Pain: Extreme pain, especially on passive motion, is a significant sign of probable neurovascular impairment in an extremity. Subjective and objective assessments should be included. Opioid analgesia is unlikely to relieve the pain.
Pallor (perfusion): Comparison between affected and unaffected limb is important. Color and temperature of the extremity: Pale skin, decreased tone, or white color may indicate poor arterial perfusion. Cyanosis may indicate venous stasis. Coolness or decreased temperature may indicate decreased arterial supply. Compare distal to proximal temperature variation in affected limb. Assess capillary refill. Using your thumb and forefinger, squeeze the patient's fingernail or toenail until it appears white. Release the pressure and observe the time it takes for normal color to return. Normally, color returns immediately, in less than 2 to 3 seconds.
Peripheral pulses: Comparison between affected and unaffected limb is important. Assess the consistency of arterial blood flow (pulse presence, rate, quality) up to and past the affected area. Assess capillary refill, especially in patients whose pulses cannot be palpated due to casts or bandages and in nonverbal patients.
Paresthesia (sensation): May be first symptom of changes in sensory nerves to appear. Compare sensation to touch between affected and unaffected limb. Numbness, tingling, or “pins and needles” sensations may be reported. Evaluate the areas above and below the affected area.
Paralysis (movement): The ability of the patient to move the extremity distal to the injury. Paralysis of an extremity may be the result of prolonged nerve compression or irreversible muscle damage.
Pressure: Comparison between affected and unaffected limb is important. Swelling occurs as a physiologic response to injury. Affected area may become taut and firm to the touch, with surrounding skin appearing shiny. The feeling of tightness or pressure may be present.
Blood loss/ooze: Assess blood loss on dressings, casting materials, and any surgical drains.
Source: Adapted from Hinkle, J. L., & Cheever, K. H. (2018). Brunner & Suddarth's textbook of medical-surgical nursing (14th ed.). Wolters Kluwer; Johnston-Walker, E., & Hardcastle, J. (2011). Neurovascular assessment in the critically ill patient. Nursing in Critical Care, 16(4), 170-177.