This document provides information on neurovascular assessments, including: - The purpose is to assess nerve and blood circulation in the body to detect potential issues like compartment syndrome. - Key terms are defined, like neurovascular, compartment syndrome, and neurovascular deficit. - The policy outlines when assessments should be done, like after injuries or procedures. It also lists the mandatory assessment parameters. - The procedure explains how to conduct the assessment, including checking pulse, sensation, color, warmth, swelling, and range of motion. It also provides examples of assessing specific nerves.

1. NEUROVASCULAR
ASSESSMENT
Prepared by: GIANNE T. GREGORIO - CRN

2. OUTLIN
E
2
PURPOSE
DEFINITION OF TERMS
POLICY
PROCEDURE
REFERENCES

3. PURPOSETo assess for adequate nerve function and
circulation to the parts of the body in order to
detect signs and symptoms of potential
complications such as compartment syndrome.
3
To evaluate vascular and neurological
integrity of an extremity.
To be able to recognize early signs of
neurovascular deterioration or compromise.
To support assessment and prevent permanent
damage to the limb.
To determine clinical risks factors that may
lead to neurovascular deficits, loss of functions
and even death.
To aid in diagnosis, treatment, management and
referral.

4. 4
DEFINITION
Is the structure and
function of the vascular
and nervous system in
combination.
Is the assessment of the peripheral
circulation and the peripheral neurologic
integrity. Neurovascular impairment is
usually caused by pressure on the nerve
or altered vascular supply to the
extremity. Assessment is done to
patients who have sustained injury or
trauma to a limb or have a cast or
restrictive bandages in place.
NEUROVASCULAR
NEUROVASCULAR
ASSESSMENT

5. 5
DEFINITIONA serious complication of
musculoskeletal injury. This results
from increase in pressure inside a
compartment which comprises of
muscles and nerves and is enclosed
by fascia- inelastic and not
expandable to increase volume/
pressure.
Refers to deficit in function, which may
be temporary or permanent. Such
deficits can have a significant effect on
the patient’s functional ability and
overall outcome, with severe cases at
risk of amputation of the affected limb
COMPARTMENT SYNDROME
NEUROVASCULAR DEFICIT

6. 6
DEFINITION
tingling or sensation of
numbness resulting from
nerve compression
late sign of compartment syndrome
which results from prolong nerve
compression or muscle damage.
This presents inability to move the
limb.
PARESTHESIA
PARALYSIS

7. 7
DEFINITION
a quick test done in the nail beds
to monitor amount of blood flow to
tissues. This is done by pressing
the nail beds until it turns white
(blanching). Once the tissue had
blanched, release the pressure.
Staff will take note of the time it
takes for blood to return to the
tissue (normal is < 3 seconds).
This is indicated by turning of nail
to pink color.
CAPILLARY REFILL

8. NEUROVASCULAR ASSESSMENT POLICY
8
 Neurovascular assessment should be done to the following conditions, but is
not limited to:
• Trauma to an extremity
(e.g. fracture and crush injury)
• Application of traction
• Application of plasters/back slabs
• Post operatively
• (e.g. application of external fixator device)
• Spinal surgery
• Burns patient
• Cardiac catheterization

9. NEUROVASCULAR ASSESSMENT POLICY
9
 Neurovascular assessment should be done to the following conditions, but is
not limited to:
• Trauma to an extremity
(e.g. fracture and crush injury)
• Application of traction
• Application of plasters/back slabs
• Post operatively
(e.g. application of external fixator device)
• Spinal surgery
• Burns patient
• Cardiac catheterization

10. NEUROVASCULAR ASSESSMENT POLICY
10
 Neurovascular assessment should be done to the following conditions, but is
not limited to:
• Trauma to an extremity
(e.g. fracture and crush injury)
• Application of traction
• Application of plasters/back slabs
• Post operatively
• (e.g. application of external fixator device)
• Spinal surgery
• Burns patient
• Cardiac catheterization

11. NEUROVASCULAR ASSESSMENT POLICY
11
Mandatory parameters for assessment
includes the basic 5 P's such as: Pulse,
Paresthesia, Pallor, Pain, Paralysis.
Always perform bilateral assessment for
comparison and documentation.
Involve the parents/guardians in the
assessment process for children; they are
more familiar with the child’s responses to
pain.

