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Cardiovascular

Chronic Venous Insufficiency

CVI High-yield Verified · Sep 2026

Chronic venous insufficiency is impaired venous return from the legs — from reflux through incompetent valves or from obstruction — causing venous hypertension and the changes that follow it: edema, skin pigmentation and thickening, varicose veins and, at its end stage, the venous leg ulcer.

The venous-versus-arterial contrast the NCLEX loves: swelling that is worse by evening and better with the legs up, a shallow ulcer over the medial malleolus, why the ABPI must be checked before compression, when a compression bandage must come off, and why an ulcer that heals will come back without lifelong compression.

What’s going wrong in the body

The normal physiology, where it fails, and why the body’s compensation backfires.

01 Blood climbing against gravity — and what happens when the valves fail

"To return to the central circulation, blood must travel against gravity and other pressures in the upright position." "A number of 1-way bicuspid valves throughout the deep and superficial veins allow blood to travel toward the heart while preventing it from returning to the feet," and "Calf muscle contraction and intraluminal valves promote prograde flow and prevent blood reflux under normal conditions."

Reflux or obstruction — either way the result is venous hypertension. "CVI pathophysiology is due to either reflux (ie, backward flow) or obstruction of venous blood flow." "In all cases, the result is ultimately the development of venous hypertension of the lower extremities." "In most cases, the underlying cause of CVI is incompetent venous valves," and "In most cases, the leaky valve is located near the termination of the greater saphenous vein into the common femoral vein." "Perforating vein valvular failure allows higher pressure to enter the superficial venous system."

Primary or secondary. "Recent studies suggest that approximately 70% of patients have primary CVI, and 30% have secondary disease." "Secondary CVI occurs in response to a DVT, which triggers an inflammatory response, subsequently injuring the vein wall" — "Deep vein dysfunction usually results from a prior deep vein thrombosis (DVT), which leads to inflammation, valve scarring and adhesions, and luminal narrowing."

Valves and the calf pump normally carry blood upward; primary valve failure or post-DVT damage lets it fall back, producing venous hypertension in the lower legs.

02 From high pressure to stained skin to an ulcer

"persistently elevated venous hydrostatic pressure may result in lower-extremity pain, edema, and venous microangiopathy." Red cells leak out: "Some patients develop permanent skin hyperpigmentation from hemosiderin deposition as red blood cells extravasate into the surrounding tissue." "Many of these patients will also have lipodermatosclerosis, skin thickening from subcutaneous fat fibrosis."

Why the skin cannot heal. "The increased intraluminal pressure causes protein extravasation and fibrin cuff formation, which impedes the diffusion of oxygen and growth factors and activates the inflammatory response." "Together, this inflammatory cascade impairs healing processes, resulting in ulcer formation upon wounding." NHS: "Venous leg ulcers can develop after a minor injury, if persistently high pressure in the veins of the legs has weakened the skin."

The ulcer is the late stage. "Venous leg ulcers (VLUs) are late indicators of chronic venous insufficiency (CVI) and venous hypertension." "The average time from CVI diagnosis to ulceration is 5 years, according to a 25-year population study," although "ulceration occurs rarely (5.1%) for unclear reasons." The CEAP clinical classes run from "C0: No visible or palpable signs of venous disease" through "C2: Varicose veins C3: Edema" to "C5: Healed venous ulcer C6: Active venous ulcer." "If left untreated, CVI is usually progressive and leads to postphlebitic syndrome and venous ulcers."

Sustained venous hypertension stains and hardens the skin and builds a fibrin cuff that starves it of oxygen; after a minor injury the weakened skin breaks down into a venous leg ulcer that often recurs.

03 Treatment works against gravity — compress, elevate, walk

Compression. Compression "aims to provide graduated external compression to the lower extremities and counteract the hydrostatic pressures of venous hypertension." Stockings are "usually tightest at the ankle and less tight further up your leg. This encourages blood to flow upwards towards your heart." "Compression treatment is the main component of the conservative approach," and for ulcers it is "first-line treatment" — but only after arterial disease is excluded, because "approximately 20% of patients with VLU have concurrent arterial disease."

