PERIPHERAL CIRCULATION EXAM (VENOUS)

Question 1

How should the patient be positioned for the peripheral venous circulation examination?

Answer 1

The should initially be standing

Question 2

What might you look for during general inspection of the patient in a peripheral venous circulation examination?

Answer 2

Whether patient looked stable
Breathlessness - PE
Any obvious swelling in either leg - DVT
Any obvious varicose veins
Any medicines around the bed

Question 3

Whilst the patient is standing at the beginning of the peripheral venous circulation examination, what would you look at?

Answer 3

Any obvious swelling in either leg - DVT
Any obvious varicose veins
Gait

Question 4

Having inspected their gait as part of the peripheral venous circulation examination, what would you do next?

Answer 4

Get the patient to lie down and inspect their legs again.

Question 5

Whilst the patient is lying on the bed as part of the peripheral venous circulation examination, what would you look for?

Answer 5

Swelling in either leg - DVT, HF 
Varicose veins 
Venous eczma
Skin colour changes
Haemosiderin deposits
Lipodermatosclerosis - inflammation of subcut fat (woody hard skin, pigmentation, swelling, redness, inverted champagne bottle leg)
Venous ulcers/Atrophy blanche

Question 6

If you notice varicose veins as part of the peripheral venous circulation examination, what aspects about them should you comment on?

Answer 6

Distribution
Colour
Prominence

Question 7

Having inspected the leg with the patient lying down as part of the peripheral venous circulation examination, what would you palpate?

Answer 7

Palpate varicosities for tenderness and hardness (phlebitis)
Palpate saphenofemoral junction - check cough impulse
Palpate for any calf tenderness

Question 8

Having palpated the leg as part of the peripheral venous circulation examination, what should you do next?

Answer 8

Elevate limb to 15 degrees and note rate of emptying

Perform Tredelenburg test if varicose veins present