NEUROVASCULAR ASSESSMENTS

Purpose:
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.

Neurovascular is the structure and function of vascular and nervous systems in combination.

Specific to post operative:
-Internal or external fixation or fracture.
-Orthopaedic surgery.
-Spinal surgery.
-Plastic surgery on extremities.

  • Cardiac cauterisation.
    -Tourniquet applied for long periods
    -Application of plaster cast

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.

Colour

Normal: Pink

Inadequate arterial supply: pale, white or cyanotic

Inadequate venous return: dusky, cyanotic, mottled, purple/black

Warmth

Normal: Warm. Capillary refil 1-2 seconds

Inadequate arterial supply: cool. Capillary refill >2 seconds

Inadequate venous return: hot . Capillary refill rapid

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.

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

Sensation

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.

Active movement is the ability to voluntarily extend and flex extremity

The level of pain for the patient should be assessed upon movement