How to check the circulation of the legs and arms
Other platforms explain it with text and video. In VMS you practice it on the patient.
Arterial and venous problems look different. The peripheral vascular exam tells them apart from the skin to the pulses.
Step by step
Prepare
Clean your hands, introduce yourself, get consent and expose both legs. [1]
Look
Color, hair loss, shiny skin, ulcers (on the toes for arterial, inside the ankle for venous), varicose veins and swelling. [1]
Temperature and refill
Compare both sides with the back of your hand. Capillary refill on the toes and fingers. [1]
Pulses
Radial, brachial, femoral, popliteal, dorsalis pedis and posterior tibial, both sides: 0 absent, 1+ weak, 2+ normal, 3+ bounding. [1]
Doppler
If a pulse cannot be felt, use gel and a Doppler probe at 45 degrees to the artery. [1]
Edema
Press for 5 seconds over the shin or ankle and grade the pit 1+ to 4+. [1]
Ankle-brachial index
Ankle systolic pressure divided by arm systolic pressure. Normal is 1.0 to 1.4; 0.90 or lower suggests peripheral artery disease. [1]
Common errors
- Not comparing both sides.
- Calling a pulse absent without trying the Doppler.
- Missing edema on the sacrum in bedbound patients.
Practice it in VMS
In VMS you do this on the patient, not on paper: every step goes on the checklist with a score, and in Teach mode Blocky tells you what comes next.
VMS cases that train this skill
Sources
Steps adapted from Open RN, Nursing Skills 2e (Chippewa Valley Technical College), licensed under CC BY 4.0. VMS is not affiliated with these organizations. Updated: 2026-10-11.