5.10 Venous Insufficiency

Overview

Venous insufficiency is a condition that occurs when the veins in the legs have difficulty returning blood back to the heart. Veins have one-way valves that help blood flow in the right direction. When the valves are weakened or damaged, blood can pool in the veins. Various conditions can cause venous insufficiency, including deep vein thrombosis, varicose veins, age, obesity, and pregnancy. Occupations that require individuals to sit for longer periods of time may also predispose clients to venous insufficiency.^[1]

 Assessment

Signs of venous insufficiency may vary based upon the severity of the venous involvement. Clients may experience swelling, especially noted in the ankles and lower legs. Swelling typically worsens throughout the day. Many clients may also report aching or pain in the affected extremity. The pain is often described as throbbing or cramping. Many clients with venous insufficiency may also report fatigue or feelings of heaviness in the legs. Some individuals may experience itching or tingling in the legs, and skin color in the affected area may appear dark or discolored. The skin texture may also change and appear dry or rough, taking on a scaly appearance. The veins of the impacted extremities may also appear enlarged and tortuous, visible near the surface of the skin. For individuals with severe cases of venous insufficiency, open sores or ulcers may develop.^[2]

Diagnostic Testing

Diagnostic testing for venous insufficiency includes methods to assess the functionality of the venous system. Providers may order ultrasound or Doppler flow studies to examine the direction and flow patterns of the blood. If more definitive identification of restricted vessel areas is needed, a venography may be performed. In this procedure, contrast dye is injected into the large veins of the leg, and X-ray images are collected to provide more comprehensive images of the venous system.^[3]

Nursing Problems and Diagnoses

Nursing problems and diagnoses for venous insufficiency focus on managing symptoms and reducing the risk of complications.

Common nursing diagnoses for clients with venous insufficiency include the following:

• Impaired Skin Integrity R/T altered circulation
• Chronic Pain R/T impaired circulation
• Activity Intolerance R/T altered circulation

Outcome Identification

Outcome identification involves setting short- and long-term goals and creating expected outcome statements tailored to the client’s specific needs. These outcomes should be measurable and responsive to nursing interventions.

Sample expected outcomes for common nursing diagnoses related to venous insufficiency are as follows:

• The patient will exhibit improved skin integrity with the absence of new ulcerations or wounds within two weeks.
• The patient will experience a reduction in chronic pain levels, achieving a pain rating of 2-3 or below within three days.
• The patient will demonstrate improved tolerance to physical activity, achieving the ability to perform walk 300 feet without undue fatigue within one week.

Interventions

Medical Interventions

Medical interventions for venous insufficiency aim to manage symptoms, improve venous circulation, and prevent complications.

Common interventions include:

• Compression Therapy: Graduated compression stockings help improve blood flow by applying pressure to the legs. They reduce swelling, prevent blood from pooling, and assist in maintaining proper venous function.
• Elevated Leg Positioning: Encouraging patients to elevate their legs regularly helps reduce swelling and improve venous return. Elevating the legs above heart level can be particularly beneficial.
• Lifestyle Modifications:
  • Regular Exercise: Physical activity, especially exercises that involve the calf muscles, promotes blood circulation. Walking and calf muscle exercises are often recommended.
  • Weight Management: Maintaining a healthy weight reduces pressure on the veins and can improve circulation.
• Sclerotherapy: Sclerotherapy involves injecting a solution into small- and medium-sized varicose veins, causing them to collapse and be reabsorbed by the body.
• Vascular Surgery: In severe cases or when other interventions are ineffective, surgical procedures such as vein ligation or vein stripping may be considered.^[4]

Nursing Interventions

Nursing interventions for venous insufficiency focus on health teaching about managing symptoms, promoting venous circulation, and preventing complications.

Health Teaching

Nurses teach the importance of regular exercise, particularly activities that engage the calf muscles. They provide information on weight management and discuss lifestyle modifications, such as avoiding prolonged sitting or standing. Nurses teach the purpose of compression stockings and assist with proper fitting. They instruct the client on techniques for applying and removing compression stockings and to monitor for signs of skin breakdown. Clients are encouraged to elevate their legs above their heart level when sitting to reduce edema and promote venous return.^[5]

Evaluation

During the evaluation stage, nurses determine the effectiveness of nursing interventions for a specific client. The previously identified expected outcomes are reviewed to determine if they were met, partially met, or not met by the time frames indicated. If outcomes are not met or only partially met by the time frame indicated, the nursing care plan is revised. Evaluation should occur every time the nurse implements interventions with a client, reviews updated laboratory or diagnostic test results, or discusses the care plan with other members of the interprofessional team.