12. NEUROVASCULAR ASSESSMENT POLICY
12
Notify physician immediately if any
alterations in neurovascular assessment
occurs.
This assessment is in addition to the
existing initial assessment and re-
assessment forms and will be properly filled
up based from medical condition of the
patient and if neurovascular impairment is
suspected.

13. NEUROVASCULAR ASSESSMENT POLICY
CLEAN
GLOVES
WATCH
(with second hand)
DOPPLER &
MARKER
13
MATERIALS

14. PROCEDURE
14
1. Explain procedure
to the patient and
obtain consent.
2. Provide privacy.
3. Wash hands
and don gloves
(clean)
4. Assess the patient’s level of
pain using an appropriate pain
scale; consider the location,
radiation, intensity/severity,
frequency, duration and
characteristics of the pain.

15. PROCEDURE
15
5. Palpate the peripheral pulse distal to the injury
and/or restriction on the unaffected side, repeat on
the affected side and note the presence of the pulse
and any inconsistencies between sides in rate and
quality of the pulse. Use Doppler if necessary
6. Perform capillary refill test, if the pulse is inaccessible or
cannot be felt and note the speed of return in seconds
on Neurovascular Assessment Form. Normal capillary
refill is < 3 seconds.

16. PROCEDURE
16
7. An assessment of sensation should be
made by asking first the patient if he or she
feels any altered sensation on the affected
limb (paresthesia) – consider any nerve
blocks or epidurals. Using touch, assess
sensation in each of the areas of the foot
or hand ensuring all nerve distribution
areas are covered. Note any altered
sensation on the chart.

17. PROCEDURE
17
• Active movement- ability to extend/ flex extremity or
digits voluntarily.
• Passive movement- staff assessing is enable to flex
and extend extremity/digits.
8. Ask the patient to flex and extend each toe and/or
finger and the ankle and/or wrist, where possible. If
the patient is unable to move actively, perform a
passive movement. Note any pain reported by the
patient either on movement or at rest.

18. Sensory Motor
Radial Nerve
Palpate the webbing
space between the thumb
and index finger,
including dorsal surface
of hand.
Radial Nerve
Ability extend wrist and
fingers at the knuckle joint. If
case is over hand, assess
extension of fingers.
Median Nerve
Palpate the webbing
space between the thumb
and index finger,
including palmar surface
of hand.
Median Nerve
Ability to bring thumb and
little finger together so they
are touching each other.
Ulnar Nerve
Palpate between the little
finger and distal ring
finger on palmar and
Ulnar Nerve
Ability to abduct all fingers.

19. Sensory Motor
Tibial Nerve
Palpate plantar
surface of the
foot.
Tibial Nerve
Ability to plantar
flex ankle and
toes.
Peroneal Nerve
Palpate dorsal
surface of the
foot.
Peroneal Nerve
Ability to
dorsiflex ankle
and toes.

20. PROCEDURE
20
9. Observe the color of the limb in comparison
with the affected side noting any pale,
cyanotic, pinky or dusky appearance.
10. Feel the warmth of the limb above and below the site of
injury using the back of the hand and compare with the
other side. Note any excess warmth, coldness or
coolness or hot sensation of the limb.

21. PROCEDURE
21
11. Inspect the limb for swelling and compare
with the unaffected side. Note whether
swelling is moderate or marked, particularly
noting any increase since the last set of
observations was taken.
12. Place patient in comfortable position.

22. PROCEDURE
22
13. Ensure that all documentation is complete.
Actions taken should be reflected in the
nurses notes. Where deficit is suspected,
report to a member of the medical team

23. RECOMMENDATION
23
 Record the observation in neurovascular assessment form
immediately after assessing patients neurovascular condition
 Evaluate by comparing the neurovascular status with previous
reading if available and identify any changes.
 Notify the physician right away for any changes in the patient’s
condition.

24. REFERENCE
24
 NR 121 V01 POLICY

25. THANK YOU!
SHUKRAN!
SALAMAT! NANNI!