In this section
Definition of Terms
Parent & Family Education
Monitoring neurovascular status is essential in early recognition of neurovascular deterioration or compromise. Delays in recognising neurovascular compromise can lead to permanent deficits, loss of a limb and even death. Recognition of neurovascular deterioration is therefore crucial. Neurovascular deterioration can occur late after trauma, surgery or cast application.
The aim of this clinical practice guideline is to prevent permanent damage to the limb through early recognition of neurovascular compromise.
Frequency of observations
A validated age appropriate pain assessment tool should be used to determine patients pain levels, this same scale should be used throughout the patient hospital stay to enhance reliability of assessment RCH Pain Assessment Tool. The most important indicator of neurovascular compromise is pain disproportionate to the injury. Pain associated with compartment syndrome is generally constant however worse with passive movement to extension and is not relieved with opioid analgesia. Indication of pain in non-verbal patients includes restlessness, grimacing, guarding, tachycardia, hypotension, tachypnoea or diaphoresis If pain is disproportionate to injury notify medical team. See the Pain directory for more information.
* Capillary refill assessment is evaluated by firmly pressing down on the nail bed of fingers or toes, the nail bed will blanch and the colour should return within 2-3 seconds once the pressure is released.
Age appropriate education should be provided to the patient, including encouragement for the patient to move their digits regularly. Educate parents on the importance of performing neurovascular observations and why it is necessary to disturb the patient when sleeping. If compartment syndrome develops the patient will need to return to theatre, this can occur quickly and be difficult to deal with. Patients or parents may require support from social workers.
For patients at risk of neurovascular compromise education on neurovascular assessment is crucial. Many patients who are at risk of neurovascular compromise leave hospital before the risk of compartment syndrome is over. Parents need to be aware of the signs and symptoms of neurovascular compromise.
Compartment syndrome is a serious complication of musculoskeletal injury. Compartment syndrome results from an increase in pressure inside a compartment which comprises of muscles and nerves and is enclosed by fascia, fascia is inelastic and does not expand to increased volume or pressure. When the compartment pressure increases, nerves and then muscles become compressed resulting in decreased blood flow and tissue perfusion, muscle ischemia and loss or altered sensation. This will progressively deteriorate until pressure is relieved inside the fascia. Compartment syndrome is a surgical emergency to relieve the pressure or reduce volume within the compartment, which will preserves blood supply and tissue function. Early recognition of neurovascular deterioration is crucial in limb salvage or survival.
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The development of this nursing guideline was coordinated by Rachael Sedgwick, Registered Nurse and Stacey Richards, CSN, Platypus Ward, and approved by the Nursing Clinical Effectiveness Committee. Updated Janurary 2015.