NEUROVASCULAR ASSESSMENTS (Sensation (To assess radial nerve palpate…
Neurovascular status is essential in early recognition of neurovasular deterioration or compromise. Any delays can lead to permanent deficits, loss of limb, and even death.
When can neurovascular deficit occur?
After trauma, surgery, or cast application.
Specific to post operative:
-Internal or external fixation or fracture.
-Plastic surgery on extremities.
-Tourniquet applied for long periods
-Application of plaster cast
Neurovascular is the structure and function of vascular and nervous systems in combination.
Frequency of observations:
-1 hourly for the first 24 hours post injury, surgery or application of cast.
-4hourly for a further 48 hours
-More frequently if any deviations from baseline observations.
Inadequate arterial supply: pale, white or cyanotic
Inadequate venous return: dusky, cyanotic, mottled, purple/black
Normal: Warm. Capillary refil 1-2 seconds
Inadequate arterial supply: cool. Capillary refill >2 seconds
Inadequate venous return: hot . Capillary refill rapid
Assess motor function in hand
Radial nerve is the ability to extend wrist and fingers and knuckle joint.
Median nerve allows the ability to bring thumb and little finger together so they are touching
Ulna nerve assess the ability to abduct all fingers
Active movement is the ability to voluntarily extend and flex extremity
The level of pain for the patient should be assessed upon movement
Also palpate for peripheral pulses distal to the injury if assessable due to casting. Pulselessness is a late sign of deficit and indicates tissue death.
To assess radial nerve palpate wedding space between thumb and index finger, including dorsal surface of hand.
Median nerve palpate wedding space between thumb and index finger, including palmer surface of hand
Ulna nerve to palpate between little finger and distal ring finger on palmar and dorsal surface of hand
If neurovasular compromise is present, patients may report decreased sensation, loss of sensation, numbness, tingling, or pins and needles.
Altered sensation may be result of nerve block or epidural, which should be documented and assessed for this to have no effect any longer.