Peripheral vascular exam Flashcards
What are you looking for on general inspection in a peripheral vascular exam?
- Missing limbs/digits
- Scars
- Dressings
- Mobility aids
What are you looking for on inspection of the upper limbs in a peripheral vascular exam?
- Cyanosis/pallor: PVD due to poor perfusion
- Tar staining: smoking is a risk factor for PVD
- Xanthomata: yellow cholesterol deposits due to hyperlipidaemia
- Gangrene: necrosis due to poor perfusion
What do you palpate on the upper limbs in a peripheral vascular exam?
- Temperature
- Capillary refill time
- Radial pulses
- Radial-radial delay
- Brachial pulses
- Carotid pulses (auscultate first, one at a time)
How do you perform Allen’s test?
- Compress the radial and ulnar arteries at the wrist
- Ask the patient to make a tight fist and release it
- Release pressure on one artery and observe blood flow back to the hand
- Repeat and release the other artery
What are you looking for on inspection of the face in a peripheral vascular exam?
- Subconjunctival pallor (anaemia)
- Corneal arcus (hyperlipidaemia)
- Dehydration
- Central cyanosis
What are you looking for on inspection of the abdomen in a peripheral vascular exam?
- Scars
- Visible masses
- Visible pulsations
How do you assess the aorta in a peripheral vascular exam?
- Palpate: hands moving up and out suggests expansile mass (AAA)
- Auscultate: for bruits suggesting turbulent blood flow
What are you looking for on inspection of the lower limbs in a peripheral vascular exam?
- Cyanosis/pallor: PVD die to poor perfusion
- Ulcers: venous/arterial
- Xanthomata: yellow cholesterol deposits due to hyperlipidaemia
- Gangrene: necrosis due to poor perfusion
- Muscle wasting
- Paralysis: in critical limb ischemia
- Trophic changes: hair loss, shiny or dry skin
What do you palpate on the lower limbs in a peripheral vascular exam?
- Temperature
- Capillary refill time
- Femoral pulses (also ausculate)
- Radio-femoral delay
- Popliteal pulses
- Posterior tibial pulses
- Dorsalis pedis pulses
What is tested on the lower limbs in a peripheral vascular exam?
Light touch sensation:
- start distal, move proximal if not felt
- compare each side
Movement:
- ask patient to wiggle toes
- test power by pressing down on hands like car peddle
What special test is required for a peripheral arterial exam?
Buerger’s test:
- lie the patient flat and raise their leg to 45 degrees, hold for 2 minutes
- observe any pallor in the feet, suggesting loss of perfusion (note the angle this occurs)
- sit the patient up and hang their legs over the edge of the bed
- observe for colour changes: initially blue (deoxygenated blood) then red (reactive hyperaemia)
How do you complete a peripheral arterial exam?
- Perform a cardiovascular and neurological examinations
- Measure the blood pressure in both arms
- Calculate the ankle-brachial pressure index (divide the highest systolic bp in the ankles by the highest systolic bp in the arms, ABPI < 0.8 indicates severe PAD)
