Neurovascular Observations: Improving Accuracy and Relevance in Nursing, Exercises of Nursing

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Neurovascular

Observations – more

than just a tick!

Cheryl Kimber ONP

Larissa Bailey CN

Flinders Medical Centre

Adelaide, South Australia

Neurovascular Observation

 Neurovascular obs – fundamental nursing

observation and monitoring skill

 Basic observation undergraduate education

 Prevention compartment syndrome

Why change

 Observation by clinical nurses – inconsistencies in

accuracy, useful information

 What does CWMS √ mean

 Current policy & NV Chart poor tool for collection of

important/relevant information

 Documentation varied

 Lack understanding significance of NV results

 Useful Information = Timely action

Results

 Nerve blocks – tibia

 No neurovascular observations charted at

all for couple patients (same ward)

 Post surgery at 12 hours lower limb

surgery no documentation by nursing staff

Neurovascular Observations

Performance

This graph shows the usage of the neurovascular observation methods on 4 surgical wards audited. Time Period - 2 week Audit

Result

 New Policy/procedure

 New Chart

 Upper and lower Limb

Parameters tested

 Nerve Block

 Pain – increasing, on active or passive movement

 Colour, warmth – descriptive terms

 Venous return – quantified

 Pulse

 Testing specific motor and sensation characteristic

 Swelling, Ooze - descriptive

 ABSENTS OF THE TICK METHODOLOGY

Ulnar nerve Radial nerve

Median nerve Deficit to median nerve

Education Strategies

 Inservice

 Moodle

 Consultant - expert

Current status

Orthopaedic Nurse driven

 Making difference

 Filling the gap

 Improving practice

 Patient outcome

References:

 Altizer L (2002) Neurovascular assessment. Orthopaedic Nurse 21 (4): 48-50.  Edwards S (2004) Acute compartment syndrome. Emergency Nurse 12 (3): 32-8.  Judge NL (2007) Neurovascular Assessment. Nursing Standard. 21 (45) 39-  Love C (1998) A Discussion and Analysis of Nurse Led Assessment for the Early Detection of Compartment Syndrome. Journal of Orthopaedic Nursing 2(3): 160-167.  Middleton C (2003) Compartment Syndrome: the importance of early diagnosis. Nursing Times. 99 (21) 30-