Elevation and the calf pump. "Leg elevation above the heart for at least 30 minutes, 3 times a day, helps to reduce venous pressure and edema and prevent recurrent ulcers." "Resistance exercises help improve the calf muscle pump, which normally aids venous blood return from the lower extremities in healthy individuals and is impaired in those with CVI." Weight matters: "Excess weight leads to high pressure in the veins in your legs, which can damage your skin."

Procedures fix the reflux; compression still continues. "Superficial vein reflux can be managed with foam sclerotherapy, endovenous thermal ablation, or stripping," and "early endovenous ablation was associated with faster healing and a longer ulcer-free period." But "No matter which surgery is selected, patients should combine it with compression stockings for maximal effectiveness" — "VLUs are chronic processes that require lifelong evaluation and care, even after wound closure."

Management: check the ABPI before any compression, then compress to the level the arteries allow, elevate, walk, treat the skin and the wound, correct reflux, and continue compression for life.

Causes & risk factors

Modifiable factors are teaching targets — the patient can act on them.

Age — StatPearls lists "Advanced age (ie, aged 55 or older)" Female sex and family history of varicose veins — "The most common nonmodifiable risk factors are female gender and nonthrombotic iliac vein obstruction (eg, May-Thurner syndrome)." Previous deep vein thrombosis or thrombophlebitis — the cause of secondary CVI modifiable Obesity modifiable Smoking modifiable Pregnancy and oral contraceptive use modifiable Prolonged standing or sitting and a sedentary lifestyle — including occupations that require long periods of sitting modifiable Leg injury or recent leg surgery such as a hip replacement modifiable Difficulty walking — osteoarthritis, paralysis or a leg injury raise the risk of a venous leg ulcer

Signs & symptoms

Each finding tied to the mechanism that produces it — and the triage it calls for.

Dependent pitting edema, leg aching or heaviness, fatigue and itching early Expected
Why: "Patients with CVI commonly present initially with a combination of dependent pitting edema, leg discomfort, fatigue, and itching." Swelling is "especially noted in the ankles and lower legs" and "typically worsens throughout the day."
Symptoms that improve with rest and leg elevation, with no link to exercise Expected
Why: The venous-versus-arterial discriminator: "Patients may describe symptoms that improve with rest and leg elevation and with no association with exercise. This latter feature can be used to distinguish venous from arterial claudication." Arterial claudication is "Predictable muscle pain, cramping, or fatigue during physical activity (e.g., walking) that resolves with rest and recurs with activity."
Varicose veins — swollen, twisted veins under the skin Expected
Why: "Varicose veins are characterized by subcutaneous dilated, tortuous veins greater than or equal to three millimeters" (CEAP C2). NHS: "They’re common and are not usually serious."
Brown-orange skin staining, stasis dermatitis, hard thickened skin (lipodermatosclerosis), atrophie blanche late Expected
Why: Hemosiderin from leaked red cells and fibrosis of the subcutaneous fat. "Varicose veins, brown-orange hyperpigmentation, chronic leg edema, stasis dermatitis, atrophie blanche, and lipodermatosclerosis are late indicators of venous insufficiency."
A shallow, irregular ulcer over the medial ankle with a fibrinous base late Hold & notify
Why: "VLUs typically affect the distal end of the legs over the medial aspect, appearing as shallow, irregular, well-defined ulcers with fibrinous material on the base," most commonly "overlying the medial malleolus." Contrast arterial ulcers: "deep, dry wounds affecting the toes, foot dorsum, and the anterior aspect of the leg, with abnormal distal pulses, ABPI, and cold extremities."
A sore on the leg that has not healed after 2 weeks Hold & notify
Why: NHS advises seeing a GP if "you get a sore on your leg that has not healed after 2 weeks" — a leg ulcer is "a long-lasting (chronic) sore that takes more than 2 weeks to heal."
Ulcer with more discharge, more pain, surrounding redness, or feeling unwell Hold & notify
Why: Signs of infection: "You should contact your GP or leg ulcer specialist as soon as possible." NHS notes redness "may be harder to see on black or brown skin." Systemic signs such as fever and chills support systemic antibiotics.
Bleeding from a varicose vein Hold & notify
Why: NHS lists "you have varicose veins that are bleeding" under urgent advice: "Ask for an urgent GP appointment or get help from NHS 111." Heavy bleeding is an emergency — see Complications.
Under a compression bandage: numbness or tingling, unusual pain, or toes that are swollen, pale or blue Report immediately
Why: NHS: the bandage must be removed or cut off if these occur; "Once you remove the bandage, make sure you keep your leg highly elevated and contact your doctor or nurse as soon as possible."

