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How to check the circulation of the legs and arms

Other platforms explain it with text and video. In Making Synapses you practice it on the patient.

MD / DOPANursing (NCLEX)
Practice it in VR with Blocky

Arterial and venous problems look different. The peripheral vascular exam tells them apart from the skin to the pulses.

Step by step

  1. Prepare

    Clean your hands, introduce yourself, get consent and expose both legs. [1]

  2. Look

    Color, hair loss, shiny skin, ulcers (on the toes for arterial, inside the ankle for venous), varicose veins and swelling. [1]

  3. Temperature and refill

    Compare both sides with the back of your hand. Capillary refill on the toes and fingers. [1]

  4. Pulses

    Radial, brachial, femoral, popliteal, dorsalis pedis and posterior tibial, both sides: 0 absent, 1+ weak, 2+ normal, 3+ bounding. [1]

  5. Doppler

    If a pulse cannot be felt, use gel and a Doppler probe at 45 degrees to the artery. [1]

  6. Edema

    Press for 5 seconds over the shin or ankle and grade the pit 1+ to 4+. [1]

  7. 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

Practice it in Making Synapses

In Making Synapses 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.

Making Synapses cases that train this skill

82 Making Synapses cases train this skill: open the case library

Sources

  1. Open RN, Nursing Skills 2e (Chippewa Valley Technical College) (CC BY 4.0)

Steps adapted from Open RN, Nursing Skills 2e (Chippewa Valley Technical College), licensed under CC BY 4.0. Making Synapses is not affiliated with these organizations. Updated: 2026-10-11.