The Peripheral Vascular System Examination - Podcast Version 0:00 / 0:00 1x 0.25x 0.5x 0.75x 1x 1.25x 1.5x 1.75x 2x OSCE Checklist for The Peripheral Vascular System Examination 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 2nd and 3rd 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) Frequent questions What is the purpose of a peripheral vascular system examination? The peripheral vascular system examination aims to assess blood flow and identify signs of vascular compromise in a patient. This includes evaluating the upper and lower limbs for abnormalities such as cyanosis, skin changes, and pulse characteristics. How do you assess capillary refill during a vascular examination? Capillary refill is assessed by pressing on a nail bed or skin area until it blanches, then observing the time taken for colour to return. A normal capillary refill time is less than two seconds, indicating adequate perfusion. What signs might indicate peripheral vascular disease in the arms? Signs of peripheral vascular disease in the arms include peripheral cyanosis, tar staining, and anaemia visible in the palmar creases. Palpating the radial, ulnar, and brachial pulses can further help identify vascular issues. How should the legs be examined for vascular health? During the examination of the legs, inspect for scars, skin changes, and ulcers, while also assessing temperature and capillary refill. It is essential to palpate the femoral, popliteal, dorsalis pedis, and posterior tibial pulses to evaluate blood flow. What additional assessments can be performed to complete a vascular examination? To complete a vascular examination, additional assessments such as a cardiovascular examination, capillary glucose test, fundoscopy, or Ankle-Brachial Pressure Index (ABPI) can be performed. These tests provide further insight into the patient's vascular and overall health. Rate This Article