Step into Chithrakoota to have an experience with Ancient Indian Medical Knowledge of “Ayurveda” and treat your soul. The knowledge of Ayurveda has been passed from generation to generation to the able hands of Chithrakoota.
Chithrakoota is a paradise, located deep in the Western Ghats, the heaven on earth. Visit Chithrakoota gives you an everlasting satisfaction of calm, beautiful and serene nature. The eye-catching landscapes, adorned with the cool and calm breeze from the trees and the musical notes from the hummingbirds is a visual treat to your soul. Relax, Refresh and Rejuvenate your mind, body, and soul with the Ancient Indian Medical Knowledge of Ayurveda.
1. Tittle - Thrombophlebitis
2. Definition
3. Types
4. arterial vs venous thrombus
5. types of thrombus
6. Causes of thrombus
7. Risk factors
8. Symptoms of thrombophlebitis
9. Treatment of thrombophlebitis - conservative and surgical
10. DVT - Deep vein thrombosis
11. Localisation of DVT
12. Symptoms of DVT
13. Normal leg vs leg with DVT
14. Diagnosis of DVT
15,16. Differential diagnosis
18. Treatment of DVT - conservative and surgical
19. Complications
20. Thank you.
At RNV Podiatry, Dr. Rachel N. Verville provides you with the best medical advice regarding your feet, the most advanced treatments for your foot condition or disorder and the best patient care available in Plano, Frisco, and Dallas, Texas.
http://www.rnvpodiatry.com/
Step into Chithrakoota to have an experience with Ancient Indian Medical Knowledge of “Ayurveda” and treat your soul. The knowledge of Ayurveda has been passed from generation to generation to the able hands of Chithrakoota.
Chithrakoota is a paradise, located deep in the Western Ghats, the heaven on earth. Visit Chithrakoota gives you an everlasting satisfaction of calm, beautiful and serene nature. The eye-catching landscapes, adorned with the cool and calm breeze from the trees and the musical notes from the hummingbirds is a visual treat to your soul. Relax, Refresh and Rejuvenate your mind, body, and soul with the Ancient Indian Medical Knowledge of Ayurveda.
1. Tittle - Thrombophlebitis
2. Definition
3. Types
4. arterial vs venous thrombus
5. types of thrombus
6. Causes of thrombus
7. Risk factors
8. Symptoms of thrombophlebitis
9. Treatment of thrombophlebitis - conservative and surgical
10. DVT - Deep vein thrombosis
11. Localisation of DVT
12. Symptoms of DVT
13. Normal leg vs leg with DVT
14. Diagnosis of DVT
15,16. Differential diagnosis
18. Treatment of DVT - conservative and surgical
19. Complications
20. Thank you.
At RNV Podiatry, Dr. Rachel N. Verville provides you with the best medical advice regarding your feet, the most advanced treatments for your foot condition or disorder and the best patient care available in Plano, Frisco, and Dallas, Texas.
http://www.rnvpodiatry.com/
Kayachikitsa IMP Schlok – Part 7 - PPT
By Prof. Dr. R. R. Deshpande
• This PPT has following features –
• Imp Contents – Vata Vyadhi Chikitsa,Gudagat-Aamashayagat –Pakwashayagat – Siragat, Asthi Majjagat –Vata ,Ardit or Facial Palsy ,Pakshaghat or Hemiplegia, Grudhrasi or Sciatica ,Pashangardabha or Mumps, Kadar or corn ,Indralupta or Alopecia areata ,Darunak or Dandruff, Niruddha Prakash or Phimosis ,Unmad or Hysteria ,Apasmar or Epilepsy ,
• Visit – www.ayurvedicfriend.com
Phone – 922 68 10 630
The oil is chosen depending on the constitution of the body as well as the imbalance of the bio energies. At Chithrakoota Ayurveda, the therapists thoroughly examine a person’s body properties and if any past injuries and then select the most suitable oil. Don’t suffer from knee pain thinking it’s quite common. Consider Janu basti for great comfort and relief.
