Venous Disorders: Varicose Veins
Varicosities (varicose veins) are abnormally dilated, tortuous superficial veins caused by incompetent venous valves. It may be considered primary (no involvement of deep veins) or secondary (resulting from obstruction of deep veins). Most commonly, this condition occurs in the lower extremities, the saphenous veins, or the lower trunk. It is estimated that varicose veins occur in up to 60% of the adult population in the US, with an increased incidence with increased age. The condition is most common in women and in people whose occupations require prolonged standing. A hereditary weakness of the vein wall may contribute to the development of varicose veins. Pregnancy may also cause varicose veins and it is rare before puberty.
Manifestations
- Dilated veins
- Dull aches
- Muscle cramps
- Increased muscle fatigue in the lower legs
- Ankle edema
- Leg heaviness
- Nocturnal cramps
For deep venous obstruction
- Edema
- Pain
- Pigmentation
- Ulceration
Assessment and Diagnosis
- Duplex scan which documents the anatomic site of reflux and provides quantitative measure of severity of valvular reflux
- Air plethysmography measures the changes in venous blood volume
- Venography to visualize vein anatomy during various leg movements by x-ray studies
Management
- Surgery: Saphenous vein is ligated and divided, then an incision is made in the ankle and a metal or plastic wire is passed the full length of the vein to the point of ligation. The wire is then withdrawn, pulling the vein as it is removed (“stripping”). Pressure and elevation keep bleeding at a minimum
- Sclerotherapy: a chemical is injected into the vein, irritating the venous endothelium and producing localized phlebitis and fibrosis, obliterating the lumen of the vein. After injection of sclerosing agent, elastic compression bandages are applied to the leg and are worn for approximately 5 days. These bandages will be removed and be replaced by elastic compression stockings which will be worn for an additional 5 weeks. After sclerotherapy, patients are encouraged to walk to maintain blood flow in the leg.
- Instruct to maintain on bed rest for 24 hours, after which the patient begins walking every 2 hours for 5 to 10 minutes.
- Apply compression stockings
- Assist patient to perform exercises and to move the legs
- Elevate the foot of the bed
- Administer analgesics as prescribed
- Inspect dressings for bleeding
- Be alert for reported sensations of “pins and needles”
- Instruct patient to dry the incisions well with a clean towel by patting rather than rubbing
- Instruct to avoid application of skin lotion until incisions are completely healed to decrease chances of infection
Byron Webb Romero, RN, MSN
Finished BSN at Lyceum of the Philippines University, and Master of Science in Nursing Major in Adult Health Nursing at the University of the East Ramon Magsaysay Memorial Medical Center. Currently working at Manila Doctors College of Nursing as a Team Leader for Level I and II, Lecturer for Professional Nursing Subjects, and also a Clinical Instructor.
