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Assessment of neurovascular status is essential for the early recognition of neurovascular deterioration or compromise. Delays in recognising neurovascular compromise can lead to permanent deficits, loss of a limb and even death. Neurovascular deterioration can occur late after trauma, surgery or cast application.
The aim of this clinical practice guideline is to outline the required neurovascular assessment to recognise early compromise and prevent permanent damage to the limb(s).
Patients who require neurovascular assessment include but are not limited to:
Frequency of observations
For cardiac catheter patient’s:
A neurovascular assessment is required for each affected limb and includes assessment of
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
Please refer to the Pain Assessment and Measurement Clinical Guideline for further information regarding paediatric pain assessment.
If neurovascular status is compromised, patients may report decreased sensation, loss of sensation, dysesthesia, numbness, tingling or pins and needles. Altered sensation may be a result of a nerve block or epidural, this should be documented in the patient’s neurovascular assessment in the flowsheet in EMR.
Note amount of pain on movement of the limb, including if it was is active or passive movement. It is important to compare movement of digits bilaterally and to the baseline observations as some patients may have had limited or no movement previous to injury.
The medical team should be contacted immediately if the child experiences any deterioration or deviation from the baseline assessment.
* 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.
Ensure affected limb is elevated to minimise the risk of compartment syndrome. Lower extremities can be elevated with pillows or using bed mechanics; upper extremities can be elevated on either a pillow, sling or box sling.
If neurovascular status improves keep affected limb elevated and continue to monitor closely.
If neurovascular status does not improve or continues to deteriorate, the patient may need to attend theatre for pressure monitoring and/or fasciotomy.
For cardiac catheter patients:
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. Compartment syndrome is a surgical emergency to relieve the pressure or reduce volume within the compartment, which will preserve blood supply, tissue perfusion and function. Early recognition of neurovascular deterioration is crucial in limb salvage or survival.
The medical team should be contacted immediately as soon as compartment syndrome is suspected.
Indications of compartment syndrome
For patients at risk of neurovascular compromise education on neurovascular assessment is crucial. 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 assessment and why it is necessary to disturb the patient when sleeping while in hospital.
Many patients who are at risk of neurovascular compromise leave hospital before the risk of compartment syndrome is over. Parents should be educated regarding the signs and symptoms of neurovascular compromise and when to return to their GP/RCH if they are concerned.
Cardiac Catheter patients: Advise parents/carers to limit their child’s activity for the first 24 hours at home and avoid any strenuous lifting.
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The development of this nursing guideline was coordinated by Alicia Waters, CNS, Platypus Ward, and approved by the Nursing Clinical Effectiveness Committee. Updated May 2019.