Kayachikitsa IMP Schlok – Part 7 - PPT
By Prof. Dr. R. R. Deshpande
• This PPT has following features –
• Imp Contents – Vata Vyadhi Chikitsa,Gudagat-Aamashayagat –Pakwashayagat – Siragat, Asthi Majjagat –Vata ,Ardit or Facial Palsy ,Pakshaghat or Hemiplegia, Grudhrasi or Sciatica ,Pashangardabha or Mumps, Kadar or corn ,Indralupta or Alopecia areata ,Darunak or Dandruff, Niruddha Prakash or Phimosis ,Unmad or Hysteria ,Apasmar or Epilepsy ,
• Visit – www.ayurvedicfriend.com
Phone – 922 68 10 630
The oil is chosen depending on the constitution of the body as well as the imbalance of the bio energies. At Chithrakoota Ayurveda, the therapists thoroughly examine a person’s body properties and if any past injuries and then select the most suitable oil. Don’t suffer from knee pain thinking it’s quite common. Consider Janu basti for great comfort and relief.
THROMBOPHEBLITIS
Thrombopheblitis is an inflammation of the vein walls it usually occurs in an extremity, especially one of the legs, inflammation due to response to a blood clot in the vessel.
Fwd: Bambury lecture on venous and lymphatic disorders of the limbJeku Jacob
---------- Forwarded message ----------
From: Henning L. Stokmo <helangen@gmail.com>
Date: 2009/2/12
Subject: Bambury lecture on venous and lymphatic disorders of the limb
To: ucdgrad09@gmail.com
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
The Gram stain is a fundamental technique in microbiology used to classify bacteria based on their cell wall structure. It provides a quick and simple method to distinguish between Gram-positive and Gram-negative bacteria, which have different susceptibilities to antibiotics
Thyroid Gland- Gross Anatomy by Dr. Rabia Inam Gandapore.pptx
Vein Disorder
1. Presented by: Dave Jay S. Manriquez RN.
Veins
• are thin-walled vessels that transport deoxygenated blood from the capillaries
back to the right side of the heart
3 Layers – intima, media, adventitia
• there is little smooth muscle & connective tissue Ú makes the veins more
distensible Ú they accumulate large volumes of blood
• Major veins, particularly in the lower extremities, have one-way valves ---allow
blood flow against gravity
• Valves allow blood to be pumped back to the heart but prevent it from draining
back into the periphery
Vein Disorders
Venous Thrombosis (Superficial and Deep Vein Thrombosis), Thrombophlebitis,
Phlebothrombosis – the above terms do not necessarily represent an identical
pathology, for clinical purposes they are often used interchangeably.
Cause of Venous thrombosis remains unclear, three antecedents factors are believed to
play a significant role in its development: stasis of blood, injury to the vessel wall, and
altered blood coagulation.
Thrombophlebitis – is inflammation of the walls of the veins, often accompanied by the
formation of a clot. When a clot develops initially in the veins as a result of stasis or
hypercoagulability , but without inflammation, the process is referred to as
Phlebothrombosis.
Venous thrombosis can occur in any vein but is most frequent in the veins of the lower
extremities. Both superficial and deep veins of the legs may be affected. Of the superficial
veins, the saphenous vein is most frequently affected. Of the deep leg veins, the
iliofemoral, popliteal, and small calf veins are most often involved.
Chronic Venous Insufficiency - Venous insufficiency is a disease state resulting from the
obstruction or reflux of venous valves in the legs. Both superficial and deep leg veins can
be involved. The resulting venous hypertension can occur whenever there has been a
prolonged increase in venous pressure, such as occurs with deep venous thrombosis. The
walls of veins are thinner and more elastic than walls of arteries, they distended readily
when venous pressure is consistently high. In this state, leaflets of the venous valves are
stretched and prevented from closing completely, thereby allowing a backflow or reflux
of blood in the veins.
When a deep veins in the legs have incompetent valves after a thrombus, postphlebitic
syndrome may develop. This result in edema, altered pigmentation, pain, stasis
dermatitis, and stasis ulceration.
Varicose Veins - abnormally dilated, tortuous, superficial veins cause by
incompetent venous valves.
