Varicose Veins

Dr. Belal Hijji, RN, PhD

April 4, 2012
 Learning Outcomes

At the end of this lecture, students will be able to

Define and describe varicose veins.
Describe the prevalence and risk factors of varicose veins.
Discuss the clinical picture and diagnosis of varicose veins.
Describe the medical and nursing management of varicose
veins.

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 Definition

Varicose veins are

abnormally dilated,
tortuous, superficial
veins caused by
incompetent venous
valves (see Fig. 1).
Most commonly, this
condition affects the
lower extremities, the
saphenous veins (Slide
2), and may occur in
the esophagus. Fig. 1: Competent valves showing blood flow
patterns when the valve is open (A) and closed
(B), allowing blood to flow against gravity. (C)
With faulty or incompetent valves, the blood 3is
unable to move toward the heart.
.Fig. 2 The greater and lesser saphenous veins
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 Prevalence And Risk Factors For Developing Varicose
Veins

Varicose veins affects about 60% of the adult population in

America. In KSA, the prevalence of chronic venous
insufficiency (of which varicose veins is just one class) was
found to be 45.6% (50% among female and 25% among male)
(Bawakid et al. 2005).
The risk for developing varicose veins is associated with
increased age, gender, those with occupations requiring
prolonged standing, such as salespeople, hair stylists, teachers,
nurses, ancillary medical personnel, construction workers,
family history, pregnancy (hormonal effects, increased
pressure).

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 Clinical Manifestations

The patient maybe asymptomatic. However, the patient may

have dull aches, muscle cramps, increased lower legs muscle
fatigue, ankle edema and a feeling of heaviness of the legs.
Nocturnal cramps are common. When deep venous obstruction
results in varicose veins, patients may have edema, pain,
pigmentation, and ulcerations. Susceptibility to injury and
infection is increased.

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 Assessment and Diagnostic Findings
Duplex scanning (see figure below) has become the 'gold
standard' for confirming reflux and demonstrating anatomy in
cases of lower limb venous disease.

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 Prevention of Varicose Veins
Activities that cause venous stasis should be avoided. These
include wearing tight socks or a constricting panty girdle (Rt.
Figure), crossing the legs, and sitting or standing for long
periods.
Changing position frequently, elevating the legs when tired, and
walking (if not contraindicated), rather than using an elevator,
promote circulation. Swimming is also good exercise for the
legs. Patients should use knee-high stockings (Middle Figure)
than thigh-high stockings (Lt. Figure). The overweight patient
should reduce his weight.

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 Medical Management
Sclerotherapy. In this procedure, small- and medium-sized
varicose veins are injected with a chemical that scars and
closes those veins. In a few weeks, treated varicose veins
should fade. After the injection, elastic compression bandages
are worn for approximately 5 days. Elastic compression
stockings are then worn for an additional 5 weeks. Patients are
encouraged to perform walking activities as prescribed to
maintain blood flow in the leg.
Laser surgeries. Laser treatments are used to close off smaller
varicose veins and spider veins. Laser surgery works by
sending strong bursts of light onto the vein, which makes the
vein slowly fade and disappear. No incisions or needles are
used.
 Medical Management
Vein stripping. This procedure involves removing a long vein
through small incisions. This is an outpatient procedure for
most people. Removing the vein won't affect circulation in
your leg because veins deeper in the leg take care of the larger
volumes of blood.
 Nursing Management
Postoperatively, bed rest is maintained for 24 hours.
Subsequently, the patient begins walking every 2 hours for 5 to
10 minutes.
Elastic compression stockings are used to maintain
compression of the leg. They are worn continuously for about
1 week postop.
The nurse assists the patient to perform exercises and move
the legs. The foot of the bed should be elevated.
Standing still and sitting are discouraged.

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 Promoting Comfort and Understanding
The nurse administers analgesics to help patients move affected
extremities more comfortably. Dressings are inspected for
bleeding, particularly at the groin, where the risk of bleeding is
greatest.

The nurse is alert for reported sensations of pins and needles.

Hypersensitivity to touch in the involved extremity may indicate
a temporary or permanent nerve injury resulting from surgery,
because the saphenous vein and nerve are close to each other in
the leg.

The patient may shower after the first 24 hours. The patient is
instructed to dry the incisions well with a clean towel without
rubbing. Application of skin lotion is to be avoided until the
incisions are completely healed to decrease the chance of
developing an infection. 12