Assessment peripheral blood vessel

Peripheral Vascular

Assessment

Maria Carmela L. Domocmat, MSN, RN

Associate Professor, College of Nursing

Manila Adventist College

a. Dorsalis pedis

b. Facial

c. Carotid

d. Brachial

e. Radial

f. Femoral

g. Popliteal

h. Posterior tibial

i. Temporal

j.

8/14/2017 2 Maria Carmela Domocmat, RN, MSN

1.

2.

3.

4.

5.

6.

7.

8.

9.

Answer

a. Dorsalis pedis

b. Facial

c. Carotid

d. Radial

e. Brachial

f. Femoral

g. Popliteal

h. Posterior tibial

i. Temporal

j.


1. i.

2. b.

3. c.

4. e.

5. d.

6. f.

7. g.

8. h.

9. a.



Equipments

centimeter tape

stethoscope

Doppler ultrasound devices

conductivity gel

tourniquet

gauze or tissue

waterproof pen

BP cuff


Arms

Observe arm size and venous pattern; also look for edema

Observe for coloration of the hands and arms

Palpate the client’s fingers, hands, arms, and note the temperature

Palpate to assess for capillary refill time

Palpate for radial pulse

Palpate the ulnar pulse

You can also palpate the brachial pulses if you suspect arterial insufficiency

Palpate the epitrochlear lymph nodes

Perform the Allen Test

8/14/2017 Maria Carmela Domocmat, RN, MSN 7

Legs

Observe skin color while inspecting both legs

from the toes to the groin

Inspect distribution of hair

Inspect for lesions or ulcers

Inspect for edema

Palpate edema

Palpate bilaterally from temperature of feet and

legs


Legs

Palpate the superficial inguinal lymph nodes

Palpate the femoral pulses

Auscultate the femoral pulses

Palpate the popliteal pulses

Palpate the dorsalis pedis pulses

Palpate the posterior tibial pulses

Inspect for varicosities and thrombophlebitis

Check for Homan’s sign


Special Tests for Arterial or Venous

Insufficiency

Position change test for arterial insufficiency

Ankle-Brachial pressure index (ABPI)

Manual compression test

Trendelenburg test


Assessing the Arms


1. Observe arm size and venous

pattern; also look for edema

o normal findings:

arms- bilaterally symmetric; minimal variation in size

and shape

no edema or prominent venous patterning


o abnormal findings:

lymphedema – blocked lymphatic circulation; from

breast surgery

usually affect 1 extremity; causing induration and

nonpitting edema

prominent venous patterning with edema – venous

obstruction


2. Observe for coloration of the

hands and arms

o normal findings:

color varies – depend on client’s skin tone

should be same bilaterally



rapid changes of color (pallor, cyanosis, and

redness), swelling, pain, numbness, tingling, burning,

throbbing, and coldness – Raynaud’s disease:

vascular disorders caused by vasoconstriction or

vasospasm of dingers or toes

commonly occurs bilaterally

symptoms last minutest to hours


3. Palpate the client’s fingers, hands,

arms, and note the temperature

o normal findings:

skin form fingertips to upper arms – warm to touch

bilaterally



cool extremity – sign arterial insufficiency

cold fingers and hands – Raynaud’s dse


4. Palpate to assess for capillary refill

time

o Note: inaccurate findings – may result if

room is cool

client has edema

client has anemia

client recently smoked a cigarette


o normal findings:

capillary beds refill in 1 to 2 seconds or less


capillary refill time exceeding 2 seconds –

vasoconstriction, decreased CO, shock, arterial

occlusion, or hypothermia


5. Palpate for radial pulse

Note: for difficult-to-palate pulse – use Doppler

ultrasound device


o normal findings:

radial pulse – equal strength bilaterally (2+)

artery walls have a resilient quality (bounce)



increased radial pulse volume – hyperkinetic state

diminished or absent pulse – partial or complete

arterial occlusion

decreased pulse – Buerger’s dse, scleroderma


6. Palpate the ulnar pulse if you

suspect arterial insufficiency

o not routinely assessed – located deeper than

radial pulse

o normal findings:

may not be detectable



lack of resilience or inelasticity of artery wall –

arteriosclerosis


7. Palpate the brachial pulses if suspect

arterial insufficiency

o normal findings:

equal strength bilaterally


increased, diminished, or absent


8. Palpate the epitrochlear lymph

nodes

o normal findings:

not palpable


enlarged – infection in hand or forearm, or

generalized lymphadenopathy; or lesion in area


9. Perform the Allen Test

o normal findings:

pink coloration returns to palms within 3 to 5 secs if

ulnar is patent


pallor persist – arterial insufficiency or occlusion of

ulnar artery


ASSESSING THE LEGS


1. Observe skin color while inspecting

both legs from the toes to the groin


o normal findings:

color – same with body skin tone


pallor – esp when elevated – arterial insufficiency

rubor, when dependent – arterial insufficiency

cyanosis when dependent– venous insufficiency

rusty or brownish pigmentation around ankles –venous

insufficiency


2. Inspect distribution of hair

o normal findings:

hair covers skin on legs and appears on dorsal surface of

toes

elderly – may have hair loss on lower extremities



loss of hair in legs – arterial insufficiency

+ thin, shiny skin – arterial insufficiency


Inspect for lesions or ulcers

o normal findings:

free of lesions or ulcerations


ulcers with smooth, even margins that occur at pressure

areas (such as toes and lateral ankle)– arterial insufficiency

ulcers with irregular borders, bleeding and possible

bacterial infections that occur at medial ankle –venous

insufficiency


Inspect for edema

omeasure bilateral using cm tape

o normal findings:

