Peripheral Vascular System
and Lymphatics: A&P and
Assessment
Jensen, ch 20
Arteries
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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
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
Lymphatics
• Completely separate system of microscopic, openended 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
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
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
Developmental
Considerations
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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
Assessment: History
• Risk factors:
– Arterial—same as those for CAD
– Venous—bedrest, prolonged sitting
and standing, hypercoagulation, vein
wall trauma, genetics, obesity,
pregnancy, BCPs
History cont’d
• Ask about:
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Leg pain
Color changes (red, white, blue, brown)
Ulcerations
Edema
Swollen glands
Sx of hypertension (if any)
Meds (esp hormones, antihypertensives,
anticoagulants)
Physical Assessment
• Accessible arteries for examination:
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Temporal
Carotid
Brachial
Radial
Ulnar
Femoral
Popliteal
Pedal (dorsalis pedis, posterior tibial)
Assessment cont’d
• Accessible lymph nodes: epitroclear, inguinal
• Accessible veins for examination:
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Jugular
Brachial
Cephalic
Femoral
Popliteal
Saphenous (great and small)
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
Assessment cont’d
• Palpate for:
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Rate, rhythm, symmetry, amplitude
Edema—pitting or not, grade
Temperature
Texture
Cap refill
Epitroclear and inguinal nodes
• Measure for calf size and symmetry
Assessment cont’d
• Tests for PV system:
– Allen test, positional color changes, and
Doppler (arterial)
– Homan’s sign (venous)
– Doppler ultrasound and ABI (PVD)