Clinical update
Varicose veins GETTY IMAGES
Essential facts Varicose veins are dilated, often palpable subcutaneous veins with reversed blood flow. Most commonly found in the legs, they are estimated to affect at least one third of the adult population. While for many people varicose veins do not present a serious health problem, for others they cause pain, aching and itching.
Varicose veins are dark purple or blue in colour and are usually twisted and bulging in appearance. Symptoms include aching, heavy and uncomfortable legs; swollen feet and ankles; burning or throbbing in the legs; muscle cramps, especially at night; and dry, itchy, thin skin over the affected vein. Symptoms are usually worse during warm weather or after standing up for long periods.
Causes and risk factors Varicose veins are generally caused by weak vein walls and valves. Women are more likely to develop them than men, and the risk increases if a close family member has the condition. Pregnancy is a risk factor, as the amount of blood increases to support the developing baby, putting extra strain on veins. Risks also increase with age, being overweight or if the person’s job requires long periods of standing.
Expert comment Nikki Fenwick, vascular nurse specialist, Sheffield Teaching Hospitals NHS Trust
NICE interventional procedures guidance (2013) www.nice.org.uk/ Guidance/IPG435
Treatment
Signs and symptoms
NICE quality standard (2014) www.nice.org.uk/guidance/ QS67/chapter/Introduction NICE guidelines (2013) www.nice.org.uk/ Guidance/CG168
What’s new The National Institute for Health and Care Excellence (NICE) has published a new quality standard, Varicose Veins in the Legs. This includes three statements to improve quality of life, limit the progression of venous leg disease and help prevent recurrence.
Find out more
Over time, varicose veins can become more severe, leading to complications such as skin damage, bleeding and venous ulceration. NICE estimates that between 3 and 6 per cent of people with varicose veins will develop venous ulcers. NICE recommends that those who have symptoms or complications should be referred to a vascular service to be assessed with duplex ultrasound. Those with confirmed varicose veins and truncal reflux should first be offered endothermal ablation or, secondly, ultrasound guided foam sclerotherapy. Surgery should be offered only if these procedures are unsuitable. These newer therapies are less invasive than surgery and allow for shorter hospital stays.
How you can help your patient Think about whether the patient would benefit from referral to a specialist vascular service. You should be able to give patients up-to-date and accurate information, especially on the newer, less invasive treatment techniques.
‘The NICE guidelines that were published last year make some very good recommendations about the groups of patients who would benefit from being referred to a specialist vascular service. The less invasive treatment techniques that are now recommended mean that even older and more frail patients can be treated – age is no longer a barrier.
The Society for Vascular Nursing (SVN) www.svn.org.uk The Vascular Society www.vascularsociety.org.uk The Circulation Foundation www.circulationfoundation. org.uk Commissioning guide (2013) – The Royal College of Surgeons of England tinyurl.com/RCSvaricose Assessment and management of patients with varicose veins (2009) Nursing Standard. 23, 23, 49-57. tinyurl.com/ NSvaricoseveins
‘Patients’ quality of life can be affected. Many are still trying to work and are doing jobs that aggravate their condition, standing on their feet all day. There are many people who would benefit from the relief of being treated. I have seen patients before and after treatment who cannot believe how much better they feel.’
NURSING STANDARD october 1 :: vol 29 no 5 :: 2014 19 Downloaded from RCNi.com by ${individualUser.displayName} on Nov 22, 2015. For personal use only. No other uses without permission. Copyright © 2015 RCNi Ltd. All rights reserved.
Varicose veins GETTY IMAGES
Essential facts Varicose veins are dilated, often palpable subcutaneous veins with reversed blood flow. Most commonly found in the legs, they are estimated to affect at least one third of the adult population. While for many people varicose veins do not present a serious health problem, for others they cause pain, aching and itching.
Varicose veins are dark purple or blue in colour and are usually twisted and bulging in appearance. Symptoms include aching, heavy and uncomfortable legs; swollen feet and ankles; burning or throbbing in the legs; muscle cramps, especially at night; and dry, itchy, thin skin over the affected vein. Symptoms are usually worse during warm weather or after standing up for long periods.
Causes and risk factors Varicose veins are generally caused by weak vein walls and valves. Women are more likely to develop them than men, and the risk increases if a close family member has the condition. Pregnancy is a risk factor, as the amount of blood increases to support the developing baby, putting extra strain on veins. Risks also increase with age, being overweight or if the person’s job requires long periods of standing.
Expert comment Nikki Fenwick, vascular nurse specialist, Sheffield Teaching Hospitals NHS Trust
NICE interventional procedures guidance (2013) www.nice.org.uk/ Guidance/IPG435
Treatment
Signs and symptoms
NICE quality standard (2014) www.nice.org.uk/guidance/ QS67/chapter/Introduction NICE guidelines (2013) www.nice.org.uk/ Guidance/CG168
What’s new The National Institute for Health and Care Excellence (NICE) has published a new quality standard, Varicose Veins in the Legs. This includes three statements to improve quality of life, limit the progression of venous leg disease and help prevent recurrence.
Find out more
Over time, varicose veins can become more severe, leading to complications such as skin damage, bleeding and venous ulceration. NICE estimates that between 3 and 6 per cent of people with varicose veins will develop venous ulcers. NICE recommends that those who have symptoms or complications should be referred to a vascular service to be assessed with duplex ultrasound. Those with confirmed varicose veins and truncal reflux should first be offered endothermal ablation or, secondly, ultrasound guided foam sclerotherapy. Surgery should be offered only if these procedures are unsuitable. These newer therapies are less invasive than surgery and allow for shorter hospital stays.
How you can help your patient Think about whether the patient would benefit from referral to a specialist vascular service. You should be able to give patients up-to-date and accurate information, especially on the newer, less invasive treatment techniques.
‘The NICE guidelines that were published last year make some very good recommendations about the groups of patients who would benefit from being referred to a specialist vascular service. The less invasive treatment techniques that are now recommended mean that even older and more frail patients can be treated – age is no longer a barrier.
The Society for Vascular Nursing (SVN) www.svn.org.uk The Vascular Society www.vascularsociety.org.uk The Circulation Foundation www.circulationfoundation. org.uk Commissioning guide (2013) – The Royal College of Surgeons of England tinyurl.com/RCSvaricose Assessment and management of patients with varicose veins (2009) Nursing Standard. 23, 23, 49-57. tinyurl.com/ NSvaricoseveins
‘Patients’ quality of life can be affected. Many are still trying to work and are doing jobs that aggravate their condition, standing on their feet all day. There are many people who would benefit from the relief of being treated. I have seen patients before and after treatment who cannot believe how much better they feel.’
NURSING STANDARD october 1 :: vol 29 no 5 :: 2014 19 Downloaded from RCNi.com by ${individualUser.displayName} on Nov 22, 2015. For personal use only. No other uses without permission. Copyright © 2015 RCNi Ltd. All rights reserved.
