Anatomy Vein Definition Type of Vericose Vein Factor/ causes Pathophysiology Clinical Manifestation Physical Assessment Management Nursing Diagnosis

1. Varicose Vein
Group 4
Fanny
Aishwarriya
Jane
Naga
Munirah

2. ANATOMICAL REVIEW

3. What is varicose vein?
• Dilated, swelled leg
veins with back flow of
blood caused by
incompetent valve
closure, which results in
venous congestion and
vein enlargement
• Usually affects the
saphenous vein and its
branches

4. TYPE OF VaRICOSE VEIN
Type of varicose vein:-
1.) Greater saphenous varicose veins
2.) Lesser saphenous varicose veins
3.) Genital area varicose vein
4.) Reticular type and Web type (spider
veins) varicose vein

5. 1.) Greater Saphenous Vericose Vein
• Greater saphenous vein is the superficial vein that goes
up from inside of ankle and is connected to femoral vein
at the inguinal region
• The area of outset of varicose vein is lower legs, inside
of thigh, outside of lower extremities and the back of
thigh

6. 2.) Lesser saphenous Varicose Veins
• next to greater saphenous varicose vein
• Lesser saphenous vein runs up from the outside of
Achilles tendon and is connected to deep vein at
the back of the knees
• The area of outset of lesser saphenous varicose
vein is at the back of ankle or knees

7. 3.) Genital area Varicose Vein
• Varicose vein that occurs due to the blood
that backflows from the vein around ovary and
womb
• Genital area varicose vein is suspected when
bumpy blood vessel meanders diagonally from
the groin at the back of femur and spreads
through lower extremity
• Become worsens when the flow of the blood
into ovary and womb increases during menstrual
period

8. 4.) Reticular type and Web type (spider Vein)
Varicose Vein
• Reticular type varicose vein swollen fine
subcutaneous veins in the size of 2-3mm in
diameter that spread like a mesh
• Web type (spider vein) varicose vein is dilated
capillary veins that are finer than reticular type in
the size of less than 1mm in diameter that exist
just below the skin
• Web type varicose veins are not bumpy like
saphenous varicose veins

9. Causes / Factors
1) Long time standing
- nurses have higher risk of getting varicose veins
due to prolong standing during shift time
2) Pregnancy
- Pregnant woman having pressure at lower limb part
3) Heavy physical activity
- Such as gym and boxing
4) Lifting heavy object frequently
- Lifting heavy object would give pressure to both
arms and hands

10. Pathophysiology
Any risk factor /causes
Increased venous pressure
Dilation of veins
Valves stretched
Incompetent valve
Reverse blood flow
Calf muscles fail to pump blood
Venous distension

11. Clinical Manifestation
• Enlarged veins that are visible on skin
• Mild swelling of ankles and feet
• Pain, achy or “heavy” legs
• Throbbing or cramping in legs
• Itchy legs, especially in the lower leg and ankle
• Discolouration of skin surrounding the varicose veins

12. ASSESSMENT
• History
- Complaints of leg pain, aching , heaviness or
fatigue; ankle swelling; history of venous
thrombosis
• Physical examination
- Visible, dilated, tortous superficial veins in
lower extremities
• Investigation
- Duplex Ultrasound
-Trendelenburg test

13. A) Duplex Ultrasound
- A non-invasive evaluation of blood flow through
your arteries & veins
- Provide a quantitative measure of severity of
valvular reflux
- Painless and easy. It tooks 30 mins to finished

14. B) Trendelenburg test
- To determine the underlying cause of superficial
venous insufficiency

15. TREATMENT
Surgical management
• Ligation and stripping
• Radiofrequency ablation
• Sclerotherapy

16. 1.) Ligation and stripping
• Ligation means the surgical tying of veins
through a small incision in the skin to prevent
pooling of blood
• The saphenous vein is ligated and divided at
high in the groin ( saphenous vein meet femoral
vein) and at the calf vein

17. 2.) Radiofrequency ablation
• Radiofrequency ablation involves
heating the wall of your varicose
vein using radiofrequency energy.
The vein is accessed through a
small cut made just above or below
the knee
• A narrow tube called a catheter is
guided into the vein using an
ultrasound scan. A probe is
inserted into the catheter
that sends out radiofrequency
energy
• This heats the vein until its walls
collapse, closing it and sealing it
shut. Once the vein has been
sealed shut, your blood will
naturally be redirected to one of
your healthy veins

18. 3.) Sclerotherapy
• Medical procedure used to
eliminate varicose veins and spider veins
• Involves an injection of a solution
(generally salt solution) directly into the
vein
• The solution irritates the lining of the
blood vessel and causing it to collapse
and stick together and the blood to clot

19. Conservative management
• Elevation of the legs
• Avoid prolonged standing
• Avoid cross-leg while sitting
• Compression stockings
• Exercise
• Lose weight

20. COMPLICATION
LipodermatosclerosisSuperficial thrombophlebitis
venous ulceration venous eczema

21. Nursing diagnosis: Impaired blood circulation related
to venous insufficiency
Goal: Improve venous return from peripheral tissue
1) Assess peripheral pulses, capillary refill, skin
colour, and temperature every 4 hourly
Rationale: To obtain baseline data and further
treatment can be carry out
2) Assess pain in extremities by asking the pain
score using numerical pain scale
Rationale: to evaluate the severity of the pain to
plan for pain management
3) Teach application and use of properly fitted elastic
graduated compression stockings

22. Rationale: Elastic compression stockings compress
the veins, and promoting venous return from the
lower extremities
4) Instruct patient to perform regular exercise, such
as walking for 20-30 minutes several times a day
Rationale: exercises help to maintain muscle tone,
joint mobility, venous return as it promotes to
stimulates circulation and promotes blood flow
through the vascular system
5) Advice patient to elevate the legs for 15 to 20
minutes several times a day and to sleep with the
legs elevated above the level of the heart
Rationale: To promotes venous return, reducing
tissue congestion and improving arterial circulation

23. 6) Encourage patient to wear socks during night time to
keep extremities warm
Rationale: to maintain vasodilatation as it can increase
blood supply
7) Advice patient to avoid crossing legs when sitting
Rationale: to prevent impairment of blood flow to
distal tissues
8) Advice patient to reduce weight
Rationale: as obesity can cause pressure to lower limbs
9) Educate patient about sign & symptom of cellulitis such
as severe redness, pain & increased swelling in an
extremities.
Rationale: so further treatment can be carry out
Evaluation: Venous return from peripheral tissue as
evidenced by normal capillary refill, pinkish and warm
skin

25. SUMMARY
Varicose veins are gnarled and enlarged
veins. Any vein may become varicose,
but the veins most commonly affected
those legs and feet. That's because
standing and walking upright increases
the pressure in the veins of your lower
body
Press this
button

26. References
• http://www.varixlaser.com/english/treatment-
of-typical-varicose-veins/
• https://www.slideshare.net/diliprajpal/endoven
ous-laser-ablation
• Medical-Surgical Nursing Critical Thinking in
patient care Lemone Burke Bauldoff 5th Edition
• Medical-Surgical nursing patient-centered
collaborative Care Ignatavicius Workman 8th
Edition
• Nursing diagnosis handbook – Betty J. Ackley &
Gail B. Ladwig