VARICOSE VEINS FOR NURSING STUDENTS

1. Prepared by ,
Mrs. PREETHY MARY
MATHEW
MSN.

2. VARICOSE VEINS

3. Varicose veins are abnormally
dilated, tortuous, superficial veins caused
by incompetent venous valves.

4. Anatomy and physiology
The venous system in the leg
comprises of
• Superficial system in the skin and
subcutaneous fat [long & short
saphenous veins]
• Deep system beneath the fascia and
leg muscles
• Perforator veins which connects
these two systems

5. Factors that help return flow of blood to heart
• Calf muscle pump
• Competent valves
• Vis-a-tergo [a force acting
from behind]
• Negative intrathoracic
pressure
• Venae comitantes

6. Types- etiologic
• Congenital
• Primary varicose veins- without
involvement of deep veins
• Secondary varicose veins- resulting from
obstruction of deep veins.
All the three systems have
several venous valves , incomptence of
these venous valves permits reflux and
the veins dilate become tortous and
varicose.

7. Types- anatomic
• Deep
• Superficial
• Perforator

8. Types- pathophysiologic
• Reflux
• Obstruction
• Both

9. Manifestations – when deep vein not involved
• Dull aches
• Muscle cramps
• Increased fatigue in the lower
leg
• Ankle edema
• Feeling of heaviness of the
legs
• Nocturnal cramps
• Dermatitis
• Pruritis

10. Manifestations – when deep vein is involved
Patients develop s/s of
chronic venous insufficiency
occurs
• Edema
• Pain
• Pigmentation
• Ulcerations
Susceptibility to injury and
infection is increased

11. Diagnostics
• Physical examination
• Thorough history
• Tourniquet test
• Assess skin changes
• Peripheral pulses
• Abdominal examination
• Duplex scan
• Air plethysmography
• Venography

12. Tourniquet test
Three tourniquet test: To find out the site of incompetent
perforator, three tourniquets are tied after emptying the
vein.
1. at sapheno- femoral junction
2. above knee level
3. another below knee level.
Patient is asked to stand and looked for filling of
veins and site of filling. Then tourniquets are released
from below upwards, again to see for incompetent
perforators

13. Management- Conservative
• Limb elevation
• Elastic compression bandage
• Elastic compression stockings
• Unna boot
The Unna Boot itself is a compression
dressing, usually made of cotton, that contains
zinc oxide paste. The zinc oxide paste in the Unna
Boot helps ease skin irritation and keeps the area
moist. The zinc promotes healing within wound
sites, making it useful for burns and ulcers. Unna
Boots also contain calamine lotion and glycerin.

17. Management – injection
Indicated in below knee varicosity and
recurrent varicosity after surgery .
Complications:
Allergy, pigmentation, DVT ,
thrombophlebitis, skin necrosis
Eg: sodium tetradecyl sulphate 1.5-3%,
polidocanol 3-5 %

18. e• Stripping and ligation
• Sclerotherapy – Sclerotherapy is used to
eliminate varicose veins and spider veins.
During the procedure a solution is injected
directly into the vein. The solution irritates
the lining of the blood vessel, causing it to
swell and stick together and the blood to
clot. Over time, the vessel turns into scar
tissue that fades from view.
•

19. Prevention
• The patient should avoid activities that cause
venous stasis, such as
– wearing tight socks or a constricting panty
girdle,
– crossing the legs at the thighs, and
– sitting or standing for long periods.
• Changing position frequently,
• elevating the legs when they are tired,
• and getting up to walk for several minutes of
every hour promote circulation.

20. • The patient should be encouraged to walk
1 or 2 miles each day if there are no
contraindications.
• Walking up the stairs rather than using
the elevator or escalator is helpful in
promoting circulation.
• Swimming is also good exercise for the
legs.
• Elastic compression stockings, especially
knee-high stockings
• The overweight patient should be
encouraged to begin a weight-reduction
plan.

21. Management
• Stripping and ligation
• Sclerotherapy