Peripheral Vascular Examination

Question 1

General Inspection?

Answer 1

A - Appearance
B - Breathing
C - Colour
D - Dolor
E - Environment

Question 2

Summarise inspection of hands?

Answer 2

• Colour
• Cap refill
• Tar staining
• Clubbing
• Anaemia
• Radial Pulse - rate, rhythm, volume, character
• Check and compare pulses (radial, ulnar, brachial)
• Allen’s test

Question 3

Summarise Allen’s test?

Answer 3

• Instruct the patient to clench his or her fist; if the patient is unable to do this, close the person’s hand tightly.
• Using your fingers, apply occlusive pressure to both the ulnar and radial arteries, to obstruct blood flow to the hand.
• Positive modified Allen test – If the hand flushes within 5-15 seconds it indicates that the ulnar artery has good blood flow; this normal flushing of the hand is considered to be a positive test.
• Negative modified Allen test – If the hand does not flush within 5-15 seconds, it indicates that ulnar circulation is inadequate or non-existent.

Question 4

Summarise inspection of arms?

Answer 4

BP on both arms.

Question 5

Inspection of neck?

Answer 5

Carotid pulses (one at a time)

Question 6

Inspection of face/mouth?

Answer 6

• Look in eyes for conjunctival pallor (iron deficiency anaemia)
• Look in eyes for corneal arcus and around eyes for xanthelasma (hyperlipidaemia)
• Look under tongue for central cyanosis..
• Identify whether mucous membranes are moist?

Question 7

Inspection of abdomen?

Answer 7

Look for any obvious scars, pulsations or masses.

Question 8

Inspection of legs, feet and toes?

Answer 8

• Note any scars from previous vascular or non-vascular surgery.
• Symmetry, colour, temperature (feel thighs, front of shins and back of calves).
• Oedema, trophic changes (is there hair?).
• Varicose eczema, venous guttering, sensation and cap refill.
• Broken areas - especially check between toes for ulcers, and the heels for ischaemic changes (common site for pressure sores).