Video

http://geekymedics.com/2010/09/23/peripheral-vascular-examination/

Exam Summary


1. Introduction

  • Introduce yourself and the exam
  • Position the bed at 45
  • Hand hygiene

2. Observations

  • Temperature
  • Heart Rate
  • Blood Pressure
  • BloodSugar Level

3. General Inspection

Look for:
  • Overall appearance (well/unwell)
  • Alertness
  • Body Habitus
  • Dyspnoea
  • Patient comfort
  • IV lines, other machines

4. Hands and Upper Limbs

a. Inspection

Look for:
  • Clubbing - a sign of tissue hypoxia which may be due to vascular disease
  • Peripheral cyanosis
  • Capillary refill - should be less than three seconds
  • Nicotine stains - a sign of smoking
  • Arteriovenous fistula - which may be created for dialysis
  • Tendon xanthomata - a sign of hypercholesterolaemia
AV Fistula.jpg
Arteriovenous Fistula


Hand Xanthomata.jpg
Hand Xanthomata
Cyanosis.JPG
Peripheral Cyanosis

clubbing.jpg
Clubbing
Capillary Refill.jpg
Capillary Refill

b. Radial Pulse

Assess for:
  • Rate
  • Rhythm
  • Character
  • Radio-radial delay - a sign of subclavian coarction
  • Radio-femoral delay - a sign of aortic coarction

c. Blood Pressure

Take the blood pressure in both arms lying and standing

5. Head

a. Eyes

Look for:

b. Mouth

Look for:
  • Cyanosis
  • Hydration

6. Neck

a. Carotid Arteries

Assess each side individually for:
  • Pulse
  • Character
  • Auscultate for bruit

b. Jugular Venous Pressure

  • Assess the neck with the patient at 45⁰

7. Chest

8. Abdomen and Groins

a. Inspection

Lie the patient supine.
Look for:

b. Palpation

  • Place hand on the epigastrium to feel for an Abdominal Aortic Aneurysm. Feel for the borders of the aneurysm.
  • Palpate the sapheno-femoral junction and assess if there is a thrill when the patient coughs. This indicate venous valve incompetence.

c. Auscultation

  • Listen to the Thoracic Aorta and Common Iliac Vessels

9. Legs and Feet

a. Inspection

Check for:

Diabetic_Wound_121.jpg
Diabetic Ulcer
Venous Ulcer.jpg
Venous Ulcer

Arterial Ulcer.jpg
Arterial Ulcer
Varicose.jpg
Varicose Veins



b. Auscultation

  • Listen for Femoral Artery bruit and adductor hiatus bruit.

c. Palpation

  • Assess Temperature
  • Capillary refill - should be less than three seconds
  • Pulses
    • Femoral
    • Popliteal
    • Posterior Tibial
    • Dorsalis Pedis
  • Veins
    • Hard - thrombosis (see DVT)
    • Tender - thrombophlebitis
Pulses.png

d. Buergher's test

  • Elevate legs to 45º for 1 minute
  • Hang legs over bed at 90º
  • If the legs remain pale for >10 seconds then poor arterial supply is likely

e. Varicose veins

  • Stand the patient up to assess properly

10. Further Tests and Examinations

11. Conclude

Thank the patient and offer assistance

See Also

http://geekymedics.com/2010/09/23/peripheral-vascular-examination/

References

Arterio-Venous Fistula: By Pravdaz (Own work) [GFDL (http://www.gnu.org/copyleft/fdl.html) or CC BY-SA 3.0 (http://creativecommons.org/licenses/by-sa/3.0)], via Wikimedia Commons
Venous Ulcer image:
"Úlceras antes da cirurgia" by Nini00 - Own work --> http://www.varizinforma.com/Photo.htm (.jpg). Licensed under CC BY-SA 3.0 via Wikimedia Commons - https://commons.wikimedia.org/wiki/File:%C3%9Alceras_antes_da_cirurgia.JPG#/media/File:%C3%9Alceras_antes_da_cirurgia.JPG
Arterial Ulcer image:
"Arterial ulcer peripheral vascular disease" by Jonathan Moore - Creating the Ideal Microcosm for Rapid Incorporation of Bioengineered Alternative Tissues Using An Advanced Hydrogel Impregnated Gauze Dressing: A Case Series. The Foot and Ankle Online Journal 1 (9): 2.. Licensed under CC BY 3.0 via Wikimedia Commons - https://commons.wikimedia.org/wiki/File:Arterial_ulcer_peripheral_vascular_disease.jpg#/media/File:Arterial_ulcer_peripheral_vascular_disease.jpg
Diabetic Ulcer image:
By Intermedichbo at sr.wikipedia [CC BY-SA 3.0 rs (http://creativecommons.org/licenses/by-sa/3.0/rs/deed.en) or GFDL (http://www.gnu.org/copyleft/fdl.html)], from Wikimedia Commons
Pulses Image:
from http://intranet.tdmu.edu.ua/data/kafedra/internal/propedeutic_vn_des/classes_stud/en/med/lik/ptn/Nurse%20practice/3/leson_1_Organization%20of%20nurse%20post.htm
Varicose veins image: "Varicose ASV1" by Nini00 - Own work. Licensed under CC BY-SA 3.0 via Wikimedia Commons - https://commons.wikimedia.org/wiki/File:Varicose_ASV1.jpg#/media/File:Varicose_ASV1.jpg
Peripheral cyanosis image: "Cynosis" by James Heilman, MD - Own work. Licensed under CC BY-SA 3.0 via Commons - https://commons.wikimedia.org/wiki/File:Cynosis.JPG#/media/File:Cynosis.JPG


Diabetic_Wound_121.jpg
Diabetic Ulcer
Venous Ulcer.jpg
Venous Ulcer

Arterial Ulcer.jpg
Arterial Ulcer


Peripheral cyanosis image: "Cynosis" by James Heilman, MD - Own work. Licensed under CC BY-SA 3.0 via Commons - https://commons.wikimedia.org/wiki/File:Cynosis.JPG#/media/File:Cynosis.JPG