THE PERIPHERAL VASCULAR SYSTEM

To perform a thorough peripheral vascular assessment, the nurse needs to understand

the structure and function of the arteries and veins of the arms and legs, the lymphatic
system, and the capillaries. Equally important is an understanding of fluid exchange.
ARTERIES
Arteries are the blood vessels that carry oxygenated, nutrient-rich blood from the
heart to the capillaries. The arterial network is a high-pressure system. Blood is
propelled under pressure from the left ventricle of the heart. Because of this high
pressure, arterial walls must be thick and strong; the arterial walls also contain elastic
fibers so they can stretch.
Each heartbeat forces blood through the arterial vessels under high pressure,
creating a surge. This surge of blood is the arterial pulse. The pulse can be felt only by
lightly compressing a superficial artery against an underlying bone.
Many arteries are located in protected areas, far from the surface of the skin.
Therefore, the arteries discussed in this chapter include only major arteries of the arms
and legs—the peripheral arteries—that are accessible to examination.
Major Arteries of the Arm
● The brachial artery is the major artery that supplies the arm. The brachial pulse
can be palpated medial to the biceps tendon in and above the bend of the elbow.
● The brachial artery divides near the elbow to become the radial artery
(extending down the thumb side of the arm) and the
● ulnar artery (extending down the little finger side of the arm

Major Arteries of the Leg

 ● The femoral artery is the major supplier of blood to the legs. Its pulse can be
palpated just under the inguinal ligament
● The popliteal artery divides below the knee into anterior and posterior branches.
● The anterior branch descends down the top of the foot, where it becomes the
dorsalis pedis artery.
● The posterior branch is called the posterior tibial artery

VEINS
Veins are the blood vessels that carry deoxygenated, nutrientdepleted, waste-laden
blood from the tissues back to the heart. The veins of the arms, upper trunk, head, and
neck carry blood to the superior vena cava, where it passes into the right atrium. Blood
from the lower trunk and legs drains upward into the inferior vena cava. The veins
contain nearly 70% of the body’s blood volume. Because blood in the veins is carried
under much lower pressure than in the arteries, the vein walls are much thinner.
Veins differ from arteries in that there is no force that propels forward blood flow; the
venous system is a low-pressure system. If there is a problem with any of these
mechanisms, venous return is impeded and venous stasis results.
Three Types of Veins:
1. Deep veins - these veins account for about 90% of venous return from the lower
extremities.
a. Femoral
b. Popliteal
2. Superficial veins
a. Great saphenous veins – the longest of all veins and extends from the
medial dorsal aspect of the foot, crosses over the medial malleolus, and
continues across the thigh to the medial aspect of the groin, where it joins
the femoral vein
 b. Small saphenous veins - begins at the lateral dorsal aspect of the foot,
travels up behind the lateral malleolus on the back of the leg, and joins the
popliteal vein.
3. Perforator (or communicator) veins - connect the superficial veins with the
deep veins

CAPILLARIES AND VENOUS EXCHANGE

Capillaries are small blood vessels that form the connection between the
arterioles and venules and allow the circulatory system to maintain the vital equilibrium
between the vascular and interstitial spaces.
Venous Exchange
Oxygen, water, and nutrients in the interstitial fluid are delivered by the arterial
vessels to the microscopic capillaries (Fig. 21-4). Hydrostatic force (generated by the
blood pressure) is the primary mechanism by which the interstitial fluid diffuses out of
the capillaries and enters the tissue space. The interstitial fluid releases the oxygen,
water, and nutrients and picks up waste products such as carbon dioxide and other by-
products of cellular metabolism. The fluid then reenters the capillaries by osmotic
pressure and is transported away from the tissues and interstitial spaces by venous
circulation.

THE LYMPHATIC SYSTEM

The lymphatic system, an integral and complementary component of the
circulatory system, is a complex vascular system composed of lymphatic capillaries,
lymphatic vessels, and lymph nodes. Its primary function is to drain excess fluid and
plasma proteins from bodily tissues and return them to the venous system.
The fluids and proteins absorbed into the lymphatic vessels by the microscopic
lymphatic capillaries become lymph. These capillaries join to form larger vessels that
pass through filters known as lymph nodes, where microorganisms, foreign materials,
dead blood cells, and abnormal cells are trapped and destroyed.
The epitrochlear nodes and the superficial inguinal nodes:

1. Epitrochlear nodes - are located approximately 3 cm above the elbow on the

inner (medial) aspect of the arm. 
2. Superficial inguinal nodes - consist of two groups. These nodes drain the legs,
external genitalia, and lower abdomen and buttocks
a. Horizontal Chain - the horizontal chain is located on the anterior thigh just
under the inguinal ligament
b. Vertical Chain - is located close to the great saphenous vein.