identical size and shape bilaterally

no swelling

no atrophy



absence of visible veins, tendons, bony prominences

- bilateral edema

bilateral edema – indicates systemic problem (CHF) or

local problem (lymphedema) or prolonged standing or

sitting (orthostatic edema)

lymphedema – abnormal or blocked lymph vessels

unilateral edema

1-cm difference in measurement of ankles; 2-cm

difference at calf; swollen extremity

indicates venous stasis due to insufficiency or obstruction

or lymphedema

difference in measurements of both legs – muscular

atrophy; from disuse due to stroke or from being in

cast for a long time


Palpate edema

o determine if pitting or nonpitting

o normal findings:

no edema


Palpate edema


pitting edema

systemic problems (CHF, hepatic cirrhosis) or

local causes (venous stasis due to insufficiency or

obstruction or

prolonged standing or sitting (orthostatic edema)

nonpitting edema

Arterial disease, arterial occlusion

Unilateral – occlusion major vein



Palpate edema


1+ to 4+ scale – grading the severity of pitting

edema



http://ncsbn.myncsbnlx.com/data/companies/ncsbn/media/unmanaged/ReviewforNCLEXRN/rep

ository/ContentAssets/lesson10_pitting_edema_scal.gif


Disappear 10-15 secs

Lasts for more than 1 min

Lasts for 2-5 min

Palpate bilaterally from temperature

of feet and legs

o normal findings:

toes, feet and legs – equally warm bilaterally



generalized coolness in one leg or change in

temperature from warm to cool as you move down

the leg – arterial insufficiency

increased warmth - superficial thrombophlebitis –

due to inflammation in tissue around vein


Palpate the superficial inguinal

lymph nodes

normal findings:

nontender, movable lymph nodes, 1-2 cm

abnormal findings:

larger than 2 cm without tenderness –

lymphadenopathy

fixed node – malignancy


Palpate the femoral pulses

normal findings:

strong and equal bilaterally

abnormal findings:

weak or absent - partial or complete arterial

occlusion


Auscultate the femoral pulses

o if arterial occlusion is suspected

o normal findings:

no sounds auscultated


bruits over 1 or both – partial obstruction of vessel

and diminished blood flow to lower extremities


Palpate the popliteal pulses

o usually detected at medial tendon

o supine or prone positions

o normal findings: may be difficult or impossible to palpate

o abnormal findings: absent pulse – occluded artery

need further assessment – temperature changes, skin color

differences, edema, hair distribution variations, dependent

rubor (dusky redness)












Representation of arterial coats: (A), tunica

intima; (B), internal elastic lamina; (C), tunica

media; (D), external elastic lamina; (E), tunica

externa.


http://img.tfd.com/dorland/thumbs/artery.jpg












Palpating popliteal pulse


Palpating popliteal pulse








Manual Compression test





Palpation of the dorsalis pedis artery

(sagittal view) (superior view)


http://www.latrobe.edu.au/podiatry/vascular/vascpics/colourpics/PTpalpate.jpg

Palpation of the posterior tibial

artery An alternate method to

palpate this pulse is to

cup one hand (in this

case, the right hand)

around the posterior

aspect of the heel, letting

the fingers of the hand

rest close to the medial

malleolus. For the

average sized hands, this

often places the fingers in

a good position for

palpation automatically.







http://en.academic.ru/pictures/enwiki/71/Great_saphenous_vein.png

Trendelenburg test:

Determines the competency of the valves in communicating veins between

the superficial and deep veins of the leg.

Used to evaluate the competence of the valves in the great saphenous vein

and in the communicating veins between the superficial and deep venous

systems.

Elevate the patient’s leg to 90 degrees to empty it of venous blood.

Place a tourniquet around the upper thigh tightly enough to occlude the great

saphenous

Ask the patient to stand

Normally this takes about 35s for the saphenous vein to fill from below

Release of the tourniquet at 60 s produces no sudden increment in venous

filling if the saphenous valves are competent.



http://en.academic.ru/pictures/enwiki/71/Great_saphenous_vein.png



8/14/2017 Maria Carmela Domocmat, RN,

MSN

93

Pulses of the lower limb

There are 4 arterial pulses which are routinely

felt in the lower limb.

The four pulses are:

1. femoral

2. popliteal

3. posterior tibial

4. dosalis pedis (dorsum of foot)


http://www.gla.ac.uk/ibls/US/fab/tutorial/generic/sapulse.html


8/14/2017 Maria Carmela Domocmat, RN,

MSN

95

Femoral pulse

8/14/2017 Maria Carmela Domocmat, RN, MSN

96

Popliteal pulse


97

Posterior tibial pulse


98

Dorsalis pedis pulse


99





Arterial ulcers

most commonly occur distally on the foot (i.e.

toes and the sole of the foot).


Venous ulcers

often occur in the region above the medial

malleolus.


SPECIAL TESTS FOR ARTERIAL

OR VENOUS INSUFFICIENCY


Position Change Test (Arterial Insufficiency )

indication: if pulses of legs weak

Note: inaccurate if client has peripheral vascular

dse of veins with incompetent valves


Position Change Test

(Arterial Insufficiency )

supine position

place both your hand on ankle; raise both feet 12

inches above level of heart

ask client to pump feet up and down – to drain

venous blood, leaving only arterial blood to color the

legs

client sit and dangle legs off side of bed



(Arterial Insufficiency ) normal findings

(a) feet pink to slightly pale with elevation – for light-

skinned

inspect soles for dark-skinned – see subtle color changes

(b) pinkish color return to tips of toes in 10 sec or less

superficial veins on top of feet – fill in 15 sec or less



(Arterial Insufficiency ) abnormal findings

arterial insufficiency

marked pallor

longer 10 sec pink or 15 sec top of feet

persistent rubor (ducky redness) of toes or feet



Peroneal artery


Health & Medicine

Assessment peripheral blood vessel