Diagnostics

Test In this disorder Normal
Venous duplex ultrasound "Venous duplex ultrasound is the primary modality to confirm a CVI diagnosis and is considered the gold standard." The consensus relayed by StatPearls recommends the patient be upright when able to stand safely Reflux through incompetent valves — reflux "greater than 0.5 seconds" in superficial veins and "greater than 1 second in the deep veins" AVF/SVS/AVLS/SIR consensus (via StatPearls) —
Ankle-brachial pressure index (ABPI) and distal pulses Done because "approximately 20% of patients with VLU have concurrent arterial disease." "ABPI is obtained by dividing the systolic ankle pressure by the systolic arm pressure in the supine position." An ABPI above 1.3 suggests vascular calcification and needs urgent vascular referral. If ABPI is unavailable, mild compression (20 mm Hg or less) may start after arterial disease is clinically ruled out, with a vascular assessment within 4 to 6 weeks Before compression: over 1 to 1.3 — apply compression · 0.8 to 1.0 — with caution · 0.6 to 0.8 — modified compression and vascular referral · under 0.5 — do not compress, urgent referral "An ABPI greater than 1 to 1.3 is considered normal" (VLU chapter); the general ABI chapter gives "Normal: 0.9 to 1.4"
Trendelenburg test A bedside test that "may help differentiate between CVI caused by superficial vein valves and that caused by the deep system" If the leg does not refill, superficial valves are incompetent; if it refills, the valves connecting superficial and deep veins are incompetent —
Ulcer assessment "Tissue culture (as opposed to a swab) must be performed in fetid, purulent, or nonhealing wounds to guide antimicrobial therapy." "Unless another diagnosis is suspected, a biopsy is not warranted" Area, depth, edges, wound base, signs of infection, and surrounding skin changes —
CEAP clinical class The 2020 update added C4c (corona phlebectatica) and the modifier r for recurrent disease C0 none · C1 telangiectasias · C2 varicose veins · C3 edema · C4 skin changes · C5 healed ulcer · C6 active ulcer American Venous Forum CEAP 2020 (via StatPearls) —

Complications

Warning: Venous leg ulcer — chronic and recurrent
"The formation of an ulcer carries a poor prognosis, with 40% of patients experiencing recurrence despite standard treatment." "VLUs carry the highest recurrence rate among chronic wound types."
NHS: "Most venous leg ulcers heal within 6 months if they’re treated by a healthcare professional trained in compression therapy for leg ulcers." Older, larger ulcers heal less often — 78% closure failure by six months for wounds older than 1 year and larger than 10 cm². VLUs are also linked to "a 2-fold higher risk of all-cause mortality compared to nonulcer patients."
Warning: Infection and recurrent cellulitis Hold & notify
Chronic ulcers carry "a risk of infection"; recurrent cellulitis is on the StatPearls complication list.
Antibiotics treat infection but "do not heal ulcers and should only be used in short courses to treat infected ulcers."
Warning: Deep vein thrombosis and superficial thrombophlebitis
"Nearly 60% develop phlebitis, which often progresses to deep vein thrombosis in more than 50% of patients." "patients with varicose veins are also at high risk for deep vein thrombosis."
See the venous thromboembolism page.
Black-box warning — most severe: ■ Severe hemorrhage from a varicose vein Report immediately
"The venous insufficiency can also lead to severe hemorrhage." Secondary hemorrhage is on the StatPearls complication list.
NHS directs anyone with bleeding varicose veins to urgent help; heavy bleeding is an emergency.
Caution: Malignant transformation
"Chronic venous ulcerations entail a risk of infection and cancerous transformation (eg, Marjolin ulcer)."
"chronic, nonhealing ulcers may undergo malignant transformation."
Caution: Lymphedema, chronic pain and ankle stiffness
Secondary lymphedema, chronic pain and "Ankle joint stiffness from chronic scarring" complete the StatPearls list; "heavy exudates can cause malodor, social isolation, and emotional disturbances."

