Venous Disorders: Chronic Venous Insufficiency
Venous insufficiency results from obstruction of the venous valves in the legs or a reflux of blood back through the valves. Superficial and deep leg veins can be involved. Resultant venous hypertension can occur whenever there has been a prolonged increase in venous pressure. Because walls of veins are thinner and more elastic than the walls of arteries, they distend readily when venous pressure is consistently elevated. In this state, leaflets of the venous valves are stretched and prevented from closing completely, allowing a backflow of blood in the veins. Venous ulceration is the most serious complication.
The following the evident signs and symptoms for chronic venous insufficiency:
- Altered pigmentation
- Stasis dermatitis
- Dilated superficial veins
- Stasis ulcers (brownish discoloration usually in the medial malleolus of the ankle, skin is dry, cracked and itchy, subcutaneous tissues fibrose and atrophy)
Venus ulceration is the most severe complication of chronic venous insufficiency. This can be associated with other conditions and underlying factors affecting the circulation of the lower extremities. Caring for chronic venous insufficiency is vital, dermatitis and cellulitis may complicate the treatment of this condition.
Management is directed at reducing venous stasis and preventing ulceration. the following are the medical and nursing management aimed to treat chronic venous insufficiency:
- Anti gravity activities are recommended to prevent venous stasis, such as elevating the leg, compression of superficial veins with elastic compression stockings. Wearing these stockings would also prevent formation of ulcerations.
- Leg elevation decreases edema, promotes venous return, and provides symptomatic relief. Legs should be elevated frequently throughout the day (at least 15 to 30 minutes every 2 hours). During night time, the patient should sleep with the foot elevated approximately 6 inches.
- Walking is encouraged. Prolonged sitting and standing can cause detrimental effects.
- Avoid crossing the legs when sitting, placing pressures on the popliteal spaces is also detrimental.
- Avoid clothing that would constrict blood flow. Tight ants, shorts, panties, girdles and socks should be avoided.
- Compression stockings reduce venous pooling and enhance venous return to the heart. These should be applied after the legs have been elevated for a period, when the amount of blood in the veins is at its lowest.
- Elastic compression stockings are recommended for patients with chronic venous insufficiency.
- Extremities should be carefully protected from trauma
- Skin must be kept clean, dry and soft
- Immediately report to the healthcare provider if there are signs of ulceration