Peripheral Vascular
System and Lymphatic
System
By InnaKorda, MD,
Institute of Nursing, TSMU
Direction of Blood Flow
Lecture objectives:
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Structure and function of vascular system:
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Taking client’s complaints and history.
Assessment techniques:
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Arteries
Veins
Lymphatics
Inspection and palpation of the neck vessels
Inspection and palpation of the arms (radial pulse, lymph nodes)
Inspection and palpation of the legs (edema, Homans’ sign; femoral,
popliteal, dorsalis pedis pulses, manual compression test
Additional techniques: Trendelenburg test, colour changes, doppler
ultrasonic stethoscope.
Abnormal findings:
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Variations in arterial pulse
Raynauld’s syndrome
Lymphedema
Arteriosclerosis
Superficial varicose veins
Peripheral artery disease: occlusions, aneurysms
Structure And Function
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The vascular system consists of the vessels of
the body.
Vessels are tubes for transporting fluid, such as
the blood or lymph.
Function - transporting the blood or lymph :
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Delivery of oxygen to the tissues
Delivery of nutrients to the tissues
Elimination of carbon dioxide from cells
Elimination of waste products from cellular metabolism
Arteries.
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Carry freshly oxygenated blood to tissues
High-pressure system
Walls are strong, tough, and tense
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with elastic fibers ► stretch with systole, recoil with diastole
with muscle fibers (VSM) ► control the amount of blood
delivered to the tissues and the rate of blood flow
Pulse is a pressure wave created by each heartbeat,
palpable at body sites where the artery lies close to the
skin and over a bone.
Arteries accessible to examination
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Temporal artery (review chapter 13)
Carotid artery
Arteries in the arm:
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Brachial
Radial
Ulnar
Arteries in the leg:
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Femoral artery
Popliteal
Anterior tibial ► dorsalis pedis
Posterior tibial ► plantar arteries
Ischemia is a
deficient supply of
oxygenated arterial
blood to a body part,
due to constriction or
obstruction of a blood
vessel
Arteries accessible to examination
Arteries
accessible to
examination
Veins accessible to examination
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Jugular veins
Veins in the arm:
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Superficial – in the subQ tissue, responsible for most of the
venous return
Deep
Veins in the leg:
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Deep veins: femoral, popliteal; responsible for most of the
venous return
Superficial: great and small saphenous
Perforators: connecting veins that join the two sets. They
have one-way valves ► blood ► into the deep veins.
Veins accessible
to examination
Lymphatics.
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A completely separate vascular system.
It retrieves excess fluid from the tissue spaces and
returns it to the blood stream.
Lymphatic
ducts and
drainage
patterns
Functions of the lymphatic system:
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To converse fluid and plasma proteins that leak
out of the capillaries.
To form the major part of the immune system
that defends body against infection.
To absorb lipids from the intestinal tract.
Structure of the lymphatic system
Microscopic open-ended tubes (capillaries)
Vessels, like veins, have valves
Lymphatic ducts
Subclavian veins
Lymphoid tissue:
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Lymph nodes:
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Tonsils:
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Filter the fluid before it comes back to the bloodstream
Filter out microorganisms
Pharyngeal (adenoid)
Palatine
Lingual
Spleen
Peyer’s patches (Lymphoid tissue in intestines)
Tymus gland
Bone marrow
Groups of peripheral lymph nodes:
1.
2.
3.
4.
5.
6.
7.
8.
9.
Auricular: anterior and posterior
Sublingual.
Submandibular.
Cervical: anterior and posterior.
Supra- and subclavian.
Axillary.
Epithrochlear.
Inguinal.
Popliteal.
Assesment:
 Inspection and palpation
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Amount in each group
Size
Shape
Consistency
Movable/connected with
surrounding tissues
Pain/tenderness
Signs of inflammation:
swelling and redness
above the node
Claudication distance is the number
of blocks walked or stairs climbed
to produce pain.
Note sudden dencrease in
claudication distance, or pain
suddenly not relieved by rest.
