Varicose Veins Nursing Management

 VARICOSE VEINS AND ANEURYSMS

Varicose veins are abnormally dilated tortuous, superficial veins caused by incompetent venous values. Most common in women and in persons in occupations requiring prolonged standing such as sales people, barbers, beauticians, nurses and dentists. Can occur elsewhere in the body i.e. Esophageal and hemorrhoidal veins.

Causes

1. Hereditary weakness of vein wall or values.
2. Long-standing-distention of veins brought about by pregnancy, obesity or prolonged standing. 
3. Old age-loss of tissue elasticity.

Pathophysiology

Equilibrium of liquid and pressure exerted by liquid at rest.

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Hydrostatic pressure and vein weakness

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Vein walls become distended with asymmetrical dilatation and some valves become incompetent.
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Prevents valve cusps from meeting.

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Increased back-up pressure, which is passed into the next lower segment of the vein.
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Varicosity.

Clinical Manifestation

1. Disfigurement due to large, discoloured, tortuous leg veins,
2. Easy leg fatigue, cramps in leg, heavy feeling, increased pain during menstruation, nocturnal muscle cramps - superficial veins are affected.
3. When deep venous obstruction results in varicose veins, the s/s edema, pain, pigmentation and ulceration. Susceptibility to injury and infection is great.

Diagnosis

1.Brodie Trendelenburg test (With the patient lying down, the affected leg is elevated to empty the veins. A soft rubber tourniquet is then applied around the upper thigh to occlude the veins, and the patient is asked to stand. If the valves of the communicating veins are incompetent, blood flows into the superficial veins from the deep veins. If, upon release of the tourniquet, blood flows rapidly from above into the superficial veins, this indicates that the valves of the superficial veins are also incompetent.] This demonstrates the backward flow of blood through incompetent valves of the superficial veins and of the branches that communicate with the deep veins of the leg.

2. Perthe's test indicates whether the deeper venous system and communicating veins are competent. [A tourniquet is applied just below the knee and the patient is asked to walk. If the varicose veins disappear, the deep system and communicating vessels are competent. If the vessels do not empty and become even more distended on walking, it indicates incompetency or obstruction.

3. Doppler flow meter detects the retrograde flow of blood in superficial veins with incompetent valves following compression of the leg proximally.

4. Phlebography involves injection of radiographic contrast into the leg veins so that vein anatomy can be visualized during various leg movements.

5. Plethysmography allows measurement of changes in venous blood volume.

Medical Management

Patient is instructed to:

1. Avoid activities that cause venous stasis by obstructing venous flow like wearing tight garters, right girdle, sitting or standing for prolonged periods of time, crossing the legs at knees for prolonged periods while sitting.

2. Control excessive weight gain.

3. Wear firm elastic support, from toe to thigh when in upright position, put elastic stockings on in bed before getting up.

4. Elevate foot of bed 15-20 cm (6-8") for night sleeping

5. Avoid injuring legs

Surgical Treatment:

Ligation and stripping:

Under GA, vein (saphenous) is ligated high in the groin where the saphenous vein meets. the femoral vein. An incision is then made in the ankle, and a metal or plastic wire is passed the full length of the vein, "stripping" as it passes. The branches of the saphenous vein break off at their junctions. Pressure and elevation keep bleeding at a minimum during surgery.

Sclerotherapy An irritating chemical, such as 3% sodium tetradecyl sulfate, is injected into the vein, which irritates the vein wall and produces localized phlebitis and fibrosis, thereby obliterating the vein lumen. This is done for small varicosities and may follow vein ligation and stripping.

Following injection of the sclerosing agent, elastic compression bandages are applied to the leg-6 weeks. Walking is important for maintenance of blood flow.

Post-Operative Nursing Care

1. Elastic compression of the leg is maintained continuously for about 1 week after vein stripping
2. Exercise and movement of the legs and elevation of the foot of the bed are necessary.
3. Walking may be started 24-48 hours after surgery.
4. Standing still and sitting are contraindicated.
5. Administer analgesics as prescribed.
6. The bandages are inspected for bleeding, particularly in the groin
7. Sensations of "pins and needles" or hypersensitivity to touch in the involved extremity may indicate a temporary or permanent nerve injury.