Medications for this condition

Why each class is prescribed here — every card links to its full pharmacology page.

Topical Corticosteroids
Integumentary · hydrocortisone

Stasis dermatitis / varicose eczema. "Topical steroids may be used to treat stasis dermatitis." NHS: treated "with a moisturiser (emollient) and occasionally a mild corticosteroid cream or ointment."
Acetaminophen (Non-Opioid Analgesic)
Nervous · acetaminophen

Pain when compression starts. "When compression bandages are first applied to an unhealthy ulcer, it’s usually painful." "Ideally, you should have paracetamol or an alternative painkiller prescribed by your GP." "The pain will lessen once the ulcer starts to heal."
Wound & Burn Agents
Integumentary · silver sulfadiazine

Topical antiseptics and antimicrobials in wound care. "Topical treatments are typically used as antiseptics (eg, cadexomer-iodine), antimicrobials (eg, silver sulfadiazine), and debriding agents (eg, collagenase or hydrogels)." For silver dressings the evidence is "low-certainty," and "the authors could not establish specific treatment recommendations."
Calcium Channel Blockers
Cardiovascular · amlodipine

A cause of leg edema to consider, not a treatment. StatPearls lists "Medication adverse effects (eg, calcium channel blockers, NSAIDs, and oral hypoglycemic agents)" in the differential of leg swelling.

Beyond medications

  • Compression is the cornerstone — pressures differ by indication, so keep each with its source. StatPearls (CVI): "Compression strengths between 30 and 50 mm Hg are believed to improve venous reflux, pain, edema, pigmentation, ulcer healing, and prevention." StatPearls (varicose veins): "the recommended graduation is 20-30 mmHg and, in more severe cases, can be elevated to 30-40 mmHg." StatPearls (VLU): "High compression is the preferred strength and should reach the knee or higher." "Compression therapy is long-term and only benefits patients who remain compliant."
  • Check arteries first. Compression "should be used with caution in patients with coexisting peripheral arterial disease." StatPearls (CVI) names "Severe arterial insufficiency and uncompensated congestive heart failure" as contraindications; the VLU chapter lists "arterial occlusive disease, ABPI less than 0.5, serious uncontrolled high blood pressure, heart failure, suspected or documented thrombosis, extensive thrombophlebitis, and erysipelas" as absolute contraindications.
  • Ulcers are bandaged by trained staff. "Ulcers are treated best with compression bandaging systems." "The application of a compression bandage is a skilled procedure and should only be done by trained healthcare staff." "The bandage is usually changed 1 to 3 times a week, when the dressing is changed." Intermittent pneumatic compression "can be used in addition to compression therapy or in patients who are unable to tolerate the latter."
  • Elevate — sources give slightly different schedules. StatPearls: "Leg elevation above the heart for at least 30 minutes, 3 times a day." NHS: "You should elevate your feet for 30 minutes, 3 to 4 times a day," and whenever possible "with your toes above your hips." Open RN: elevate the legs "above their heart level when sitting to reduce edema and promote venous return." (Arterial disease is the opposite — dangling, not elevation.)
  • Walk and exercise the calf. "Activities that involve ankle dorsiflexion, ankle plantarflexion, and forceful toe flexion (eg, walking and cycling) are the most effective movements." NHS: "Regularly exercise your legs by moving your feet up and down, and rotating them at the ankles."
  • Avoid long standing and sitting; stop smoking. NHS: "do not stand for long periods" and "do not sit for long periods, unless your feet are raised"; "do not smoke, as it damages your veins."
  • Skin and wound care. "Topical moisturizers, commonly containing lanolin, minimize skin fissuring and disintegration." Avoid scratching — it "damages the skin and may lead to further ulcers." Wounds: "The standard of care for VLUs relies on 2 strategies: compression therapy and direct wound management"; "Reducing leg edema is crucial for the effectiveness of wound closure"; surgical debridement of non-viable tissue "is strongly recommended." As an adjunct to compression, "treatment with pentoxifylline or micronized purified flavonoids is an effective ancillary measure"; aspirin and cilostazol are among treatments with insufficient evidence. Nutrition: "Adequate intake of protein, zinc, and vitamin C has been associated with improved wound healing in venous ulcers."
  • Procedures. Endothermal ablation "is usually the first choice of treatment for varicose veins"; "You’ll be able to go home the same day" and "may need to wear compression stockings for about a week." Complications include DVT and pulmonary embolism, which "remain, although seldom, the possible complications of ablation."

