Neurovascular assessment
The sheet on the RCSI reading list is a tick chart: one column per observation, a pre-op baseline first, and a row for every finding under extremity, colour, movement, sensation, pulses, temperature, capillary refill, positioning, pain score and oedema. Movement rows, pulse sites and the nerve tests are on the reverse. You tick what you find, initial the column and compare it with the columns before it. The tip printed at the top is the whole method: always compare with the unaffected limb.
The decision comes from the ALERT line on the sheet and two current documents. Pain is the primary symptom: pain out of proportion, not relieved by appropriate analgesia, or increased on passive stretch of the fingers or toes, is escalated on its own (RCN observation chart, 2026). Pulse, sensation and colour changes are late; any abnormal neurovascular status is escalated immediately. On suspicion, BOASt says release circumferential dressings to the skin, senior surgical review, re-evaluate within 30 minutes; the Irish guideline (Children’s Health Ireland, 2025) adds: elevate the limb no higher than heart level, split the cast or cut the bandage as advised, keep the limb aligned. Frequency, in both the RCN chart and the CHI guideline: hourly for the first 24 hours, four-hourly to 48 hours, back to hourly if anything changes.
Sources: Neurovascular Assessment form (sample), the version on the RCSI reading list; British Orthopaedic Association, BOASt: Diagnosis and Management of Compartment Syndrome of the Extremities (2014, updated July 2025); Royal College of Nursing, Acute Limb Compartment Syndrome Observation Chart (012 564, August 2026); Children’s Health Ireland, Neurovascular Assessment Guideline (December 2025). Pairs with the acute situation station and the INEWS chart.