02.10 Peripheral Vascular Assessment

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Peripheral Artery Disease Pathochart (Cheat Sheet)
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Vascular System (Image)
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Circulatory System (Image)

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In this video we’re going to review the peripheral vascular assessment. Not only are we looking at actual blood vessels and pulses, but we’re looking at other signs of perfusion as well, like skin and nail color and condition. We always recommend starting with the upper extremities and moving to the lowers.

Start by inspecting the arms and compare them bilaterally. Is one more swollen than the other? Is there any edema? What color is the skin and nailbeds and are there any lesions? Is there hair where there should be hair?
Next, we’ll palpate. Feel for the temperature, texture, and turgor of the skin. If there’s edema, is it pitting? Press one finger into it to find out.
We’ll also press down on the nailbeds to check capillary refill. You should see the color return to the nails in less than 3 seconds.
Once we’ve done that, we can check our pulses. There are two main pulses you’ll check in the upper extremities - the brachial pulse - found in the medial aspect of the elbow.
And the radial pulse found on the wrist in the groove just below the thumb. Make sure you compare these pulses bilaterally and give them a score from 0 to 4, with 0 being absent, 2 being normal, and 4 being bounding. An absent pulse is never normal, so if you need to, get a doppler and verify whether it’s truly absent before you call the provider.
Now we’ll move on to the lower extremities and basically look at all of the same things. Inspect the skin color and nail beds, look for lesions or ulcerations and look for edema. If there is edema, is it the same bilaterally? Is it pitting? And, make note of the hair distribution - any kind of venous insufficiency can cause a lack of hair growth and dark discolorations.
We also want to look at vasculature - are there any tortuous or varicose veins - a really common place is behind the knees.
You also want to palpate the temperature, texture, and turgor as well. Then you can move on to pulses.
There are 3 main pulses we check in the legs, the popliteal - which is located behind the knee, the dorsalis pedis on the top of the foot, and the posterior tibial, which is along the medial malleolus. Again, check that they’re the same on both sides and give them a score.
Then finally check the capillary refill on the toes, should also be less than 3. You’ll notice the nurse took off the socks - you cannot properly assess the peripheral vascular system without actually visualizing the feet - that’s so important.

If you note any abnormalities, make sure you assess the details and report them to the provider, especially if they’re new. Poor perfusion is nothing to mess with!

So that’s it for the peripheral vascular assessment. Now, go out and be your best self today. And, as always, happy nursing!
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