Varicose VEIN Examination PDF

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Varicose VEIN Examination...

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VARICOSE)VEIN)EXAMINATION) Introduction:+ - Wash+hands+ - Introduce+ - Confirm+patients+details+ - Explain+procedure+—>+“this+examination+will+involve+me+looking+at+your+legs+whilst+standing,+ feeling+the+veins+and+performing+some+other+tests,+please+could+you+take+your+trousers+off+but+ keep+your+underwear+on”+ - Consent+(offer+chaperone?)+ General+inspection:++ - Does+the+patient+look+comfortable?+ - Do+they+appear+clinically+unstable?+(e.g.+shortness+of+breath)++ - Look+around+the+bed+for+clues+(e.g.+compression+stockings,+wound+dressings/bandages)++ Leg+inspection:++ 1. With+patient+standing+(if+able)+look+for+signs+of+venous+disease+from+the+front,+side+and+back+of+ the+legs++ - Surgical+scars++ - Venous+eczema+ - Lipodermatosclerosis+ - Venous+ulcers+(along+medial+distal+leg)+ - Saphena+varix+ - Arterial+disease+ - Varicose+veins+(great+saphenous,+small+saphenous)+ Palpation:+ 1. Assess+the+temperature+of+any+varicosities++ 2. Palpate+any+visible+varicosities++ 3. Assess+for+pitting+oedema+in+the+limb++ 4. Palpate+the+pulses+in+the+legs+to+briefly+assess+the+arterial+blood+supply+of+each+leg+ - Femoral+ - Popliteal+ - Posterior+tibial++ - Dorsalis+pedis+++ Percussion:++ - Tap+test++ Auscultation:++ - Auscultate+varicosity+with+bell+of+stethoscope+(presence+of+bruit+indicates+turbulent+blood+flow+ which+may+suggest+an+underlying+AVM)+ Trendelenburg+test+(a.k.a+Tourniquet+test):+ 1. Position+patient+flat+on+couch,+lift+leg+up+and+empty+superficial+veins+ 2. Place+tourniquet+over+SFJ+and+ask+patient+to+stand+and+observe+for+filling+of+veins++ 3. If+veins+have+not+filled+and+remain+collapsed+it+indicates+the+incompetent+venous+valves+was+at+ the+level+of+SFJ++ 4. If+veins+have+filled+up+again,+incompetent+valves+are+inferior+to+SFJ+(i.e.+perforator+veins+that+ drain+venous+blood+from+superficial+to+deep+veins+in+the+muscle)+ 5. Repeat+with+tourniquet+3cm+lower+

Cough+impulse+test:+ 1. Place+hand+over+SFJ+and+ask+patient+to+cough++ 2. If+you+feel+an+impulse+over+the+SFJ+this+indicates+a+saphena+varix+(dilation+of+saphenous+vein+at+ the+SFJ)++ Perthe’s+test:++ 1. Apply+tourniquet+at+proximal+mid-thigh+level+whilst+the+patient+is+standing++ 2. Ask+the+patient+to+walk+around+the+room+(or+continually+alternate+between+standing+on+tiptoes+and+flat+feet)+for+5+minutes++ To+complete+the+examination:++ - Thank+patient,+wash+hands,+document++ Further+assessment+and+investigations:++ - Abdominal+examination++ - Doppler+ultrasound+of+any+varicosities+noted++ - Peripheral+arterial+examination+...