3. VARICOSE VEIN
Presented by
Aseem.B, MBA, MSc N, PGDHA,
Assistant Professor in Nursing,
SP FORT College of Nursing,
Thiruvananthapuram
aseem.sapphire
5. DEFINITION
Varicose veins are dilated tortuous subcutaneous
veins most frequently found in the saphenous
system.(Lewis Heitkemper).
Varicose veins are dilated, tortuous superficial veins
that result from defective structure and function of
the valves of the saphenous veins, from intrinsic
weakness of the vein wall, from high intraluminal
pressure, or rarely from arteriovenous fistulas.
Varicose vein is a dilated and twisted condition of the
veins caused by structural changes in the walls or
valves of the vessels.
19. pathophysiology
Due to various Etiology and risk factors
Enlargement of vein in the leg
Streching of valves and it become incompetent
Back flow of blood
Increased back pressure Calf muscle pump fails
Venous distention and edema
20. TYPES
• PRIMARY : originate in the superficial system.
More common in women and patients with
strong family history.it is caused by the congental
weakness of veins.(idiopathic varicosities)
• SECONDARY : it result from deep venous
insufficiency or from deep venous occlution
causing enlargement of superficial veins.it may
occur in the esophagial varices, anorectal
areas(haemorrhoids),AV fistulas.
21. CLINICAL MANIFESTATIONS
• Aching, heavy legs (often worse at night and after
exercise).
• Appearance of spider veins (telangiectasia) in the
affected leg.
• Ankle swelling.
• A brownish-blue shiny skin discoloration near the
affected veins.
• Redness, dryness, and itchiness of areas of skin -
termed stasis dermatitis or venous eczema,
because of waste products building up in the leg.
22.
23.
24. CLINICAL MANIFESTATIONS continued
• Cramps may develop especially when making a
sudden move as standing up.
• Minor injuries to the area may bleed more than
normal and/or take a long time to heal.
• In some people the skin above the ankle may shrink
(lipodermatosis) because the fat underneath the
skin becomes hard.
• Whitened, irregular scar-like patches can appear at
the ankles. This is known as atrophic blanche.
33. Medical Management
• Drug Therapy,
• Sclerotherapy,
• Foam Sclerotherapy,
• Endovenous Laser Therapy.
34. DRUG THERAPY
• Anti inflammatory drugs such as
IBUPROFEN, ASPIRIN can be used for
treatment of superficial
thrombophlebitis
• Anti coagulation therapy is used in
extensive thrombophlebitis
35. SCLEROTHERAPY
• Commonly performed non surgical treatment
• Medicine is injected into the veins to make them
shrink
• Two techniques : 1. injection of a sclerosing
agent alone
• 2.Injection of a mixture containing a sclerosing
and foaming agent.
• Commonly used agents are hypertonic saline,
saline plus hypertonic dextrose, morruate
sodium, ethanolamine oxalate.
36.
37. SCLEROTHERAPY
• Direct IV induces inflammation and results in
eventual thrombosis of the vein
• Performed in the clinical setting or office
setting : minimal discomfort
• After injection leg is wrapped with elastic
bandage for 24-72 hours
• Potential complication are itching, pian ,
blister, oedema, hyperpigmentation,
thrombophlebitis and DVT
40. FOAM THERAPY
• In this technique a sclerosing foam agent
is used
• Foam has more surface area than liquid,
which increases the likelihood that it will
cling to its target area
• Foam irritates the vein and causes it to
shrink more quickly.
43. ENDOVENOUS LASER THERAPY
• New technique
• Uses laser to destroy the vein
• Is a OP procedure with minimal discomfort
• It takes around 30-45 mins
• Small laser is passed in to the vein with the
guidance of ultrasound dupplex scanning
• Mild bruising and numbing is the reported
complications
45. RADIO FREQUENCY ABLATION
• Newer technique
• Uses heat to destroy the vein
• Ultrasound sound guidance is there
• Performed under local anesthesia
• Takes around 30 mins
48. SURGICAL STRIPPING AND LIGATION
• Oldest method for treatment of varicose vein
• Ussually used to remove the main superficial
vein( the long saphenous vein)
• Strippers of various designs are used to pull
out the vein
• General anaesthesia is given and connected to
ventillator
• Performed in a hospital OT or equivalent
setting.
52. MINI PHLEBECTOMY
• Office surgical procedure
• Performed under local anaesthesia
• Faulty area is removed through minute
incisions
53. SIDE EFFECTS OF SURGERY
• Surgery can leave permanent scars.