Nursing considerations

The RN-specific layer — each action paired with the reason it matters.

Assessment
Palpate distal pulses and make sure an ABPI is on record before applying any compression.
Why: About 20% of patients with a venous ulcer also have arterial disease; an ABPI under 0.5 means "Do not compress and urgently refer to a vascular specialist."
Assess the edema pattern, skin and ulcer — area, depth, edges, base, signs of infection, and surrounding skin.
Why: "Clinical assessment should describe the ulcer area, depth, edges, wound base, signs of infection, and peripheral skin changes." StatPearls also advises assessing ulcers, distal pulses and neuropathy in the upright and supine positions.
Distinguish venous from arterial findings at the bedside.
Why: Venous: symptoms better with elevation, shallow ulcer over the medial malleolus, brown staining. Arterial: pain with walking relieved by rest, deep dry ulcers on the toes or foot, cold extremities, and a foot that turns pale when raised and red when lowered (pallor on elevation, dependent rubor).
Check the toes and sensation below a compression bandage at every contact.
Why: Numbness, tingling, unusual pain, or swollen, pale or blue toes mean the bandage must come off.
Interventions
If toes become pale or blue, numb or tingling, or pain is unusual: remove or cut off the compression bandage, keep the leg highly elevated, and contact the provider or nurse specialist as soon as possible.
Why: NHS: "you’ll need to remove or cut the bandage off if" these occur, then "keep your leg highly elevated and contact your doctor or nurse as soon as possible."
Apply or reinforce compression as prescribed; bandaging is done by trained staff.
Why: "The application of a compression bandage is a skilled procedure and should only be done by trained healthcare staff."
Give prescribed analgesia when compression is new and painful.
Why: Pain is expected at first and "will lessen once the ulcer starts to heal."
Report signs of infection in an ulcer promptly; obtain a tissue culture if ordered.
Why: Increased discharge, pain, redness or feeling unwell are signs of infection; a tissue culture, not a swab, guides antibiotics.
Patient teaching
Put compression stockings on as you get up and take them off only at night; after an ulcer heals, wear them at all times when out of bed.
Why: NHS: "these stockings should be put on as you get up and only taken off at night"; after healing, "The most effective method of preventing this is to wear compression stockings at all times when you’re out of bed."
Keep the bandage on as instructed; if it feels a little tight in bed, get up for a short walk.
Why: "If you have any problems, it’s usually best to contact your nurse instead of trying to remove it yourself," and a short walk usually helps a slightly tight bandage — the exceptions are the remove-or-cut warning signs.
Elevate the legs above heart level several times a day and walk daily.
Why: Elevation lowers venous pressure; walking restores the calf muscle pump.
Moisturize the skin, do not scratch, avoid injuring the leg, and wear well-fitting footwear.
Why: Fragile skin breaks down easily; "Be careful not to injure your affected leg, and wear comfortable, well-fitting footwear."
Reach a healthy weight, stop smoking, and avoid long periods of standing or sitting.
Why: Excess weight raises venous pressure; smoking "damages your veins."
Explain that this is lifelong care.
Why: "Key strategies for preventing recurrence include lifelong compression therapy, physical activity, health education, and structured self-care."

