Question

procedure 5 : Neurovascular observation

Answer 1

Neurovascular observation

To test sensory and motor control ('neuro') and peripheral circulation ('vascular'), a neurovascular evaluation of the extremities is carried out. Neurovascular test components include pulses, capillary refill, colour of the skin, temperature, feeling, and motor control. During this test, pain and edoema are also evaluated. Bilateral comparison of evaluation results is extremely significant. There can be major consequences for even minor adjustments. Note to provide in your report the results of the neurovascular evaluation of all extremities and to inform the relevant health care provider of any adjustments.

Pulses

Bilateral measurement of peripheral pulses of the upper extremity (brachial, radial and ulnar) and peripheral pulses of the lower extremity (femoral, popliteal, posterior tibialis and dorsalis pedis). Be sure to determine the presence of distal pulses for any damage.

• Use a scale of 0-4 points (0 = absence and 4 = strong / bound), noting also whether the pulse is small, decreased or absent.

•• Use a marker to show a pulse palpation site that is difficult to locate; this can help others determine and maintain accuracy.

Where a pulse palpation site is difficult to locate or if the pulse is slow, a manual Doppler scan should be used.

• Evaluate all other criteria if tangible pulses are not evaluable due to casting.

Capillary refill

· Test capillary refill to determine peripheral vascular perfusion by pulling on the nailbeds.

· Remember how long it takes for a distal capillary bed to recover its colour after applying pressure to induce blanching.

· A capillary refill period of two seconds or less is common for an adult; excessive perfusion can be indicated by prolonged capillary refill period.

· Age, temperature, ambient light, and application of pressure can affect capillary refill time.

Skin color

• Bilateral contrast of the colour of the eyes.

• Consider the normal skin tone of a patient and any skin conditions when carrying out this evaluation; cyanosis can appear differently in different skin tones.

· Pallor or cyanosis may indicate insufficient arterial supply; black coloration may indicate inadequate venous return in dusky, cyanotic, mottled, or purple.

· Shiny and pale skin may be a symptom of compartment syndrome, indicating pressure in the affected region, and needs urgent intervention to avoid vascular compromise that can result in muscle and nerve ischemia.

Temperature

• Use the back of the hands for a bilateral measurement of skin temperature.

• Skin should be touch wet. Cool skin may indicate insufficient supply of arteries; warmth may indicate insufficient return of veins.

Sensation

· Ask the patient about sensory changes, such as tingling, numbness (paresthesia), tension, or burning.

· A pressure sensory assessment also consists of evaluating light contact with a cotton swab and evaluating temperature differentiation with warm and cold stimuli; the sharp end of a disposable safety pin may be used to assess pinprick sensation.

· Consider applying the 2-point discrimination test, if indicated.

· Severe numbness or tingling symptoms should be examined immediately, with proximal and distal examination of the site of injury or surgery (if not precluded by casting or splinting).

· Nerve involvement, compromised blood flow, or the use of ice may change the sensory function of a patient.

Motor function

· Test motion and strength range. A main measure of the motor activity of particular nerves is the capacity of the patient to execute complex movements.

· Loss of motor control is often a late sign of neurovascular compromise, so to identify these subtle changes in the patient, regular examination and careful attention is needed.

Pain

When pain is detected and treated early, complications may be avoided.

Pain may be caused by damage to sensory nerves and/or reduced flow of blood.

Using a pain assessment method to measure pain severity.

• Note the location, severity and areas of pain that radiate.

• Be conscious of nonverbal pain signals like grimacing, protecting, tachycardia and hypotension in sedated patients or those unable to verbalise details.

Edema

· Edema can be caused by musculoskeletal injury, may lead to vascular compromise and may cause muscle and nerve tissue damage.

· Pre-existing processes of illness (i.e. heart failure, cirrhosis, or kidney disease) can put a patient at increased risk of complications associated with edema.

· The elevation of the limb, no higher than the level of the heart, will help reduce edema.