"Old" Neuro assessmet of Nipple Twisting of Pinching

  1. 0 Can anyone give a little history regarding nursing's involvement with nipple twisting or pinching in order to elicit a neurologic response? Approx. how long was it a part of our nursing assessment? Appreciate any information on the subject.

    Zachhorse
  2. Visit  Zachhorse profile page

    About Zachhorse

    Joined Jul '09; Posts: 3.

    32 Comments so far...

  3. Visit  groovy jeff profile page
    0
    Your kidding, right?????
  4. Visit  Zachhorse profile page
    0
    No, I'm not kidding---this was a neuro assessment practiced by physician's and some nurses (advanced practice?) in the 1960's or '70s-'80's. Does anyone remember a history about it? Appreciate your answer!

    Zachhorse
  5. Visit  CoffeeGeekRN profile page
    0
    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.
  6. Visit  NotReady4PrimeTime profile page
    1
    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!
    maloneys likes this.
  7. Visit  mcknis profile page
    0
    are we moving away from supra-orbital pressure? (i head that it can cause a vagal response) How is the trapezius pinch performed?
  8. Visit  NotReady4PrimeTime profile page
    0
    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!
  9. Visit  docbkh profile page
    0
    Quote from janfrn
    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.)
  10. Visit  morte profile page
    2
    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
    Last edit by morte on Jul 26, '09
    fiveofpeep and Zachhorse like this.
  11. Visit  Zachhorse profile page
    0
    Thanks for your information!


    Zachhorse!
  12. Visit  rnbsn17 profile page
    1
    "Old" Neuro assessment? It is still widely used for different neuro/death assessments. How long have you been a nurse and what type of practice? Thank you.
    maloneys likes this.
  13. Visit  meandragonbrett profile page
    1
    It's still routinely used in Trauma Assessment bays and trauma intensive care units. I've never seen it used outside of a trauma setting.
    maloneys likes this.
  14. Visit  ThrowEdNurse profile page
    2
    Ummmm, I hate to even say this here, after reading the other responses, but I do this all the time! I work in the ER so maybe it's a little different.....I don't do it to assess for responsiveness to pain, I do it to arouse a drunk or a high drama pt. For instance, I may have a pt who I know can hear me, but refuses to follow commands due to high drama serum level so, I little nipple twist always gets an appropriate response. It's sort of a quick assessment on initial arrival to the ER to determine a true level of consciousness.
    maloneys and Twiggyo like this.

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