How a real nurse thinks

The clinical-judgment loop, worked for a typical presentation — reasoning, not reference.

  1. 1
    Recognize cues

    New numbness and tingling, unusual pain, and pale, bluish, swollen toes under a compression bandage. These are exactly the NHS signs for which "you’ll need to remove or cut the bandage off." His ulcer itself shows no new signs of infection.

  2. 2
    Analyze cues

    The bandage is compromising the circulation or nerves of his foot. His last ABPI of 0.95 falls in the band for compression "with caution," and arterial disease coexists in about 20% of people with venous ulcers — so a pale, cool, blue foot under compression must not be watched and waited on.

  3. 3
    Prioritize

    Remove the bandage now, then elevate the leg and contact the clinic or provider as soon as possible. Keeping the bandage on "exactly as instructed" applies to ordinary tightness — not to these warning signs.

  4. 4
    Generate solutions

    Cut off the bandage, keep the leg highly elevated, reassess the toes, and report. Anticipate a review of the compression plan and of his arterial status before any compression is reapplied.

  5. 5
    Take action

    The nurse removes the bandage and elevates the leg, then calls the leg-ulcer clinic with an SBAR: 72-year-old man, left medial venous ulcer, multilayer compression applied 2 days ago, ABPI 0.95 last month. Overnight numbness and tingling, unusual foot pain, toes pale-blue, swollen and cool. Bandage removed and leg elevated. Requesting same-day review of compression and arterial assessment.

  6. 6
    Evaluate

    Twenty minutes after removal with the leg elevated, the toes are pinker and the tingling is easing. The clinic arranges review before compression is reapplied. The nurse reinforces the warning signs, elevation, and daily walking.

Scenario — you’re the nurse

Work each question before revealing the answer. Rationales explain the wrong options too.

Home health visit · 1000

A 72-year-old man with a venous leg ulcer above his left medial malleolus had a multilayer compression bandage applied at the leg-ulcer clinic two days ago. His ABPI last month was 0.95. Today he says his toes ‘went numb and tingly overnight’ and the pain in his foot is ‘different — worse than the ulcer’.

