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CLINICAL DO'S & DON'TS

Assessing neurovascular status in a casted limb

McCONNELL, EDWINA A. RN, PhD, FRCNA

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BY ASSESSING FOR CHANGES in circulation and oxygenation in a casted or an immobilized arm or leg, you can detect threats to neurologic function.

DO

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  • Evaluate neurovascular status every 1 to 2 hours for the first 24 hours after a cast is applied.
  • Note the size of the fingers or toes to detect edema. Rule out concurrent dependent edema due to a health problem.

Make sure that the cast isn't too tight because of edema. You should be able to insert one or two fingertips into the proximal and distal ends.

  • If possible, palpate the distal pulse of the casted limb and note the strength.
  • Observe the color of the nail beds. Pink indicates normal arterial pressure; white, decreased arterial supply; and bluish, venous stasis. Bluish color may be normal in an older adult, but he shouldn't have other signs of circulatory compromise.
  • Ask the patient to describe any sensations in the limb with the cast. Be alert for reports of such sensations as numbness, burning, pins and needles, throbbing, and achiness.
  • Ask him to wiggle his fingers or toes. Then move one finger or toe while he has his eyes closed and ask him what position it's in.

Compare temperature by simultaneously feeling the affected and unaffected fingers or toes.

To assess capillary refill, press on the distal tip of an affected finger or toe until it's white, then release pressure. Normal color should return within 3 seconds.

DON'T

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  • Don't forget to compare bilateral findings when judging neurovascular status.
  • Don't coach the patient when assessing pain. Let him describe it in his own words.
  • Don't rely on just one neurovascular assessment to evaluate an older adult's circulation because certain age-related changes may be normal for him.

SELECTED REFERENCES

Nursing Procedures, 3rd edition. Springhouse, Pa., Springhouse Corp., 1999.
    Perry, A., and Potter, P.: Clinical Nursing Skills and Techniques, 4th edition. St. Louis, Mo., Mosby-Year Book, 1998.
      Phipps, W., et al.: Medical-Surgical Nursing, 6th edition. St. Louis, Mo., Mosby-Year Book, 1999.
        © 2002 Lippincott Williams & Wilkins, Inc.