Peripheral Vascular Examination Flashcards
Outline the 8 stages in a peripheral vascular examination
- Introduction
- General inspection
- Arms
- Neck
- Abdomen
- Legs
- Special tests
- Completing the examination
What should you do in the introduction stage of your examination?
- Wash hands
- Introduce yourself (name & role)
- Gain consent
- Position appropriately
- Expose appropriately
- Any pain?
What position do you want your pt to be in for peripheral vascular examination?
45 degrees until examine abdo and legs when you want them flat/supine
What will you be looking for in the general inspection stage of your examination?
Inspect pt
- Any missing limbs or digitis
- Scars
- Ulcers
- Body habitus
Surroundings
- Limb prosthesis
- Dressings
- Mobility aids
- Medications/fluids etc…
- Drug charts
What should you do in the arms section of the examination?
- Inspect and compare upper limbs for:
- Peripheral cyanosis
- Tar staining
- Peripheral pallor
- Xanthomata
- Gangrene
- Capillary refill
- Assess temperature using dorsum of hand
- Pulses:
- Radial pulse (rate & rhythm)
- Radio-radial delay
- Brachial pulse (volume & character)
- BP
State two possible causes of radio-radial delay
- Aortic dissection
- Subclavian artery stenosis e.g. compression by cervical rib
Why is measuring BP important in peripheral vascular examination?
- Wide pulse pressure can be associated with aortic regurgitation and aortic dissection
- Difference of more than 20mmHg in BP between arms is associated with aortic dissection
- Hypertension= risk factor for PVD
What should you do in the neck stage of your peripheral vascular examination?
- Ausuclate for bruits
- Palpate for carotid pulse (assess for volume & character)
Where in neck do you listen for carotid bruits?
- Between larynx and anterior border of SCM over carotid pulse
- Ask pt to take deep breath and then hold it while you listen
What should you do in the abdomen section of your examination?
- Inspect:
- Obvious pulsation
- Scars
- Palpate the aorta
- Auscultate aorta and renal arteries
Describe how you should palpate the aorta
- Use both hands
- Deep palpation
- Superior to umbilicus in midline
- Note movement of fingers:
- Healthy- fingers move superiorly with each pulsation of aorta
- Expansile mass- fingers move outwards with each pulsation
Describe where you should listen for aortic and renal bruits
- Aortic: 1-2cm superior to umbilicus
- Renal: 1-2cm superior to umbilicus and slighlty lateral to midline on each side
What should you do the leg stage of your examination?
- Inspect:
- Peripheral cyanosis
- Peripheral pallor
- Ischaemic rubor
- Skiin changes e.g. hair loss, haemosiderin deposition, varcisoe eczema, atrophie blanche
- Ulcers: arterial or venous
- Gangrene
- Missing limbs or toes
- Scars
- Xanthomata
- Muscle wasting (associated chronic PVD)
- Capillary refill time
- Feel temperature using dorsum of hand
- Pulses:
- Femoral
- Radio-femoral delay
- Popliteal
- Posterior tibial
- Dorsalis pedis
- Ausculate femoral bruits
- Assess sensation using light touch
Describe how to locate the following pulses:
- Femoral
- Popliteal
- Posterior tibial
- Dorsalis pedis
- Femoral: mid inguinal point (midpoint between ASIS and pubis symphysis)
- Popliteal: ask to relax their legs, place thumbs on tibial tuberosity, passively flex pts knee to 30 degrees as you curl fingers into popliteal fossa, compress popliteal artery against tibia to feel pulse
- Posterior tibial: posterior to medial malleolus of tibia. Palpate pulse then compare strength between feet
- Dorsalis pedis: dorsum of foot lateral to the extensor hallucis longus tendon. Palpate pulse then compare strength between feet
State some potential causes of radio-femoral delay
- Coarctation of aorta
- Atherosclerosis of aorta
- Thrombosis or embolism in aorta
