The Peripheral Vascular System Examination

Introduction

• Introduce yourself to the patient
• Wash your hands
• Briefly explain to the patient what the examination involves
• Position the patient supine
• Assess the patient from the end of the bed
  • Look for signs of obvious vascular compromise
  • Comment on any items of clinical note around the bed

Always start with the upper limb and proceed as below unless instructed otherwise; be prepared to be instructed to move on quickly to certain sections by the examiner.

The Arms

• Inspect for signs of
  • Peripheral cyanosis
  • Tar staining*
  • Anaemia (in palmar creases)

*This is typically seen between the 2^nd and 3^rd digits and is indicative of long smoking history

• Assess capillary refill
• Feel the pulses (in order)
  • Radial
  • Ulnar
  • Brachial
  • Subclavian
• Assess for any radial-radial delay

The Neck

• Feel the carotid pulse
  • Assess for character and volume
• Auscultate over the carotids
  • Listen for any carotid bruits

The Abdomen

• Look at the abdomen for obvious scars or pulsations
• Feel the abdomen for any pulsations

The Legs

• Expose the legs and observe from the end of the bed
• Scars
• Skin changes
  • Dry flaky skin or hair loss
  • Haemosiderin deposition, varicose eczema, or atrophie blanche
• Ulcers

• Feel temperature along the legs
• Capillary refill
• Feel the distal pulses
  • Femoral
  • Popliteal
  • Dorsalis pedis
  • Posterior tibial
• Check the sensation in the lower limbs
  • Soft touch sensation, working distal to proximal

Complete the Examination

Remember, if you have forgotten something important, you can go back and complete this.

To finish the examination, stand back from the patient and state to the examiner that to complete your examination, you would like to perform a:

• Cardiovascular Examination
• Capillary Glucose
• Fundoscopy
• Ankle-Brachial Pressure Index (ABPI)