Peripheral Vascular System, Lymphatic System & Breast Assessment
After completing assigned readings, attending class, viewing video, & demo/practice in
Describe the structure & function of arteries, veins, lymphatic tissue/nodes & breasts.
Demonstrate knowledge of symptoms related to peripheral vascular system, lymphatic
system and breasts by obtaining a regional/focused health history from a peer or patient.
Explain the term: capacitance vessels
Palpate peripheral arterial pulses (brachial, radial, femoral, popliteal, posterior tibial,
dorsalis pedis) by assessing amplitude & symmetry, assess for signs of arterial
Demonstrate inspection & palpation of peripheral veins, assess for venous insufficiency.
Practice using a Doppler to auscultate pulse, discuss indications for use.
Document history & physical examination findings accurately.
Differentiate normal from abnormal findings in history & physical assessment of PV
Identify ways to decrease venous stasis
Describe variations in arterial pulses
Discusses appropriate response to “irregular pulse” – ie apical pulse rate & pulse deficit
Describe developmental & cultural variations in assessment techniques & findings of PV
Describe techniques for assessment of the breasts & axillae.
Discuss abnormal findings & appropriate action to take in physical assessment of the
breasts & axillae.
Peripheral Vascular & Lymphatic System
Peripheral Vascular (PV) System
Transports oxygenated blood to organs & tissues- returns it to heart for reoxygenation in
Disruption in PV system can cause pain, edema, loss of limb, death
Helps heart & peripheral vasculature maintain circulation - retrieves excess fluid
Disruption in lymphatic system may result in edema, reduced range of motion,
susceptibility to infection VEINS - Capacitance Vessels
veins are distensible & can therefore stretch & hold more blood when blood volume
compensatory mechanism: reduces stress on heart
Exchange Gases & Nutrients Between Arterial & Venous Systems
Main Functions of Lymphatic System
1. Movement of lymph fluid in a closed circuit with CV system
2. Development & maintenance of immune system
3. Reabsorption of fat & fat-soluble substance from small intestine Interactions With Other Systems
Peripheral vascular blood flow control:
Local blood flow to tissues as needed
Nervous system involved with shifting blood flow during exercise, injury, temperature
Endocrine system through hormones, ions & other chemicals
Lymphatic system has no pumping mechanism
Assessing the Peripheral Vascular & Lymphatic Systems
Focused PV History
Any pain, pallor, pulselessness, poikilothermia (polar or cold sensation), paresthesia or
Any aching, throbbing or burning, cramping or itching in the legs
Any swelling in the ankles - symmetry or assymmetrical
Leg pain with ambulation or rest – symmetrical or assymmetrical
Sores/ulcers on legs, feet
Leg Pain or Cramps
Describe the type of pain- gradual/sudden
burning, aching, cramping, stabbing, throbbing
Is it aggravated by activity, walking?
Does the pain wake you up at night?
What relieves the pain? (dangling, rest)
Any Hx of vascular problems/varicosities?
Hx of heart problems, diabetes, obesity, pregnancy, smoking, trauma, prolonged
Skin Changes on Arms or Legs
What colour are the changes?
Erythema (redness), pallor, cyanosis (blueness), brown discolourations, dusky, mottled
Do your leg veins look bulging and/or crooked?
Leg or foot “sores or open areas”?
Location on legs/feet, ankles/toes?
Swelling in the Arms or Legs
Is the swelling in one or both legs?
What time of day is the swelling worst?
Does the swelling come and go or is it constant?
Is the swelling associated with pain, heat, redness? Sudden or gradual onset?
Bilateral edema usually caused by a systemic problem such as heart failure;
unilateral edema often caused by a local obstruction or inflammation Focused Lymphatic History
Swelling in neck, axillae or groin
Many of these questions can be combined with other assessments.
Physical assessment of the lymphatic system is usually incorporated with other system
PV & Lymphatic Assessment
Techniques for PV & lymphatic assessment
Inspection, palpation, vital signs
Positions: Examine upper body /vitals - sitting
Abdomen/ legs - supine
Legs - standing
BP may be taken in both arms (sitting, lying & standing to rule out orthostatic
hypotension or occlusion)
Stethoscope, tape measure, VS equipment, Doppler if indicated
Inspection & Palpation
hands, fingers & finger nails for colour, skin condition, temperature, moisture, turgor,
clubbing - circulation (capillary refill)
abdomen for visible veins or pulsations
legs & feet for colour, hair distribution, varicosities, temperature & edema
Inspect & Palpate Hands/ Arms
Inspect & palpate for colour of skin & nail beds, temperature, texture & skin turgor,
lesions, edema & clubbing, symmetry of arms/hands
Inspect & Palpate the Abdomen
Abdominal veins should barely be visible.
Visible, large diffuse pulsations may indicate aneurysm. Inspecting & Palpating Lower Extremities
Inspect both legs together
Note skin colour, temperature, hair distribution, venous pattern, size, skin lesions or
Leg hair should be evenly distributed, hair loss may indicate arterial insufficiency, should
be no varicosities or edema
Legs should be symmetric in size without swelling or atrophy. If asymmetric or if DVT
suspected, measure the calf circumferences
Should be <1 cm difference between calf circumferences
Inspecting for Varicosities
Have client stand when assessing varicosities so that veins are more prominent
Varicose veins create incompetent valves that increase venous pressure. Obesity,
pregnancy, & genetic predisposition are additional risk factors.
Inspecting for Arterial & Venous Insufficiency
To assess edema, press index finger over bony prominent area: severity of edema graded
on scale 1+(2mm), 2+ (4mm), 3+ (6mm) to 4+(8mm) VERY IMPORTANT
Unilateral edema - suspect occlusion of a major vein
Edema without pitting - suspect arterial disease & occlusion Palpating Pulses
Temporal artery Carotid artery
Temporal & carotid arteries: regular, elastic, smooth, 2+ bilaterally
Palpating Cervical Lymph Nodes
Nodes should not be palpable or if palpable should be less that 1 cm in size, easily
moveable & non-tender.
Tender, palpable nodes may indicate recent infection.
Large well defined nodes may indicate acute infection or tumour in or near the node
Palpating radial pulses
Radial pulses should be equally palpable, symmetrical in strength & amplitude bilaterally
Palpating brachial pulses
Note pulse rate, rhythm- absent pulses may indicate arterial occlusion; need
Palpating the Epitrochlear Nodes
Generally not palpable, if palpable then suspect infection of hand or forearm Allen Test
Palpating Femoral Pulse Place client supine, feel below inguinal ligament, palpate for groin crease, use palmar surface of
Palpating Popliteal Pulse
If client cannot lie prone: have client supine, flex knee, place one hand on each side of knee with
thumbs near front of patella. Curl fingers around knee, rest fingers in popliteal fossa
Palpating Posterior Tibialis (pedal) Pulse
Palpating Dorsalis Pedis (Pedal) Pulse
Alterations in pulse rate/rhythm may indicate a cardiac arrhythmia
If documented in past and asymptomatic, monitor for changes
If new &/or symptoms of concern, notify dr., ECG needed STAT
Absent pulses may = arterial occlusion
Most often af