Introduction

Wash your hands
Introduce yourself, explain what you are going to do and gain consent
Assess both limbs with the patient lying on a bed.
Look around for equipment including a hand-held doppler and BP cuff

Inspection

• Tissue loss/ulcers/gangrene
• Discoloration (rubor, cyanosis)
• Swellings and atrophy
• Scars – LSV harvest, groin incision

• Test Temperature, Sensation and CRT in the limb
• Feel for pulses in the abdominal Aorta, Femoral, Popliteal, Dorsalis Pedis, Posterior Tibial vessels

• If there pulses feel weak or you are unable to palpate them place a handheld doppler with jelly over the Femoral, Popliteal, Dorsalis Pedis or Posterior Tibial vessels and note the waveform.

• The brachial and leg pressures should be compared.
• This is recorded as the highest brachial systolic pressure against the highest ankle pressure.
• A BP cuff is attached and doppler probe placed at the level of the artery. The cuff is then inflated until the signal disappears.

• Pt lie flat – ask about pain in legs etc
• Raise both legs to 45◦ and hold them for one minute
• Sit up and hang legs over edge of bed
• Observe
• In PVD – elevation shows pallor as blood drains
• Dependent – shows bluish (deoxygenated blood over passage of tissue), then flush red due to hyperaemia from post-hypoxic vasodilation (reactive rubor)