2. Venous Disorders
alteration in the transport/flow of blood from the capillary back to the heart
changes in smooth muscle and connective tissue make the veins less distensible
with limited recoil capacity
valves may malfunction, causing backflow of blood
Virchow’s triad: blood stasis, vessel wall injury, and altered blood coagulation
Thrombophlebitis
inflammation of the veins caused by thrombus or blood clot
Factors assoc. with the devt. of Thrombophlebitis
venous stasis – occurs when blood flow is retarded, such as heart failure and
shock; when veins are dilated, such as after drug therapy; and when skeletal
muscle contraction is reduced, as with immobility, extremity paralysis, or
anesthesia.
damage to the vessel wall – disruption of the intimal lining of blood vessel creates
a site for clot formation, such as after a fracture or dislocation, diseases of the
veins, and chemical irritation of the vein from intravenous drugs or solutions.
hypercoagulability of the blood – oral contraceptive use
common to hospitalized pts. , undergone major surgery (pelvic or hip surgery),
MI
Pathophysiology
develops in both the deep and superficial veins of the lower extremity
deep veins – femoral, popliteal, small calf veins
superficial veins – saphenous vein
Thrombus – form in the veins from accumulation of platelets, fibrin, WBC and
RBC
Risk Factors for Thrombophlebitis
Bed Rest
General Surgery
Leg Trauma
Previous Venous Insufficiency
Obesity
Oral Contraceptives
Malignancy
Deep Vein Thrombosis (DVT)
tends to occur at bifurcations of the deep veins, which are sites of turbulent blood
flow
a major risk during the acute phase of thrombophlebitis is dislodgment of the
thrombus Ú embolus
pulmonary embolus – is a serious complication arising from DVT of the lower
extremities
Clinical Manifestations:
pain and edema of extremity – obstruction of venous flow
3. Û circumference of the thigh or calf
(+) Homan’s sign – dorsiflexion of the foot produces calf pain
Do not check for the Homan’s sign if DVT is already known to be present Ú Û
risk of embolus formation
* if superficial veins are affected - signs of inflammation may be noted – redness,
warmth, tenderness along the course of the vein, the veins feel hard and thready &
sensitive to pressure
The risk of dislodgement and embolization of superficial venous thrombi is very low
because the majority of them undergo spontaneous lysis, thus this condition can be
treated at home with rest, extremity elevation, analgesics, and possibly anti-
inflammatory agents.
Diagnostic Evaluation
Noninvasive Techniques: - rely on the thrombus to create abnormalities of venous flow.
Doppler Ultrasonography – use of a Doppler probe placed over veins that are
obstructed. Nonexpensive, portable, simple, rapid, and noninvasive.
Duplex Venous Imaging – able to obtain anatomic information, as well as to
assess physiologic parameters.
Impedance Plethysmography – is used to measure changes in venous vlume, a
blood pressure cuff is applied to patient thigh inflated enough to impede venous
flow (50-60 mmHg), calf electrodes are used to measure electrical resistance that
results from venous volume changes.
Invasive Techniques: - rely on the injection of contrast media into the venous system,
which then bind with structural elements of the thrombus.
I-labeled Fibrinogen Scanning - a sensitive method for early detection of venous
thrombosis. The test relies on the fact that radioactive fibrinogen, when injected
intravenously, will concentrate in the forming clot. The level o radioactivity can then be
serially measured by an external counter, and the progression of the clot can be
monitored.
Contrast Phlebography - involves the injection of radiographic contrast media into the
venous system through a dorsal foot vein.
Medical Management
Superficial thrombophlebitis
bed rest with legs elevated
apply moist heat
NSAID’s ( Non – steroidal anti-inflammatory drugs) - aspirin
Deep vein thrombosis
requires hospitalization
bed rest w/ legs elevated to 15-20 degrees above heart level ( knees slightly
flexed, trunk horizontal, head may be raised) to promote venous return and help
prevent further emboli and prevent edema
application of warm moist heat to reduce pain, promotes venous return
elastic stocking or bandage
anticoagulants, initially with IV heparin then coumadin
fibrinolytic to resolve the thrombus
4. vasodilator if needed to control vessel spasm and improve circulation
Nursing Intervention
Preventive care
prevent long periods of standing or sitting that impair venous return
elevate legs when sitting, dorsiflex feet at regular intervals to prevent venous
pooling
if edema occurs, elevate above heart level
regular exercise program to promote circulation
avoid crossing legs at the knees
avoid wearing constrictive clothing such as tight bands around socks or garters
use elastic stocking on affected leg
do leg exercises during periods of enforced immobility such as after surgery
Nursing Assessment - is invaluable in detecting early signs of venous disorders of the
lower extremities. Patients with history of varicose veins, hypercoagulation, neoplastic
disease, cardiovascular disease, or recent major surgery or injury, and the obese, the
elderly, and women taking oral contraceptives are in the high risk group.
characteristic of the pain
onset & duration of symptoms
history of thrombophlebitis or venous disorders
color & temp. of extremity
edema of calf of thigh - use a tape measure, measure both legs for comparison
Identify areas of tenderness and any thrombosis
Surgery
if the thrombus is recurrent and extensive or if the pt. is at high risk for
pulmonary embolism - . Surgery for deep vein thrombosis is necessary
when: 1. anticoagulant or thrombolytic therapy is contraindicated. 2. the
danger of pulmonary embolism is extreme and 3. the venous drainage is
so severely compromised that permanent extremity damage will probably
result.
