Peripheral Vascular System
Inspection and auscultation of abdominal vasculature is best performed with the client in a supine position with their head on a pillow. You will be assessing the area over the abdominal aorta, renal arteries, iliac arteries, and femoral arteries (Figure 10). Draping is important because you will need to expose the abdomen and groin area.
Steps for assessing the abdominal vasculature include:
- Observe for pulsations over the areas of the abdominal vasculature. Use with a penlight; this will help highlight any small imperfections/shadows, which accentuate visible pulsations.
- Normally, no pulsations are present. Pulsations may be present with a client who has a thin abdominal wall, but these are never considered normal in a client who has increased adipose tissue.
- Note the location of any pulsations.
- Auscultate over the abdominal vasculature (see Figure 10 and Video 4) using the bell of a cleansed stethoscope. Use slightly firmer pressure than when you use the diaphragm over the lungs or intestines. Listen for vascular sounds related to the flow of the blood through the arteries. Placing your stethoscope in each location for about 2-3 seconds is usually sufficient.
- Normally, you won’t hear any vascular sounds because unobstructed blood flow through an artery is silent.
- Note the location of any vascular sounds. Partial obstruction of an artery creates turbulent blood flow, leading to vascular sounds such as a bruit: blowing/swooshing noises. Atherosclerosis can cause stenosis (narrowing of the vessel), leading to a bruit. If you hear a bruit, notify the physician or nurse practitioner while you keep the client still and continue to monitor them. Do not palpate the abdomen if a bruit is present, as this finding suggests that blood flow is already compromised.
- Note the findings:
- Normal findings might be documented as: “No pulsations observed or bruits heard over the abdominal aortic artery and the renal, iliac, and femoral arteries.”
- Abnormal findings might be documented as: “Pulsation observed over aortic artery with a bruit noted.”
Video 4: Auscultation of the abdominal vasculature [1:27]
If you hear a bruit, do not palpate the area. Ask if the client has experienced any recent pain in their chest, back, abdomen, or groin, and if they have ever been diagnosed with an . You should also complete a primary survey and measure blood pressure in both arms. Notify the physician and nurse practitioner of the findings. Until an aneurysm is ruled out or assessed, it is best to keep the client in bed, at rest, and under continuous monitoring.
Activity: Check Your Understanding
refers to a light (penlight) directed from the side at a low angle across the body.
is an enlargement or ballooning of the vessel. Aneurysms can rupture, which is a life-threatening situation due to bleeding.