1. Neck Vessels & Peripheral vascular
Chapter 15
Seidel’s Guide to Physical Examination

2. Objectives To identify major neck vessels
To explain difference between systemic and pulmonic circulation
To identify methods to exam neck vessels
To identify arteries in arms and legs
To identify veins in legs
To explain venous obstruction or insufficiency
To identify risk factors for DVT
To identify prevention for DVT
To learn subjective and objective assessment data
To know how to inspect arms and legs

3. Key Words Peripheral Artery Disease (PAD) Pulmonic circulation
Systemic circulation
Carotid artery
Jugular venous pulse
Arteries of arms/leg
Veins of legs
Venous obstruction or insufficiency
Allen’s test
Deep vein thrombosis (DVT)

4. Anatomy & Physiology Vessels circulate blood to and from body & lungs
Great vessels
Aorta
Pulmonary artery
Superior/inferior vena cavae
Pulmonary veins

5. Anatomy & Physiology: circulatory systems
Two circulatory systems distribute oxygen to the body
Pulmonic- lungs>left atrium and ventricle>arteries
Systemic-right atrium & ventricle>pulmonary artery

6. Neck Vessels Carotid artery, jugular veins
Carotid artery pulse – ventricular systole
Level of jugular venous pressure reflects right atrial (central venous) pressure

7. Jugular Venous Pulse Wave

8. EXAMINATION NECK VESSELS
Inspection
Observe the jugular venous pulse
Evaluate jugular venous pressure
Auscultation and palpation
Auscultate the carotid arteries
Palpate the carotid arteries
External Jugular Vein Distention
Auscultation Carotid Arteries

9. Assessment Summary Carotid Artery Evaluate JVD & observes JVD Pulse
Vessel elasticity
Thrills
Evaluate JVD & observes JVD
Auscultates for bruits before palpation of carotid arteries using the bell of stethoscope
Bruit sound- similar sound to a murmur

10. Peripheral Vessels

11. Arteries of Arm
Carry oxygenated, nutrient-rich blood from heart to capillaries
Major arteries of arm: brachial,
ulnar, radial

12. Arteries of Leg Major arteries of leg: popliteal,
femoral, dorsalis pedis,
posterior tibial

13. Veins of Legs Carry deoxygenated, nutrient-depleted,
waste-laden blood from tissues back to heart
Three types of veins: deep,
superficial, perforator
Femoral, popliteal, and
saphenous veins

14. Venous obstruction or insufficiency
Pain: aching or cramping
Swelling and tenderness over the muscles
Engorgement of superficial veins
Erythema and/or cyanosis
Inspect extremities for thrombosis, varicose veins, and edema
Edema 1+, 2+, 3+ or 4+
Homan’s sign
Positive Homan’s sign not positive diagnosis DVT
Negative Homan’s sign does not rule out diagnosis DVT

15. Peripheral vascular disease
Strokes (cerebral vascular accidents (CVA))- MRI
Transient ischemic attacks (TIA)- MRI
Deep vein thrombosis (DVT) - ultrasound
Pulmonary embolism – VQ scan
Aortic aneurysm- MRI
Varicose veins

16. Peripheral Vascular assessment
Inspects extremities for color, hair distribution
swelling, and symmetry
Inspects peripheral veins
Drapes patient appropriately
Assess BILATERAL peripheral pulses
Carotid
Brachial
Radial
Femoral
Popliteal
Dorsalis pedis
Posterior tibial

17. Pulse amplitude and bruits
Pulse Amplitude: Rated on a scale of 0 – 4
4 = bounding, aneurysmal
3 = full, increased
2 = expected
1 = diminished, barely palpable
0 = absent, not palpable
Auscultate sites for bruits
Temporal
Carotid
Subclavian
Abdominal aorta
Renal/iliac/femoral arteries

18. Allen’s test Elevate hand and make fist for 30 seconds
Apply pressure over radial and ulnar arteries to occlude them
Still elevated, open hand – should be blanched (pallor) at finger nails
Ulnar pressure released, color returns in 7 seconds
Inference: ulnar blood supply is sufficient and safe to puncture radial artery
If color does not return or returns 7-10 seconds, suspect ulnar artery
insufficiency and do not puncture radial artery

19. Arterial insufficiency
Pain - intermittent claudication: a clinical diagnosis given for muscle pain (ache, cramp, numbness or sense of fatigue), classically in the calf muscle, which occurs during exercise, such as walking, and is relieved by a short period of rest. to sharp, unrelenting, constant pain
Pulses: diminished or absent
Skin color: dependent rubor- redness, cardinal sign inflammation

20. Deep Vein Thrombosis (DVT): Risk Factors
Conditions that increase blood clotting- medications: birth control or hormones
Low blood flow to deep veins due to surgery, immobilizations, injury, and constriction
Some cancers and cancer treatments
Vascular conditions such as varicose veins
Sitting for long periods – car or plane
Pregnancy, especially first 6 weeks after birth
Obesity
Placement central venous catheter
More than one risk factor

21. Deep vein Thrombosis (DVT): prevention
If sitting long periods: stand up and move around every hour
Ambulate after surgery as soon as possible
Take anticoagulants ordered by physician
Report tenderness, pain, swelling, warmth, or redness calf or thigh

22. Subjective data: current symptoms
Skin changes
Leg pain or heaviness or aching
Leg veins
Leg sores or open wounds
Leg swelling
Men – change in sexual activity
Swollen glands or nodules

23. Subjective data: lifestyle & health
Tobacco use
Regular exercise
Oral contraceptives
Stress
Medication
Peripheral vascular problems interfere with ADLs
Support hose

24. Subjective data: history
Past
Previous problems circulation legs/arms
Heart or blood vessel surgeries
Family
Diabetes
Varicose veins
Hypertension
Coronary heart disease
High cholesterol levels

25. Arms Inspection Palpation Size, edema, venous patterning Skin color
Fingertips clubbing
Palpation
Fingers, hands, & arms for temperature
Capillary refill
Radial, ulnar, & brachial pulses
Allen’s test
Epitrochlear lymph nodes
Most readily felt over bony prominences

26. Legs Inspection Palpation Skin color Distribution of hair
Lesions or ulcers
Edema
Palpation
Temperature
Superficial inguinal lymph nodes
Femoral pulse
Popliteal, dorsalis pedis, posterior tibial pulses
Pedal pulses are not always palpable

27. Summary To identify major neck vessels
To explain difference between systemic and pulmonic circulation
To identify methods to exam neck vessels
To identify arteries in arms and legs
To identify veins in legs
To explain venous obstruction or insufficiency
To identify risk factors for DVT
To identify prevention for DVT
To learn subjective and objective assessment data
To know how to inspect arms and legs