Varicose vein

Question 1

1

Answer 1

“Today I need to examine the veins in your legs. This will involve me first looking at the veins, then feeling the veins and performing some special tests. You’ll need to take your trousers off for the examination, but you can keep your underwear on.”

have patient stand and remove trousers

Question 2

2

Answer 2

general inspection of area looking for scars, ulcers, medical equipment, mobility aids etc.

Question 3

3

Answer 3

leg inspection

STANDING

SIDE, BACK, FRONT

With the patient standing (if able) look for signs of venous disease from the front, side and back of the legs.

Question 4

4

Answer 4

assess TEMPERATURE

places back of hand along the varicosities to assess temp

Question 5

5

Answer 5

Palpate any varicosities

ANY YOU SEE, PALPATE THEM

Palpate the entire length of each varicosity and ask the patient to let you know if they experience any pain

Question 6

NEXT

Answer 6

PITTING OEDEMA & 4x PULSES

FEMORAL PULSE

POPLITEAL PULSE

TIBIAL

DORASLIS PEDIS

Question 7

6

Answer 7

Find SFJ

“Place one finger, with a small amount of pressure, onto the saphenofemoral junction (SFJ) which is located 4cm inferior-lateral to the pubic tubercle”

Cough impulse - put finger on SFJ (google) and ask pt to cough (thrills)

Question 8

7

Answer 8

Percussion (tap test)

FEEL IT & TAP THE VARICOSE VEIN, SHOULD FEEL THRILL IN THE SFJ

The tap test provides a crude assessment of lower limb venous valve competency. It is rarely performed in modern clinical practice, but it is worth understanding what the test involves.

To perform the tap test: (finger on SFJ, tap varicose, feel it on SFJ)

1. Place one finger, with a small amount of pressure, onto the saphenofemoral junction (SFJ) which is located 4cm inferior-lateral to the pubic tubercle
2. Tap the varicose vein you are assessing, which should be located lower down the leg (do 2 or 3 taps of the varicose)

Should feel it in the SFJ:

3. If your finger over the SFJ detects a thrill, this suggests that there is continuity of the vein due to incompetent venous valves (normally the venous valves should prevent the thrill transmitting along the entirety of the vessel).

Question 9

8

Answer 9

Auscultate the varicosity

Question 10

9

Answer 10

Trendelenburg test (tourniquet test)

Question 11

10

Answer 11

Examine the abdomen to exclude an abdominal or pelvic cause of raised venous pressure

Question 12

13

Answer 12

summarise… ?

Thank the patient and request them to redress.
• Wash your hands.

Question 13

14

Answer 13

To complete:

I’d use a Doppler probe
Perfrom Perthes test
Perform Trendelenburg test