Peripheral Vascular System Peripheral Vascular System and Lymphatics: A&P and and Lymphatics: A&P and AssessmentAssessment

Jensen, ch 18Jensen, ch 18

ArteriesArteries

• High pressure systemHigh pressure system

• Heart is pump for systemHeart is pump for system

• Elastic, tough, thick, strongElastic, tough, thick, strong

• Recoil allows stretchingRecoil allows stretching

• Made of vascular smooth muscle so Made of vascular smooth muscle so meds that affect VSM will affect arteriesmeds that affect VSM will affect arteries

VeinsVeins

• Low pressure systemLow pressure system• More veins than arteriesMore veins than arteries• Large diameter allows expansion of holding of Large diameter allows expansion of holding of

large amounts of blood (capacitance vessels)large amounts of blood (capacitance vessels)• Do not have pump, but valvesDo not have pump, but valves• Valves, calf muscles, and respiratory cycle Valves, calf muscles, and respiratory cycle

facilitate venous returnfacilitate venous return

LymphaticsLymphatics

• Completely separate system of microscopic, Completely separate system of microscopic, open-ended tubes open-ended tubes

• Prevents edema by siphoning excess fluid Prevents edema by siphoning excess fluid from tissue spaces that is not reabsorbed by from tissue spaces that is not reabsorbed by veinsveins

• Absorbs lipids from intestinal tractAbsorbs lipids from intestinal tract• Conserves fluid and plasma proteins that leak Conserves fluid and plasma proteins that leak

out of capillariesout of capillaries

Lymphatics (cont’d)Lymphatics (cont’d)

• Nodes are the filtersNodes are the filters• Flow is propelled by valves, respiratory Flow is propelled by valves, respiratory

cycle, muscles and lymph vessel cycle, muscles and lymph vessel contractionscontractions

• Forms major part of immune systemForms major part of immune system

Lymphatics cont’dLymphatics cont’d

• Two main trunks:Two main trunks:– Right lymphatic that drains right side of Right lymphatic that drains right side of

head and neck, right arm, right thorax and head and neck, right arm, right thorax and lung, right heart, RUQ of liver. Empties into lung, right heart, RUQ of liver. Empties into right subclavian veinright subclavian vein

– Thoracic duct drains rest of body and Thoracic duct drains rest of body and empties into left subclavian empties into left subclavian

Related OrgansRelated Organs

• Spleen—destroys old RBCs and stores Spleen—destroys old RBCs and stores new ones, produces antibodies, filters new ones, produces antibodies, filters bloodblood

• Tonsils—palatine, adenoid, lingual—Tonsils—palatine, adenoid, lingual—respond to inflammationrespond to inflammation

• Thymus—develops T lymphocytes in Thymus—develops T lymphocytes in childrenchildren

Developmental Developmental ConsiderationsConsiderations

• Lymph tissue adult size by age 6; twice adult Lymph tissue adult size by age 6; twice adult size by puberty; back to adult size by age 18size by puberty; back to adult size by age 18

• Somewhat large and palpable in children Somewhat large and palpable in children (shoddy) even when not inflamed, but should (shoddy) even when not inflamed, but should not be hard, tender, or immovablenot be hard, tender, or immovable

• Vessels and nodes atrophy and vessels grow Vessels and nodes atrophy and vessels grow rigid in older adultsrigid in older adults

• Rise in systolic pressure and peripheral Rise in systolic pressure and peripheral arterial dz (PAD) are common in older adultsarterial dz (PAD) are common in older adults

Assessment: HistoryAssessment: History

• Risk factors:Risk factors:– Arterial—nonmodifiable and modifiable Arterial—nonmodifiable and modifiable

same as for cardiac dz (499)same as for cardiac dz (499)– Venous—bedrest, prolonged sitting and Venous—bedrest, prolonged sitting and

standing, hypercoagulation, vein wall standing, hypercoagulation, vein wall trauma, genetics, obesity, pregnancy, trauma, genetics, obesity, pregnancy, BCPsBCPs

History cont’dHistory cont’d

• Ask about:Ask about:– Leg painLeg pain– Color changes (red, white, blue, brown)Color changes (red, white, blue, brown)– UlcerationsUlcerations– EdemaEdema– Swollen glandsSwollen glands– Sx of hypertension (if any)Sx of hypertension (if any)– Meds (esp hormones, antihypertensives, Meds (esp hormones, antihypertensives,

anticoagulants)anticoagulants)

Physical AssessmentPhysical Assessment

• Accessible arteries for examination:Accessible arteries for examination:– TemporalTemporal– CarotidCarotid– BrachialBrachial– RadialRadial– UlnarUlnar– FemoralFemoral– PoplitealPopliteal– Pedal (dorsalis pedis, posterior tibial)Pedal (dorsalis pedis, posterior tibial)

Assessment cont’dAssessment cont’d

• Accessible lymph nodes: epitroclear, inguinalAccessible lymph nodes: epitroclear, inguinal• Accessible veins for examination:Accessible veins for examination:

– JugularJugular– BrachialBrachial– CephalicCephalic– FemoralFemoral– PoplitealPopliteal– Saphenous (great and small)Saphenous (great and small)

Assessment cont’dAssessment cont’d

• Assess in semi-Fowler’s positionAssess in semi-Fowler’s position• InspectInspect for peripheral tissue perfusion—color, for peripheral tissue perfusion—color,

clubbing, hair distribution, ulcerationsclubbing, hair distribution, ulcerations• Six Ps are important in some patients to Six Ps are important in some patients to

assess neurovascular status (499)assess neurovascular status (499)• AuscultateAuscultate temporal, carotid, and femoral temporal, carotid, and femoral

arteries for bruits; auscultate blood pressurearteries for bruits; auscultate blood pressure

Assessment cont’dAssessment cont’d

• Palpate for:Palpate for:– Rate, rhythm, symmetry, amplitude (506)Rate, rhythm, symmetry, amplitude (506)– Edema—pitting or not, grade as 1-4+ (506)Edema—pitting or not, grade as 1-4+ (506)– TemperatureTemperature– TextureTexture– Cap refillCap refill– Epitroclear and inguinal nodesEpitroclear and inguinal nodes

• Measure for calf size and symmetryMeasure for calf size and symmetry

Assessment cont’dAssessment cont’d

• Tests for PV system:Tests for PV system:– Allen test (508), positional color changes Allen test (508), positional color changes

(512), and Doppler (arterial) (511)(512), and Doppler (arterial) (511)– Ankle-brachial index (ABI) to assess for Ankle-brachial index (ABI) to assess for

peripheral vascular dz (PVD) (511)peripheral vascular dz (PVD) (511)– Homan’s sign (venous)Homan’s sign (venous)