy – removal of a clot
in the ileo-femoral region
• Application of the vena cava filter –
insertion of an umbrella-like prosthesis to
the vena cava’s lumen to filter incoming
clots
*After Surgery
• Encourage deep breathing exercises
• Early ambulation to promote vrnous return
• Use of anti-embolic stockings
• Elevate the foot of the bed to aid in venous
return
ASSISST IN DRUG REGIMEN
• Administer anticoagulants
Heparin
Warfarin
 HEPARIN
• Blocks conversion
of prothrombin to
thrombin and
reduces formation
or extension of
thrombus
 SIDE EFFECTS
a. Spontaneous bleeding
b. Injection site reactions
c. Ecchymoses
d. Tissue irritation and sloughing
e. Reversible transient alopecia
f. Cyanosis
g. Pain on arms and legs
h. Thrombocytopenia
 NURSING RESPONSIBILITIES
1. Monitor partial thromboplastin time (PTT);
dosage is adjusted to maintain PTT
between 1.5 to 2.5 times normal
2. Use of infursion pumps in IV heparin
administration
3. Ensure proper injection technique
- syringe: use gauge 26-27 syringe; inject
to subcutaneous area of abdomen
- avoid injecting within 2 inches of the
umbilicus
 - do noth withdraw plunger to assess blood
return
- apply gentle pressure after removal of
needle; avoid massaging the injection site
4. Assess for increased bleeding tendencies
and report to the physician
- hematuria; hematemesis; bleeding gums;
petichiae of soft palate; ecchymoses;
epistaxis; bloody sputum; melena
5. Instruct the client to avoid aspirin,
antihistamines, and cough preparations
containing glyceryl, guaiacolate, and to
obtain physician’s permission before using
other over-the-counter drugs
6. Always have protamine sulfate (antidote for
heparin toxicity) available at hand
 WARFARIN (COUMADIN)
• Blocks prothrombin synthesis by
interferring with vitamin K synthesis

SIDE EFFECTS
• Gastrointestinal: anorexia, nausea and
vomitting, diarrhea, stomatitis
• Hypersensitivity: dermatitis, urticaria,
pruritus, fever
• Others: transient hair loss, burning
sensation of feet, bleeding complications
 NURSING RESPONSIBILITIES
a. Monitor prothrombin time (PT) daily;
dosage is adjusted to maintain PT at 1.5-
2.5 times normal
b. Obtain careful medication history
c. Advise client to withhold dose and to notify
the physician for signsof bleeding
d. Instruct to use soft toothbrush and to floss
gently
e. Alert client to factors that may affect anti-
coagulant response (high fat diet or
sudden increases in vitamin K-rich foods)
f. Always have vitamin K (antidote for warfarin
toxicity) available at hand.
 VARICOSE VEINS
• Dilated veins that occur most often in the
lower extremities and trunk
• Vessels dilate and valves become stretched
and incompetent with resultant venous
pooling/edema
• Most common between ages 30-50
 RISK FACTORS
a. Congenital weakness of the veins
b. Thrombophlebitis
c. Pregnancy
d. Obesity
e. Heart disease
 ASSESSMENT
SYSTEMIC MANIFESTATIONS
• Pain after prolonged
standing (relieved by
elevation)
• Swollen, dilated, tortous
skin veins
• Leg heaviness and
dependent edema
 DIAGNOSTIC TESTS
BRODIE-TRENDELENBURG TEST
• Medical test to determine valvular
incompetence in superficial vein. A finger is
placed over the lower (distal) part of the
vein being examined. The upper (proximal)
part of the vein is then tapped (percussed).
If the impulse is felt by the finger placed at
the lower end, it indicates incompetence of
valves in that vein
• Varicose veins distend very quickly (less
than 35 seconds)
DOPPLER DUPLEX SCAN
ULTRASOUND
• Decreased or no
blood flow heard
after the calf or
thigh compression
 NURSING INTERVENTIONS
1. Monitor and improve client’s cardio-
circulatory state – measure circumference
of ankle and calf daily
2. Provide adequate rest
3. Instruct to avoid prolonged standing and
sitting and to change position frequently
4. Elevate legs when tired
5. Provide client health teaching and
discharge planning: same as in
thrombophlebitis
6. Provide dependent and other collaborative
nursing interventions:
a. Apply anti-embolic stockings
b. Prepare client for vein ligation (ligation of
the saphenous vein where it joins the
femoral vein and stripping the saphenous
vein system from groin to ankle)
- provide routine preoperative care
- keep affected extremity elevated above
the level of the heart to prevent edema
- Apply elastic bandages and stockings,
which should be removed every 8 hours for
short periods and then reapplied
- Assist in getting out of bed within 24
hours
- Assess for increased bleeding, particularly
the groin area