peripheral vascular exam

Question 1

What do you inspect overall for in the peripheral vascular exam?

Answer 1

Colour

Hair distrobution

Skin thickness

Scars

Ulcerations

Variscosities

Edema

Muscle Wasting

Between Toes

-important to look for fungal infections and broken down skin between toes

Nail growth and appearance

Question 2

What do you palpate for in the peripheral vascular exam?

Answer 2

Temperature-> over both legs with the backs of your hands simultaneously

Capillary refil time–> < 3 sec normal

Edema–> press and look for pitting/ non pitting edema.

-non pitting edema is likely from lymphedema

Remember, if they are bed ridded they will likely have edema on their cocxyx

Calf circumfrence–>5 cm below the tibial tuberosity symmetrically on both sides

>2 cm difference in the calf is abnormal

>1cm difference in the ankles is abnormal

Pulses–>

compare

1) Radial
2) Brachial

for rate, rhythm, symmetry and amplitude

compare

1) Abdominal
2) Femoral
3) Poplitieal
4) Dorsalis Pedis
5) Posterial Tibial

for symmetry and amplitude

Radial Femoral Delay->palpate the radial and femoral arteries looking for the femoral pulse to come before the radial pulse

if femoral pulse comes after radial pulse then think about something blocking off the aorta–> coarctation, aneurysm

Question 3

What do you ascultate for in the peripheral vascular exam

Answer 3

1)Ausculatory blood pressure

2)Pulsus paradoxus–>

–>deflate the cuff to where you can hear first heart sounds on expiration only

->deflate the cuff to where you can hear the first heart sounds on inspiration and expiration

If there is more than a 10 mmHg difference then there is pulsus paradoxus

-This is common in cardiac tamponade and pericarditis ( inflammation of the heart and surrounding tissues)

3)ascultate the following arteries commenting on bruits

• brachial
• abdominal
• renal
• iliac
• femoral

Answer 4

1)special tests–>

Allens test–> patient clenches fist, holds above head, waiting for it to loose blood

• >lower hand with it still clenched, occluding the radial and ulnar arteries
• > release the ulnar artery and look for blood to return to hand
• >do again and release radial artery first

palm should redden within 5 seconds

if one slower than the other–> the slower of the arteries has an occlusion

if time delayed for both arteries–> proximal blockage

if there is no refil from ulnar then no connection between the deep and superficial palmar arches exists

2)Straight leg raise and refil test

• raise legs to 45-60 degrees for 30 seconds
• patient sits up and holds legs over the side of the bed
• natural pink colour should return to feet within 10 seconds
• if greater than 10 seconds then arterial insufficiency
• if dusky colour exists as well then venous insufficiency–> rubor on dependency test

3)incompetent saphenous vein test

• locate saphenous vein medial thigh down leg
• occlude proximally and distally 15-20cm apart
• tap proximally
• distal hand should not feel tap–> if it does-> incompetent saphenous vein