ASSESSING THE PHERIPHERAL VASCULAR SYSTEM  INSPECTION

❶ Skin
- Skin color
o Normal:
 No localized color changes
o Abnormal:
 Pallor – Due to arterial obstruction
(obstructed blood vessel) which results to
low blood supply or less blood is going to the
leg; ISCHEMIA; Arterial insufficiency
 Redness or brownish in color – due to
incompetent valves which causes the
backflow and accumulation of blood in the
veins of the lower extremities; Accumulation
of blood results in higher pressure in the
veins which causes it to distend. RBCs are
forced out of the vein [into the ISS], giving
the skin a flush of reddish color.

- Should be mobile and elastic and able to be pinched.

- Temperature should be equal.
- Extremities should be equal in size bilaterally
o Abnormal
 Unilateral swelling / edema
- Veins should not be visible on the surface of the skin
o If visible, elevate lower extremities (LE).
Arteries & Veins  If the veins and valves are not compromised,
the distended veins will disappear (due to
the incompetent valves)
 If veins and valves are compromised, the
distended vein will remain
o Superficial veins – veins found beneath the skin
 common veins on the LE: Greater
Saphenous, and Lesser Saphenous Vein—
dorsal.

Capillaries
- Very thin walls (one layer of tissue)
- Allows diffusion materials across capillary: O2, CO2, H2O, and Fluid
waste
Aneurysm
- For smokers, o Deep veins
o Nicotine causes vasoconstriction which results in  Brachial artery – divides into radial and ulnar
increase of BP. arteries
- For patient’s that have Abdominal Aortic Aneurysm (AAA),
o Causes pulsations
 When assessing, it should be on a supine
position and eye level.
 When not seen, ultrasound is done.
 Controlled by anti-hypertensive drug.
o AAA has more cases with 75%, whereas Thoracic Aortic
Aneurysm with 25%.
- Also related to chronic hypertension
- Obesity, pregnancy and ascites makes it hard to see pulsation.
Ultrasound is done.

 Femoral artery – found in the groin area

Ascites
- It is the accumulation of fluid in the peritoneal cavity— with plenty
visceral and subcutaneous fats.
  Popliteal artery – at the dorsal side of the
knee
 Dorsalis pedis – at the dorsal side of the foot
 Inspect and palpate when leg
extremities are (+) pallor,
together with the posterior tibial
artery
- No lesions visible
o Abnormal if lesions don’t heal easily
o If there is a lesion, classify it:
 Petechiae— small red dots; common in
dengue fever
 Ecchymosis— bruise-like, larger than
purpura
 Purpura— snake bites
❷ Hair
- Hair distribution
o If hair growth is evident, it should be equal in
distribution bilaterally.
o Person with ischemia has less hair or no hair at all.
 Patient with arterial insufficiency will have
hairless shiny skin on the legs
 Due to lack of blood supply that
brings oxygen and nutrients to
the hair follicles for hair growth.
❸ Nails
- If the nails are dead / brittle, there is low blood supply which results
to low oxygen and nutrients.
→ Buerger Test
- Position: supine and sitting
- (+) sign: 1-2 mins. before the color comes back (becomes blue then
red)
- Significance: poor arterial blood supply
- Procedure: elevate the leg at 45-degree for at least 3 minutes, foot
blanches. Position is then place at short-sitting
❹ Spider Veins
- The valve is incompetent, weakened walls, and back flow of blood
- It will give you edema
❺ Varicose skin/Varicosity
- Distended vein that is greenish-bluish in color
- Damaged valves allow backflow of the blood
- This condition is hereditary
- Female are more susceptible due to the estrogen which weakens
the walls of the vein
❻ Deep Vein Thrombosis (DVT)
- Reddish, hard and warm to touch, and swelling
- Those patients who are in supine position for more than 3 days are
more susceptible on having DVT
o It is due to the blood that is stagnant allowing solid
elements (platelets) to clump together which forms
clotted blood thus, the blood does not go up
- Should be suspected if there is:
o Pain
o Swelling
o Tenderness over vein
- Turn client side to side or perform compression stocking
- Observe the lower extremities for any manifestations of arterial
insufficiency and obstruction
- A thrombus in the vein can dislodge (embolus) and will flow with
the blood back to the superior or inferior vena cava to the heart
and to the lungs via the pulmonary arteries, thus causing
PULMONARY EMBOLISM
 ASSESSMENT TESTS
Trendelenburg Test
o Purpose: to assess the competence of the valves
o LE is elevated to allow venous blood to empty
o A tourniquet on the thigh will prevent backflow
o After 20 to 30 seconds, remove the tourniquet
 o Competent valves – there will be a slow filling of blood
o Damaged valves – immediate filling of blood and veins
will distend (within 5 seconds)
o Tourniquet is applied to 1. Prevent backflow of blood,
and 2. To temporarily stop the blood flow

❸ Pitting edema
- Indentations
❼ Arterial occlusion
- Most common cause of occlusion is fats/lipids

Position Change Test

o Elevate the leg/s 12 in above the heart
o Dangle the leg beside the bed
o After 15 s, the leg/s should return into its normal pinkish
color – veins
o After 10s or less – artery
o If occlusion has been shown in developing, there will be
more likely conditions like the ff:
 Muscle atrophy
 Skin atrophy
 Loss of hair growth
 PALPATION
❶ Capillary Refill Time
- Normal
o Normal pinkish color will return after 1-3 seconds
- Abnormal
o More than 3 seconds (in people with Peripheral ❹ Bruit sound
Vascular Disease or PVD) - Done during hemodialysis
❷ Radial artery and Dorsalis pedis artery - Presence of arteriovenous fistula
- Most distal pulses
- Palpate using the 1st and 2nd finger pads
- AMPLITUDE
o Quality of pulse is the measurement of the force of
ventricular contraction that produces pulse wave
o Tests the integrity of the arterial wall
+3 Full/bounding pulse
+2 Expected
+1 Diminished/barely palpable
0 Absent pulse

Allen’s Test
o Assesses for the
 Competency
 Patency
 Adequate collateral circulation of blood
o Radial artery
 Supplies the thumb and the lateral side of  ELDERLY
the index finger - Higher blood pressure due to blood vessels being LESS ELASTIC and
o Ulnar artery RIGID due to CALCIUM and FAT DEPOSITS
 Supplies the remaining digits and the medial - Increase PERIPHERAL VASCULAR RESISTANCE
side of the index finger