Left toes — pale with a bluish tinge, swollen, cool compared with the right
Sensation — reports numbness and tingling in the left toes
Bandage — intact, no strike-through; the patient did not remove it
Vital signs — T 36.8 °C · HR 84 · BP 138/82
Ulcer (at the last dressing change) — shallow, irregular, fibrinous base, no increased discharge
Q1 Select all that apply
Which findings under a compression bandage require the bandage to be removed? Select all that apply.
  1. A. Numbness or tingling in the toes
  2. B. Toes that look pale or blue
  3. C. Unusual pain in the foot or toes
  4. D. The bandage feels slightly tight in bed at night
  5. E. Swollen toes
Reveal answer & rationale
Answer: A, B, C, E
NHS lists numbness or tingling (A), unusual pain (C), and toes that are swollen or look pale or blue (B, E) as reasons to remove or cut off the bandage. A bandage that feels a little tight in bed (D) usually improves with a short walk.
Q2 Multiple choice
Which ulcer description is most consistent with a venous leg ulcer?
  1. A. Deep, dry wound on the toes with absent pedal pulses
  2. B. Shallow, irregular ulcer with a fibrinous base over the medial malleolus
  3. C. Punched-out ulcer on the plantar surface of the heel
  4. D. Deep ulcer on the foot dorsum with cold skin
Reveal answer & rationale
Answer: B
VLUs are "shallow, irregular, well-defined ulcers with fibrinous material on the base" over the medial aspect of the distal leg (B). Arterial ulcers are "deep, dry wounds affecting the toes, foot dorsum, and the anterior aspect of the leg" with abnormal pulses and cold extremities (A, D). Option C is not a venous pattern.
Q3 Multiple choice
A different patient with a venous leg ulcer has an ABPI of 0.45. What should the nurse anticipate?
  1. A. Full multilayer compression
  2. B. Compression with caution
  3. C. No compression and urgent referral to a vascular specialist
  4. D. Compression stockings only at night
Reveal answer & rationale
Answer: C
The StatPearls ABPI table: "Less than 0.5 | Critical ischemia | Do not compress and urgently refer to a vascular specialist" (C). Compression with caution is for 0.8 to 1.0 (B); full compression is for a normal ABPI (A).
Q4 Select all that apply
Which statements about compression stockings show correct understanding? Select all that apply.
  1. A. ‘I put them on when I get up and take them off at night.’
  2. B. ‘Once my ulcer heals I can stop wearing them.’
  3. C. ‘They squeeze most at the ankle to push blood up toward my heart.’
  4. D. ‘After my ulcer heals I should wear them whenever I am out of bed.’
Reveal answer & rationale
Answer: A, C, D
NHS: stockings "should be put on as you get up and only taken off at night" (A); they are "usually tightest at the ankle" to encourage upward flow (C); and after healing the best prevention is to wear them "at all times when you’re out of bed" (D). Care is lifelong because 40% of ulcers recur (B is wrong).
Q5 Multiple choice
Which instruction best distinguishes the care of venous insufficiency from arterial disease?
  1. A. Elevate the legs above heart level to reduce edema
  2. B. Keep the legs dangling when sitting
  3. C. Avoid walking to reduce leg pain
  4. D. Apply compression before checking pulses
Reveal answer & rationale
Answer: A
Venous: elevate the legs "above their heart level when sitting to reduce edema and promote venous return" (A). Dangling is the arterial approach (B). Walking restores the calf pump (C is wrong), and pulses and ABPI are checked before compression (D is wrong).

Common questions

What causes chronic venous insufficiency?
Common causes and risk factors include age — statpearls lists "advanced age (ie, aged 55 or older)", female sex and family history of varicose veins — "the most common nonmodifiable risk factors are female gender and nonthrombotic iliac vein obstruction (eg, may-thurner syndrome).", previous deep vein thrombosis or thrombophlebitis — the cause of secondary cvi, obesity, smoking, and others.
What are the early signs of chronic venous insufficiency?
Early findings include Dependent pitting edema, leg aching or heaviness, fatigue and itching.
Which findings should a nurse report immediately in chronic venous insufficiency?
Report immediately: Under a compression bandage: numbness or tingling, unusual pain, or toes that are swollen, pale or blue, Severe hemorrhage from a varicose vein. These signal deterioration that needs rapid intervention.
Why must the ABPI be checked before compression?
Because "approximately 20% of patients with VLU have concurrent arterial disease," and arterial disease limits or rules out compression. StatPearls uses the ABPI to decide: normal — apply compression; 0.8 to 1.0 — with caution; 0.6 to 0.8 — modified compression and referral; under 0.5 — do not compress and refer urgently.
How can the nurse tell venous from arterial leg problems?
Venous symptoms "improve with rest and leg elevation and with no association with exercise," the skin is stained brown and edematous, and ulcers are shallow and over the medial ankle. Arterial pain comes with walking and eases with rest, the skin is pale when raised and cool, and ulcers are deep and dry on the toes or foot. Venous legs are elevated; arterial legs are not.
Is one compression pressure right for everyone?
No. The StatPearls chapters give different ranges for different problems — 30 to 50 mm Hg for CVI, 20 to 30 mm Hg (30 to 40 when severe) for varicose veins, and high compression reaching the knee for ulcers. The pressure is chosen by the clinician for the indication and the arterial status.

Sources

Reviewed by Hae Suk Lee, RN

Educational summary for nursing students. Scenarios are fictional teaching cases. Always verify against current guidelines and your institution's protocols before acting in practice. Not medical advice.

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