Neurovascular Assessment: The Six Ps

A neurovascular assessment, also known as a circ check, is performed to determine adequate circulation and sensation to an extremity.

The Six Ps of Neurovascular Assessment

1. Pain

   • Universal symptom in compartment syndrome.
   • May be caused by edema, movement of bone fragments, or muscle spasms.
   • Increases as pressure within the limb compartment rises.
   • Represented by: Pain bolt.

2. Paresthesia

   • Often the first sign of an impending problem.
   • Described as the "pins and needles" sensation, numbness, or tingling.
   • Sign of inadequate circulation or nerve damage.
   • Represented by: Paris t-shirt (for "pins and needles").

3. Pulse

   • Compare pulses for differences in rate and quality on unaffected and injured extremities.
   • Diminished or absent pulse distal to injury may indicate vascular dysfunction.
   • Requires immediate reporting to the provider.
   • Represented by: Heart timer.

4. Pallor

   • Refers to color and temperature of the extremity (pink, pale, cyanotic).
   • Compare against the unaffected side.
   • Pale, shiny skin may indicate compartment syndrome.
   • Warm, cyanotic extremity may indicate poor venous return.
   • Represented by: Pail with pallor.

5. Pressure

   • Increased pressure may indicate compartment syndrome.
   • Related to swelling within the cavity.
   • Can cause numbness, loss of sensation, or severe pain.
   • Represented by: Pressure cooker.

6. Paralysis

   • Partial or full loss of sensation or function.
   • May be a late sign of neurovascular damage.
   • Complete inability to move limb distal to injury may indicate severe damage.
   • Represented by: Wheelchair.

Mnemonics

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