Thrombectomy – incising the common femoral vein in the groin and extracting
the clots
Vena caval interruption – transvenous placement of a grid or umbrella filter in the
vena cava to block the passage of emboli
Nursing Management
Acute care
explain purpose of bed rest and leg elevation
use elastic stockings
monitor pt. on anticoagulant & fibrinolytic therapy for signs of bleeding
monitor for signs of pulmonary embolism – sudden onset of chest pain, dyspnea,
rapid breathing, tachycardia
Nsg. intervention often surgery of vena caval interruption
assess insertion site – bleeding, hematoma, apply pressure over site and inform
physician
5. keep pt. on bed rest for 1st 24 hrs. then encourage ROM exercises to promote
venous return
assist pt. in ambulation when permitted, elevate legs when sitting
keep elastic bandage
avoid rubbing or massaging the affected extremity
give analgesic and anti-inflammatory agents to promote comfort
Anticoagulant Therapy for Thromboembolism:
- is the administration of a medication to delay the clotting time of blood, to prevent the
formation of a thrombus in postoperative patients, and to forestall the extension of a
thrombus once it has formed. Anticoagulants cannot dissolve a thrombus that has already
formed.
Administration:
- Heparin is administered using a continuous pump infusion. To promptly reverse the
effects of heparin , the physician may prescribe intravenous injections of protamine
sulfate. For Coumadin it is Vitamin K.
- Intermittent intravenous injection is another means of administering heparin, in this
instance a dilute aqueous solution given every 4 hours.
- Oral anticougulants, such as Coumadin, are monitored by the prothrombin time.
Because Coumadin has a lag period of 3 to 5 days, it is usually administered in
conjunction with heparin until desired anticoagulation has been achieved.
Precaution and Nursing Assessment:
- The principal complication of anticoagulant therapy is the occurrence of spontaneous
bleeding anywhere in the body. A further possible complication of heparin therapy is that
of Heparin-induced thrombocytopenia which generally occurs 7 to 10 days after the
treatment has been started. Oral anticoagulants interact with many other medications. It
is advisory to study drug interactions for patients taking specific oral coagulants.
Patient Education About Oral Anticogulants:
- The patient should be informed about the medication, its purpose, and the need to take
the correct amount at the specific times prescribed, and should be aware that blood tests
are scheduled periodically to determine whether a change in medication dosage is
required.
Chronic Venous Insufficiency
Results from obstruction of venous valves in legs or reflux of blood back through
valves
Venous ulceration is serious complication – this is a result of inadequate
exchange of oxygen and other nutrients in the tissue, when the cellular
metabolism cannot maintain energy balance, cell death (necrosis) results.
Pharmacological therapy is antibiotics for infections
Debridement to promote healing
Topical Therapy may be used with cleansing and debridement
6. Management and Patient Education – management of the patient with venous
insufficiency is directed at reducing venous stasis and preventing ulcerations. Measures
that increases venous blood flow are antigravity activities and compression of superficial
veins with elastic stockings.
Elevation of the legs decreases edema, promote venous return. Elevations should be
performed frequently throughout the day (at least 30 minutes every 2 hours). At night, the
patient should sleep with the foot of the bed elevated for 6 inches. Prolonged sitting or
standing still detrimental, but walking should be encouraged. When sitting, patient
should avoid placing pressure on the popliteal spaces, such as occurs in leg crossing, or
sitting with the legs dangling over the side of the bed. Wearing of constricted garments
are also contraindicated.
Elastic stockings of the legs reduces pooling of venous blood and enhances venous return
to the heart. Prevent twisting of stockings causing tourniquet effect cause this will
worsens venous pooling. Extremities with venous insufficiency are conscientiously
protected from trauma. The skin is kept clean, dry, and soft. Signs of ulceration are
immediately reported to the nurse or physician for treatment and follow-up.
