Taking vitals - what to do when you can't feel radial pulse?

Nursing Students CNA/MA

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Hi guys! I just started a job as a CNA at a nursing home. I've had to take vitals a few times and there are a few residents that I've had a lot of trouble finding a radial pulse on. What do you do in this situation? I tried finding the carotid pulse on one resident but I couldn't find that either!!

I ended up using an electronic wrist BP cuff that one of my coworker CNAs brings from home and I got the heart rate that way but I'm wondering what to do if I don't have one of those available! I know some people have a really hard to find radial pulse - including myself. Most people can't feel mine.

Also - how do you take a BP on someone whose arms are contracted and cannot be moved from the side of their body and cannot be straightened? Once again, I used the electronic wrist BP cuff on this resident but my nurse said those are not as accurate as the manual cuffs so I shouldn't use them. She said that in general before I took any vitals. Maybe I should ask her what I should do for this resident next time.

Thank you for any tips and advice!

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Couldn't you just listen to their heart and count if you carry a stethoscope? You are assessing whether they have a pulse just the number of beats right?

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Specializes in Neurosciences, stepdown, acute rehab, LTC.

I think this is just a practice thing. Just keep looking for one, try different spots..Try pushing down a little as well, some of them have weak pulses at baseline. There was one (and only one ) resident I could never find a pulse on. And I'm an experienced RN. When I did it was in an odd place. I usually ended up with the pedal pulse. Just stay calm , this isn't an uncommon problem. Do try to get a radial because sometimes machines can be inaccurate, so Of you get a pulse of 40 and the resident looks fine , you should tell the nurse of course but also its helpful to be experienced in checking manually. Of course listening to the heart is most accurate , but I don't think CNAs are trained for that ?

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One old trick for finding pulses is to close your eyes. The more other sensory input you can eliminate, the easier it is for your brain to focus on what you're trying to focus on. Also having the room as quiet as possible helps. Close your eyes, relax, and consciously focus on your fingertips.

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Specializes in Hemodialysis.

Sometimes it is very difficult to feel a radial pulse. You could grab a stethoscope and get an apical pulse. Or if you have an SpO2 probe that would give you a HR reading along with the oxygen saturation reading.

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Also, you might not feel it if you are pushing down too hard. Try a lighter touch and it may do the trick.

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Specializes in Nurse's Aide.

I would try to find the pulse is different areas of the wrist if you can't find one at first. Sometimes their radial pulses are in weird spots than others. Just keep trying and don't let outside distractions get in the way. The more focus and alert you are, the better outcome you'll get. Always practice, practice, practice!

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Couldn't you just listen to their heart and count if you carry a stethoscope? You are assessing whether they have a pulse just the number of beats right?

Yes, you're right! I did actually try to find it with the stethoscope but I still couldn't hear it!! Maybe I was doing it wrong. I should practice that on my family.

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Sometimes it is very difficult to feel a radial pulse. You could grab a stethoscope and get an apical pulse. Or if you have an SpO2 probe that would give you a HR reading along with the oxygen saturation reading.

hmm, I do have my own SpO2 thing at home. Maybe I should start carrying it with me. Are they accurate or inaccurate like the electronic BP cuff?

As far as apical pulse goes, is there a specific place I should put the stethoscope or just somewhere near the heart where I can find a pulse? We were not trained on that in my CNA class.

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Specializes in Hemodialysis.

Doesn't the BP cuff you use give a heart rate? Being a CNA you need to be pretty quick about getting vitals, espicially in a nursing home. I imagine you have a whole bunch of people to get vitals on.

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Doesn't the BP cuff you use give a heart rate? Being a CNA you need to be pretty quick about getting vitals, espicially in a nursing home. I imagine you have a whole bunch of people to get vitals on.

Yes, it does give a heart rate but the cuff belongs to my coworker that she brings from home. My question is what do I do if I'm not working with her one day and I don't have access to it? I think I'm going to keep my SpO2 in my bag just in case that happens.

And yes, vitals do take me a while and I know I need to hurry up. I just need more practice.

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Specializes in Hemodialysis.

Your facility is legally obligated to provide you with the equipment you need to do your job. You shouldn't have to bring in your own equipment.

It actually puts you in a funny spot because the equipment you bring in is not approved by the company. If a surveyor were to see you using that equipment it could be an issue.

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