The peripheral vascular (PVS) examination is performed to elicit signs of peripheral vascular pathology, such as examining the blood vessels in the extremities.
Like most examination stations this follows the usual procedure of:
Begin by washing your hands.
Introduce yourself to the patient and clarify their identity. Explain what you would like to do and gain their consent.
For this station the patient should by lying on the bed and ideally exposed from the waist down, however for the purposes of the exam the patient will likely be wearing shorts.
Perform a general observation of the patient, noting whether they are comfortable at rest as well as their general wellbeing. Comment on the general appearance of the legs, including any obvious abnormalities such as muscle wasting or scars.
Furthermore, note any appliances or medications which may be positioned around the bed.
Focus the observation towards the patient’s legs, feet and toes. Signs to note include:
Now move onto palpating the legs. This will include an assessment of the temperature of each leg. Starting distally, feel with the back of your hand and compare the legs to each other noting any difference.
Check capillary return by compressing the nail bed and then releasing it. Normal colour should return within 2 seconds.
If this result is abnormal, you should suggest to the examiner that you would like to perform Buerger’s Test. This involves raising the patient’s feet to 45 degrees. In the presence of poor arterial supply, pallor rapidly develops.
Following this, place the feet over the side of the bed, cyanosis may then develop.
Any varicosities which you noted in the observation should now be palpated. If these are hard to the touch, or painful when touched, it may suggest thrombophlebitis.
Finally for palpation, you should feel for the abdominal aorta and each of the peripheral pulses. These are:
You should feel these on both sides and comment on their strength, comparing one side relative to the other.
Check for radio-femoral delay by palpating both the radial and femoral pulses on one side of the body at the same time. The pulsation should occur at the same time. Any delay may suggest coarctation of the aorta.
There is little to auscultate in a peripheral vascular examination. However, you should listen for femoral and abdominal aortic bruits.
On completion, thank the patient for their time and ensure they are comfortable and well-covered. Remember to wash your hands and report your findings to the examiner.