Varicose Veins
are abnormally dilated veins with incompetent valves, occurring most often in the
lower extremities, the saphenous veins, or the lower trunk however, it can occur
elsewhere in the body. Affect1 of 5 persons in the world. This condition is most
common in women and in persons in occupations requiring prolonged standing
such as salespeople, barbers, beauticians, elevator operators, nurses and dentist.
A hereditary weakness of the vein wall may contribute to the development of
varicosities, and it is not uncommon to see this condition occur in several
members of the same family.
• usually affected are woman 30-50 years old.
Causes:
– congenital absence of a valve
– incompetent valves due to external pressure on the veins from pregnancy,
ascites or abdominal tumors
– sustained Û in venous pressure due to CHF, cirrhosis
Prevention
– wear elastic stockings during activities that require long standing or when
pregnant
– moderate exercise, elevation of legs
Pathophysiology
the great and small saphenous veins are most often involved
weakening of the vein wall does not withstand normal pressureäveins dilate , pooling of
bloodävalves become stretched and incompetentämore accumulation of blood in the
veins
Clinical Manifestations
7. Primary varicosities – gradual onset and affect superficial veins, appearance of
dark tortuous veins. Affected persons may have no symptoms, but cosmetically the
appearance of the dilated vein is unappealing.
S/sx – dull aches, muscle cramps, pressure, heaviness or fatigue arising from reduced
blood flow to the tissues
Secondary Varicosities – affect the deep veins
occur due to chronic venous insufficiency or venous thrombosis
S/sx – edema, pain, changes in skin color, ulcerations may occur from venous stasis
Diagnostic Evaluation
A. Bordie-Trendelenburg test
assess competency of venous valves through measurement of venous filling time
the pt. lies down with the affected leg raised to allow for venous emptying
a tourniquet is then applied above the knee and the pt. stands. The direction and
filling time are recorded both before & after the tourniquet is removed
* Incompetent valves are evident when the veins fill rapidly from backward blood
flow
B. Perthes’ test - is a diagnostic procedure that easily indicates whether the deeper
venous system and communicating veins are competent. A tourniquet is applied just
below the knee and the patient is asked to walk. If the varicose veins disappear, the deep
system and communicating vessels are competent. If the vessels do not empty and become
distended on walking, incompetency or obstruction is inferred.
C. Additional tests for the presence of Varicose Veins are the Doppler flow meter- detect
retrograde flow of blood in superficial veins with incompetent valves after compression
of the leg proximally., Phlebography – the injection of radiographic contrast media into
the leg veins so that vein anatomy can be visualized during various leg movements. , and
Plethysmography – allows measurement of changes in venous blood volume..
Surgical Intervention
indicated or done for prevention or relief of edema, for recurrent leg ulcers or pain
or for cosmetic purposes
Vein ligation and stripping
the great sapheneous vein is ligated (tied) close to the femoral junction
the veins are stripped out through small incisions at the groin, above & below the
knee and at the ankles.
sterile dressing are placed over the incisions and an elastic bandage extending
from the foot to the groin is firmly applied
DIAGRAM:
Ligation and stripping of the great and the small saphenous veins. (A) The tributaries of
the saphenous vein have been ligated, and the saphenous vein has been ligated at the
saphenofemoral junction . (B) Vein stripper has been inserted from the ankle superiorly
to the groin. The vein is stripped from above to downward. A number of alternate
incisions may be needed to remove separate varicosities masses. (C) The small
8. saphenous vein is stripped from its junction with the popliteal vein to a point posterior to
the lateral malleolus.
Sclerotherapy – an irritating chemical (Sotradecol) is injected into the vein, which
irritates venous endothelium and produces localized phlebitis and fibrosis, thereby
obliterating the lumen. This treatment may be performed alone for small varicosities or
may follow vein ligation and stripping. Sclerosing is a palliative not a curative treatment.
Nursing care after vein ligation & stripping
Monitor for signs of bleeding, esp. on 1st post-op day
if there is bleeding, elevate the leg, apply pressure over the wound and
notify the surgeon
Keep pt. flat on bed for first 4 hrs. after surgery, elevate leg to promote venous
return when lying or sitting
Medicate 30 mins. before ambulation and assist patient
Keep elastic bandage snug and intact, do not remove bandage