BSN Tracker

Assessment Tool: Neurovascular Check

Complete all domains. Perform neurovascular checks per institutional protocol — typically every 15–30 minutes in the immediate post-operative period, then every 1–2 hours as directed. Any deterioration from baseline warrants immediate provider notification.

Neurovascular Check

Systematic assessment of the 5 P's (Pain, Pulse, Pallor, Paresthesia, Paralysis) plus capillary refill, temperature, and edema. Perform per protocol after orthopedic procedures, casting, vascular surgery, or any concern for compromised limb perfusion. Compare bilaterally and document changes from baseline.

⚠ When to escalate immediately

Absent pulse · Capillary refill > 3 s · Pallor or cyanosis · Severe pain unrelieved by position change · Absent movement or sensation — notify provider immediately and document time of finding.

Assessment Context
Pain (P₁)

Patient-reported pain in the affected limb. Note: pain that is out of proportion to injury or unrelieved by position change is a red flag for compartment syndrome.

0
0 – None5 – Moderate10 – Worst
Pulse (P₂)

Palpate the most distal pulse of the affected limb (e.g., radial, dorsalis pedis, posterior tibial). Compare bilaterally.

Pallor / Color (P₃)

Inspect skin color distal to the injury or cast. Compare to the contralateral limb and patient's baseline.

Capillary Refill

Apply pressure to the fingernail or toenail bed for 5 seconds, then release. Measure time to blanching return.

Temperature

Palpate skin temperature distally; compare bilaterally using the dorsum of the hand.

Paresthesia (P₄)

Ask the patient to describe sensation distal to injury. Numbness or tingling may indicate nerve compression or ischemia.

Movement / Paralysis (P₅)

Ask the patient to actively move distal digits (fingers or toes). Assess against gravity and compare bilaterally. Do not force movement in fracture or surgical patients.

Edema

Apply firm pressure over the tibia or dorsum of foot for 5 seconds; note depth and rebound of pitting.