Peripheral vascular Examination

0 → absent, unable to palpate

1+ → Diminished, weaker than expected

2+ → Brisk, expected (normal)

3+ → Bounding

How are pulses graded?

-Patient makes tight fist

-Compress both ulnar and radial arteries

-Patient opens hand, palm is pale

-Release pressure over ulnar artery. It should flush within 3-5 seconds.

-Repeat to test radial artery.

How to perform Allen test?

less than 2 seconds.

What is the normal time for capillary refill?

Over the dorsum of the foot

Behind the medial malleolus

Over the shins

Where do you feel for edema on the legs?

1+ → Barely detectable impression when finger is pressed into skin.

2+ → Slight indentation; 15 seconds to rebound

3+ → Deeper indentation; 30 seconds to rebound

4+ → > 30 seconds to rebound

What is the grading scale for pitting edema?

Arterial Insufficiency

skin changes

• Prolonged capillary refill

• loss of hair

• Thinning of skin

• Dependent rubor

• Intermittent caudation

• If ulceration present, on toes or pressure points of feet.

• Temperature is cool.

• Absent or mild edema

Also check:

• Pulses

  • Decreased or absent

• Bruits

• Skin temperature

• Pallor or cyanosis.

  • Pallor when legs elevated above heart.

  • Normal skin color should return in 10 seconds or less.

Chronic venous insufficiency

-Normal pulses, may be difficult to feel through edema

-Normal, cyanotic, or petechiae present. brownish color may come from being chronic.

-Normal temperature

-Present edema, often marked.

-If ulceration present, usually on side of ankle, especially medially.

DVT

-Warmth, Erythema

-Posterior calf tenderness

-Swelling

-Measure circumference (should be same as other leg)

Pain

Pallor

Pulselessness

Paresthesia

Paralysis

What are the 5 P‘s?