Peripheral vascular examination Flashcards
What is the introduction for a peripheral vascular examination?
- Wash hands
- PPE
- Introduce self
- Ask name and DOB.
- Explain the examination.
- Gain consent.
What comes after introduction?
General inspection.
What does general inspection entail? What kind of things are you looking for?
Inspect around the patient for equipment/walking aids.
Inspect the patient from the end of the bed:
- Colour (Pale, erythematous etc.)
- Build (thin, fat etc.)
- Comfort
What comes after general inspection?
Inspection of the hands.
What kinds of things are being looked for on inspection of the hands?
- Nicotine staining.
- Colour (peripheral cyanosis, pallor etc.)
What comes after inspection of the hands?
- Capillary refil.
How is capillary refill checked?
- Squeeze distal phalanx of patient for 5 seconds.
- Colour should return within 2 seconds of pressure being released.
What comes after capillary refill?
Upper limb pulse assessment.
How are the upper limb pulses assessed?
- Check both radial pulses individually. (Rate, rhythm and character).
- Check for radio-radial delay.
- Check both ulner pulses.
- Check both brachial pulses.
- Perform an Allen’s test.
- Check BP in both arms.
What comes after upper limb pulse assessment?
Carotid assessment.
How are the carotid pulses assessed?
- Assess the carotid pulses ONE AT A TIME. To assess rate rhythm and character.
What comes after carotid pulse assessment?
- Examination of the face.
What kind of things are being looked for on facial examination?
Eyes:
- Subconjunctival pallor.
- Corneal arcus (hyperlipidaemia).
Mouth:
- Dehydration.
- Central cyanosis.
What comes after inspection of the face?
Inspection of the abdomen.
What is looked for when inspecting the abdomen?
- Scars
- Visible pulsations.
- Visible masses.
What comes after inspection of the abdomen?
- Inspection of the lower limbs.
What is being looked for when inspecting the lower limbs?
- Symmetry.
- Colour.
- Scars.
- Oedema.
- Trophic changes.
- Ulceration.
What comes after lower limb inspection?
Lower limb/ abdominal pulse palpation.
Which pulses need palpating?
- Aorta.
- Femoral pulses (mid inguinal point).
- Popliteal pulses (behind the kneecap in the popliteal fossa).
- Posterior tibial pulse (behind the ball of the ankle medially).
- Dorsalis pedis pulse (on the top of the foot).
What comes after palpation of the lower limb pulses
Light touch sensation in the toes.
What comes after light touch test in the lower limbs?
Capillary refill in the toes.
What comes after capillary refill in the toes?
Auscultation of the pulses.
Which pulses need auscultating?
- Carotids.
- Subclavian arteries (in the clavicle).
- Aorta.
- Femoral arteries.
What comes after auscultation of the pulses?
Buerger’s test.
How is Buerger’s test conducted?
Lie patient down and elevate both legs to an angle of 45 degrees. Hold there for 2 mins.
- If the feet become pale this indicates ischaemia and poor blood supply to this area.
Then, ask the patient to sit on the edge of the bed and let their legs hang normally. Observe both legs simultaneously:
- The skin goes blue, then red, then back to normal if the tissue was ischaemic.
What comes after Buerger’s test?
Calculate the ABPI.
How is ABPI calculated?
Divide the highest systolic pressure in the ankle (L or R) by the highest systolic pressure in the arm (L or R).
- Less than 0.8 indicates severe arterial disease.
What comes after ABVP assessment?
Concluding the exam.
How is the examination concluded?
- Would also like to conduct a full neurological assessment of the lower/upper limbs to complete my assessment.
- Thank the patient for their time.
- Request the patient redresses.
- Wash hands.
