VERICOSE VEINS

INTRODUCTION

Vericose veins are veins that have become enlarged and tortuous. The term commonly refer to the veins on the leg although varicose vein occur elsewhere. Veins have leaflet valves to prevent blood from flowing backwards. Legh muscle pump the veins to return blood to the hearth against the effect of gravity.
When veins become varicose, the leaflet of the valves no longer meet properly and the valves do not work. This allow blood flow backward and they enlarge even more. Varicose vein are most common in the superficial veins of the leg which are subject to high pressure when standing.

Signs and Symptoms

1. Aching heavy legs often worse at night and after exercise
2. Appearance of spider vein in the affected leg
3. Ankle swelling
4. Abrownish – blue shiny skin discoloration near the affected vein
5. Redness, drynessand itchiness of area skin
6. Cramps may develop especially when making a sudden moves as standing up
7. Minor injuries to the area may bleed morethan normal and / or takes time to heel
8. Whitened, irregular scarlike patches.

Diagnostic Investigation

1. Walking treatment test – to demonstrate presence or absence of valvular incompetence of communicating veins.
2. Photoplethysmography – a non invasive technique to observe venous flow hemodynamics by noting change in the blood content of the skin.
3. Dopler ultrasound – can detect it accurately and rapidly is inexpensive and highly reproducible
4. Venous autflow and reflux plethysmography - able to detect deep venous occlusion.
5. Ascending and decending venography – an invasive technique that can also demonstrate venous occlusion and patterncollateral flow.

Management

A. SURGICAL
Vein stripping and ligation – consist of removal of all part the saphenous vein
Surgeon will make two small surgical cut in leg
- The vut will be near the top and bottom damage vein. One will be in the groin, the other will be father down your leg, either in your calf or ankle.
- Surgeon will them treat a thin, flexible wire into the vein trough your groin. Surgeon will guide the wire trough the lower cut which pull the vein out with it.
- Surgeon may also use hook to pull out vein during this procedure
- If yu have other damage veins, surgeon may also make small incision over them to remove them and tie them off
- The surgeon will close the incision with suture.

After Procedure
o Legs will be wrapped with bandages to control swelling and bleeding for 3 – 4 days after surgery. You may keep them wrapped for several weeks
o When you are resting, try to keep the legs higer than level of your ear, place pillows or blankets under your legs to raise them up
o May also wear compression stocking these help improve blood flow. It is very important to keep bandages and compression stocking all the surgical cuts have healed.
o To prevent the varicose vein from returning, may wear compression stocking for long time.

B. COMPLICATION

1. Deep venous thrombosis
2. Pulmonary embolism
3. Wound complication including infection
4. Rarely numbness can develop in a part of the lower legs or foot. This usually occur to pulling on nerve during the operation
5. Sometimes a little blood lose from wound during 12 – 24 hours. This usually stop on it,s own. If liedown , elevate the leg and press on the wound 10 minutes


NURSING CARE


A. PREPARTION FOR SURGERY IN THE WARD
- Prepare the skin at least 12 hours prior to surgery by throughout cleansing the lower abdomen and legs with germicidal soap.
- Hair removal may shave to surgeon request
- Have the patient prepare on the day before the surgery for the surgeon to mark his skin with pen

B. PREOPERATIVE NURSING CARE – RECEPTION

1. Received and identify the patien correctly by
- ask the patient name
- cecking patient identification band and conform with file data.
2. Received the endorsement form the ward regarding premedication, latest of blood investigations, X-Ray, or CT – Scan, Blood availability,
3. Check the file, consent must be signed properly
4. Check for any implants or jewelry, loose or removeable teeth and presence of contact lenses.
5. Be sure the patient is fasting minimum 6 hours
6. Wheeled the patient to preoperative waiting area.




C. ROOM PREPARATION IN OPERATHING TEATHER
1. Minor set and minor packet
2. Bethadine
3. Palin gauze
4. Raytac gauze
5. Abdominal swab
6. Isolation bag
7. Diathermi
8. Blade no, 10 and 20
9. Ligature vicryl No : 2-0, 3-0, and 0.
10. Suture material vicryl 2-0. Prolene 3-0, or stapler for skin closing
11. Ligaclip
12. Vein stripper
13. Orthoband and crape bandage " Sterile"
14. Elastoplasts.

D. INTRAOPERATIVE NURSING CARE

1. Scrub Nurse
• Works directly with surgeon within the sterile field, passing instruments, sponges and other items needed during the procedure.
• Prepares and preserves a sterile field in which the operation can take place
• Maintains sterility troughout the procedure
• Awareness of the patient,s safety
• Undertake count of sponges and instrument with circulating nurse
• Helps tp apply dressing

2. Circulating Nurse
• Take the patient from waiting room areas, be sure to verify the correct identification of the patient by checking the identification band or by asking the patient name.
• Secure proper positioning to protect the safety and skin integrity of the patient underanasthesia.
• Responsible for managing the nurse care of the patient within the OR and coordinating the needs of the surgical team eith other care provider for completion of surgery
• Observe the surgery and surgical team from broad [res[ective and assists the team to create and maintain a safety and comfortable environment for the patient
• Asses the patient,s condition before, during,and after the operation to ensure optimal outcome for the patient
• Must be able to anticipate the scrub nurse,s needs and be able to open sterile packs, operate machinery and keep accurate record
• Record patient data on register book : Name, hospital no, age, sex, nationality, ward, surgery, surgeons, type of anesthesia given, scrub nurse and circulating nurse.
• Ensure specimen area properly and labeled, data completed, and specimen request must be filled and signed by surgeon
• Documentation
• Hand over patient to recovery room.




E. POSTOPERATIVE NURSING CARE – RECOVERY ROOM

A recovery room nurse provides constant care to patient immediately following the surgery. This may be a time frame anywhere from 30 minutes to a few hours until the patient is stable and out from the effect of anasthesi. The recovery staff nurse must be:
1. Ensure that the patient is breathing spontaneously, administers oxygen
2. Assess the level of consciousness by orienting the patient by asking patient name, and any complaint
3. Monitor vital signs such as BP, HR, Temp, Saturation, Respiratory Rate. Take not for any alteration and sign of complication
4. React rapidly to signs of physical changes and inform the anesthetist
5. Assess comfort level. Asking the patient about the level of pain and administer pain medication that had been prescribed
6. Asses the patient dressing for drainage or bright red bleeding, report to the surgeon
7. Make sure the patient is warm and comfortable
8. Documentation
9. Hand over to their respective ward after fully recovered from anesthesia.