"Old" Neuro assessmet of Nipple Twisting of Pinching

Your kidding, right?????

One of my instructors told me about it. She said now it is not an appropriate action for nurses to take. She told us to take a pen and press a finger nail bed to test pain response.

Nail bed pressure doesn't actually test central pain response. It only truly tests spinal cord relexes. In my years of nursing we've evolved from the sternal rub, follower of the dastardly nipple tweak, to the trapezius pinch. This more effectively assess central pain response. The last time I saw the nipple tweak used was in 1989, and the patient was my son. Thank God we've moved beyond that!

are we moving away from supra-orbital pressure? (i head that it can cause a vagal response) How is the trapezius pinch performed?

Every hospital I've worked in limit assessing by supraorbital pressure to the physician. The vagal response is rather frightening...

Trap pinch is easy except on extremely obese patients. You put your thumb into the hollow between the clavicle and the trapezius, the knuckles of your index and middle fingers behind the muscle and squeeze. It's easier to get the greatest amount of pressure by using the knuckles rather than the tips of your fingers. Try it (gently) on yourself and see how much it hurts!

Sounds like some thing Spock would do! (Mr... not Dr.)

this has been discussed on AN recently, apparently some docs still use it ....LOL...the reason they do the 12 oclock to 12 oclock nipple twist is to check for response to central pain stimuli. They probably would do sternal rubs if ...IF they only had one patient. But most of the trauma docs and neurosurgeons have 10-20 patients with profound neuro injuries and if they wont respond to voice.....well if they did 15 sternal rubs twice a day their knuckles would be sore as hell. Difficult to operate on patients when it hurts to flex those fingers. So a 180 twist on the nipple or...the chest wall is the standard to check for central pain response to see if they withdraw or extend. Otherwise they 'd be walking around with raw inflammed knuckles bc they not only have your 1 or two patients, but also every patient that lands in the ER , every MVA with a CHI ....and every patient in the unit or the hospital that has a neuro incident. Stay around long enough and you get desensitized to it, And keep in mind....they arent doing this if they respond to voice or touch...at least...I HOOOPPPPPEEEE they arent...
this is a quote from "what you would like to tell a doc and get away with it" thread #142