Taking client’s complaints and history.
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Ask: “Any leg pain (cramps)? Where?”
Detail: pain type, onset (gradual/sudden), aggravating/
relieving factors (activity, walking, dangling, rubbing),
associated signs (skin changes, sexual malfunction),
relation to time of day, claudication distance.
Edema is bilateral when
caused by a systemic
problem (heart failure),
or unilateral when due to
a local obstruction or
inflammation.
Taking client’s complaints and history.
Objective data
Preparation:
 Environment
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Privacy
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Should be warm (about 22°C) and draftless
to prevent vasodilatation or
vasoconstriction.
Make sure the female’s breasts and client’s
genitals remain draped.
Order of exam
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Begin with observations peripherally and
move toward the heart.
1.
2.
3.
4.
Pulse and blood pressure
Extremities – peripheral vascular
assessment
Neck vessels
Precordium – (portion of body over heart
and thorax)
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Equipment needed:
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Tourniquet or blood
pressure cuff
Stethoscope
Paper tape measure
Doppler ultrasonic
stethoscope
Assessing Neck Vessels
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Carotid Artery
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Palpate the carotid artery
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Avoid excessive pressure.
Excessive vagal stimulation
could slow down heart rate.
Carotid arteries should be
same bilaterally
Auscultation
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Listen for bruits – blowing,
swishing sounds indicating
blood flow turbulence.
Caused by atherosclerotic
narrowing (one half or two
thirds of artery).
Assessing Neck Vessels
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Jugular Veins
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Can be used to assess central venous pressure (CVP) and cardiac
efficiency
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Position the patient at 30-45 degree angle, wherever pulsations can
be seen best. Remove pillow to avoid flexion of head.
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Distended external jugular veins signify increased CVP, as with heart failure
The higher the CVP, the higher the position you will need
Turn the pt’s head away from examiner’s side
Distinguish from carotid artery pulsations. Internal jugular pulse
is lower, varies with respiration, not palpable, and disappears as
person is sitting.
Assessing Neck Vessels
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Jugular Venous Pressure Estimate
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Used to assess heart failure
Position the patient at 30-45 degree angle. Place one ruler vertically
at the manubriosternal angle. Place a second ruler perpendicular to
the first and record the height of pulsation of the internal jugular
vein.
Normal pulsation is 2 cm or less above sternal angle
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Pulsations 3 or more cm above sternal angle while at 45 degrees occur with
heart failure
Record height of pulsations and degrees of elevation
Question
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The examiner has estimated the jugular venous
pressure. Identify the finding that is abnormal.
1.
2.
3.
4.
Patient elevated to 30 degrees, internal jugular vein
pulsation at 1 cm above sternal angle.
Patient elevated to 30 degrees, internal jugular vein
pulsation at 2 cm above sternal angle
Patient elevated to 40 degrees, internal jugular vein
pulsation at 1 cm above sternal angle
Patient elevated to 45 degrees, internal jugular vein
pulsation at 4 cm above sternal angle
Inspection and palpation of the arms
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Inspect for:
Color of skin and nailbeds
 Temperature, texture and turgor of skin
 Any lesions, edema
 Nail clubbing.
160 degrees
 What is normal nail bed angle?
 Use profile sign to detect early clubbing
 Capillary refill is an index of peripheral perfusion
and cardiac output.
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Depress and blench the nail beds; release and note the
time for color return. Normally 1 to 2 seconds.
Inspection and palpation of the arms
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Palpate both radial pulses:
Symmetricity (equal force), rhythm, rate, elasticity.
 Grade the force (amplitude) on a fore-point grade:
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0 – absent
 1+, weak
 2+, normal
 3+, increased
 4+, bounding
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For ulnar pulse palpate along the medial site of
the inner forearm. Not palpable in healthy
person.
Inspection and palpation of the arms
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Palpate the brachial pulses.
Palpate the epitrochlear lymph node
Modified Allen test: Normal 2 to 5 seconds