Peripheral Vascular System and Lymphatics : A&P and Assessment

1. Peripheral Vascular System and Lymphatics: A&P and Assessment Jensen, ch 20

2. 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

3. 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

4. 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

5. Lymphatics cont’d • 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

6. Related Organs • Spleen—destroys old RBCs and stores new ones, produces antibodies, filters blood • Tonsils—palatine, adenoid, lingual—respond to inflammation • Thymus—develops T lymphocytes in children

7. 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

8. Assessment: History • Risk factors: • Arterial—same as those for CAD • Venous—bedrest, prolonged sitting and standing, hypercoagulation, vein wall trauma, genetics, obesity, pregnancy, BCPs

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

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

11. Assessment cont’d • Accessible lymph nodes: epitroclear, inguinal • Accessible veins for examination: • Jugular • Brachial • Cephalic • Femoral • Popliteal • Saphenous (great and small)

12. Assessment cont’d • Assess in semi-Fowler’s position • Inspect for peripheral tissue perfusion—color, clubbing, hair distribution, ulcerations • Auscultate temporal, carotid, and femoral arteries for bruits; auscultate blood pressure

13. Assessment cont’d • Palpate for: • Rate, rhythm, symmetry, amplitude • Edema—pitting or not, grade • Temperature • Texture • Cap refill • Epitroclear and inguinal nodes • Measure for calf size and symmetry

14. Assessment cont’d • Tests for PV system: • Allen test, positional color changes, and Doppler (arterial) • Homan’s sign (venous) • Doppler ultrasound and ABI (PVD)