• Serious side effects are uncommon
• with general anaesthesia, there always is a risk of
cardiac and respiratory complications.
• Bleeding and congestion of blood can be a problem,
but the collected blood usually settles on its own and
does not require any further treating.
• Wound infection, inflammation
• swelling and redness can occur.
• A very common complication is the damage of nerve
fibres around the veins which can lead to pain.
54. PRE OPERATIVE CARE
• Explain about the surgery its benefit,
complication and after effects to the patient and
concerned bystanders.
• High risk consent should be taken from the
patient and bystanders.
• Blood investigations should be done
• Surgery site should prepared
• Patient should maintain NPO status.
• IV should be administered before surgery
• Emergency cart including lifesaving equipments
and drugs should be ready.
• Input output chart should be maintained.
55. POST OPERATIVE CARE
• Check vital signs
• Elevate the drugs
• Administer all the necessary drugs
• Maintain inut output chart
• Connect all the necessary monitors
• Promote rest
• Apply elastic bandage
• Avoid or minimise visitors
• Promote good nutrition
• Encourage avoidance of leg crossing( it causes compression of vessels
resulting in venous stasis)
• Encourage moderate amount of walking(it promotes venous return by
activating muscle pump).
• Caution to avoid scratching or vigorous rubbing(it can cause skin abrasions
and bacterial invasions)
• Encourage avoidance of constrictive clothing and accessories( It impede
circulation and promote venous stasis).
• Include family others in teaching program.
57. NURSING MANAGEMENT
The main aim of nursing management are :
• Improving circulation
• Relieving discomfort
• Improving cosmetic appearance
• Avoiding complications.
ASSESSMENT
1. Health history
2. Physical examination
58. NURSING DIAGNOSIS
• Acute pain related to venous congestion,
impaired venous return and inflammation
• Ineffective health maintenance related to lack of
knowledge about disorder and its treatment
• Risk for impaired skin integrity related to altered
peripheral tissue perfusion.
• Potential complication : bleeding related to
anticoagulant therapy
• Potential complication : pulmonary embolism
related to dehydration and immobility
59. NURSING INTERVENTIONS
• Restoring skin integrity
• Promote rest
• Improving Physical Mobility
• Promoting Adequate Nutrition
• Promoting Home and Community Based
Care
60. CONSERVATIVE MANAGEMENT
• Leg elevation
• Take rest
• Wear compression stockings
• Weight reduction
• Avoid alcohol
• Visit your health care provider
• Do not cross legs when sitting
• Take exercises
63. COMPLICATIONS
• Pain, heaviness, inability to walk or stand for
long hours thus hindering work
• Skin conditions / Dermatitis which could
predispose skin loss
• Skin ulcers especially near the ankle, usually
referred to as venous ulcers.
• Development of carcinoma or sarcoma in
longstanding venous ulcers. There have been
over 100 reported cases of malignant
transformation and the rate is reported as 0.4%
to 1%.
• Severe bleeding from minor trauma, of particular
concern in the elderly.
64. Complication continued
• Blood clotting within affected veins. Termed superficial
thrombophlebitis. These are frequently isolated to the
superficial veins, but can extend into deep veins
becoming a more serious problem.
• Acute fat necrosis can occur, especially at the ankle of
overweight patients with varicose veins. Females are
more frequently affected than males.
• Tenderness in that region.
• Restless legs syndrome: (RLS) appears to be a common
overlapping clinical syndrome in patients with varicose
veins and other chronic venous insufficiency.
66. bibliography
• Lewis Heitkemper Dirsksen O’brien Bucher “ Medical surgical nursing” seventh edition
Elsevier publications page number :917-919
•
• Joyce M Black Jane Hokanson Hawks “ Medical surgical Nursing ” 7th edition volume no 7
Elsevier publications page number :1539-1540.
•
•
• Suzanne C Smeltzer Brenda Bare “ textbook of medical surgical nursing ” 10thedition
Lippincott Williams & Wilkins publications pagenumber :849-850.
•
•
• Barbara F Weller “ Baillieres Nurses dictionary ”twenty third edition, Bailliere tindall
publication, London , UK page no : 410.
•
• Fahey VA, Schindler N “ Arterial reconstruction of lower extremities : Vascular Nursing ”ed4,
Philadelphia, Saunders publications 2004 page number 26-28.
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