PERIPHERAL VASCULAR ASSESSMENT  Release the pressure on the ulnar artery

 Watch for color to return to hand

Inspection, Palpation, and Auscultation of
circulation to arms and neck

 Brachial artery
 Carotid artery
 Use light palpation over carotids (one at a
time)
 Auscultate carotid arteries with stethoscope
bell while patient holds breath.
 Observe for bruit (swishing sound)

ALLEN TEST

• Perform the Allen test, if you suspect an

obstruction or insufficiency of an artery in the arm,  To assess radial patency, repeat the
the Allen test may determine the patency of the procedure as before, but at the last step,
radial and ulnar arteries. release pressure on the radial artery

Procedure Normal

 Have the client rest with palm up, then make ▷ Expected response is that the full color in the
a fist hand will return in 3 to 5 seconds.
 Use thumbs to occlude the radial and ulnar
Abnormal
arteries
▷ Pallor persists

Inspect and palpate circulation of the lower

extremities

 Popliteal pulse
 Dorsalis pedis
 Posterior tibial pulse

Check for Homans' sign

 Client in supine position then flex knees

about 5 degrees
 Place your hand under client's calf muscle
then quickly squeeze the muscles against
 Continue pressure to keep both arteries
the tibia
occluded
 Report presence of pain or tenderness
 Have the client release the fist
 Repeat procedure to other leg
 Note that the palm remains pale
Findings

Normal

 No pain, tenderness
 Negative Homans' sign

Abnormal

 Calf pain and tenderness may indicate deep

vein thrombosis
Check for arterial insufficiency Peripheral Perfusion

 Client lie down on back  Weak, thready, or absent peripheral pulses

 Support client's leg 12 inches above the Pale, cool, clammy skin
heart level  Delayed capillary refill >2 seconds
 Have client flap feet up and down at ankles  Infants and children only
for 60 seconds  Normal ambient air temperature
 Sit up and dangle legs

Findings

Normal

 Feet pink to slight pale color

 Color returns to tip toes in 10 sec., top of
feet in 15 sec.

Abnormal
Varicose Veins ·
 Extensive pallor, venous return to feet is
delayed 45 seconds and more in arterial • Incompetent lower leg valves will permit venous
insufficiency blood reflux. This results in tortuous dilated vessels
that are commonly called "varicose veins".
Unexpected findings Venous Status / Poor
peripheral circulation • The client often complains of leg or foot cramps,
aching, or heaviness in the calves.
 Prominent leg veins may be visualized.
 Lower leg edema, possibly extending up the
calf of the leg.
 Skin appears shiny, atrophic, and possibly
cyanotic.
 Skin may appear brownish or pigmented.
 The area is easily traumatized.
 Stasis dermatitis and ulcer may be present.

Lymphedema