Peripheral Vascular System and Lymphatics: A

1
Peripheral Vascular System and Lymphatics AP
and Assessment

• Jensen, ch 20

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Arteries

• High pressure system
• Heart is pump for system
• Elastic, tough, thick, strong
• Recoil allows stretching
• Made of vascular smooth muscle so meds that
  affect VSM will affect arteries

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Veins

• Low pressure system
• More veins than arteries
• Large diameter allows expansion of holding of
  large amounts of blood (capacitance vessels)
• Do not have pump, but valves
• Valves, calf muscles, and respiratory cycle
  facilitate venous return

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Lymphatics

• Completely separate system of microscopic,
  open-ended tubes
• Prevents edema by siphoning excess fluid from
  tissue spaces that is not reabsorbed by veins
• Absorbs lipids from intestinal tract
• Conserves fluid and plasma proteins that leak out
  of capillaries
• Nodes are the filters
• Flow is propelled by valves, respiratory cycle,
  muscles and lymph vessel contractions
• Forms major part of immune system

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Lymphatics contd

• Two main trunks
• Right lymphatic that drains right side of head
  and neck, right arm, right thorax and lung, right
  heart, RUQ of liver. Empties into right
  subclavian vein
• Thoracic duct drains rest of body and empties
  into left subclavian

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Related Organs

• Spleendestroys old RBCs and stores new ones,
  produces antibodies, filters blood
• Tonsilspalatine, adenoid, lingualrespond to
  inflammation
• Thymusdevelops T lymphocytes in children

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Developmental Considerations

• Lymph tissue adult size by age 6
• Twice adult size by puberty
• Back to adult size by age 18
• Somewhat large and palpable in children (shoddy)
  even when not inflamed, but should not be hard,
  tender, or movable
• Vessels and nodes atrophy and vessels grow rigid
  in adults

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Assessment History

• Risk factors
• Arterialsame as those for CAD
• Venousbedrest, prolonged sitting and standing,
  hypercoagulation, vein wall trauma, genetics,
  obesity, pregnancy, BCPs

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History contd

• Ask about
• Leg pain
• Color changes (red, white, blue, brown)
• Ulcerations
• Edema
• Swollen glands
• Sx of hypertension (if any)
• Meds (esp hormones, antihypertensives,
  anticoagulants)

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Physical Assessment

• Accessible arteries for examination
• Temporal
• Carotid
• Brachial
• Radial
• Ulnar
• Femoral
• Popliteal
• Pedal (dorsalis pedis, posterior tibial)

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Assessment contd

• Accessible lymph nodes epitroclear, inguinal
• Accessible veins for examination
• Jugular
• Brachial
• Cephalic
• Femoral
• Popliteal
• Saphenous (great and small)

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Assessment contd

• Assess in semi-Fowlers position
• Inspect for peripheral tissue perfusioncolor,
  clubbing, hair distribution, ulcerations
• Auscultate temporal, carotid, and femoral
  arteries for bruits auscultate blood pressure

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Assessment contd

• Palpate for
• Rate, rhythm, symmetry, amplitude
• Edemapitting or not, grade
• Temperature
• Texture
• Cap refill
• Epitroclear and inguinal nodes
• Measure for calf size and symmetry

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Assessment contd

• Tests for PV system
• Allen test, positional color changes, and Doppler
  (arterial)
• Homans sign (venous)
• Doppler ultrasound and ABI (PVD)