Can't find dorsal pedal pulses
- 0Nov 26, '08 by Tolle_legeI have had many patients that I simply couldn't find a dorsal pedal pulse on them. I have just graduated and am looking for a job, but this part of assessment bothers me. Is it just me, does anyone else have this problem. I have asked other nurses during clinical and unfortunately, a lot of them simply don't check, and brush off the question when I ask, just saying "Oh, they're fine." or something along those lines. What to do?
Thanks in advance
- 0Nov 26, '08 by ChristineNCan you not feel it on ANY pt's? I could see it being more difficult on edematous feet or poor circulators, otherwise I can often feel them bounding. Your fingers should be perpendicular to the space between the big toe and the first smaller one. If you need too, get a doppler and find it that way, and then try to feel for it at the same spot.
- 0Nov 26, '08 by caliotter3I have trouble with this also and mostly do not attempt more than a couple of times on any one patient because they kind of look at me funny when I admit I can't find the pulse and invariably say, "well soandso nurse has no trouble!" I suspect that soandso nurse is making findings up but I never say this to the patient. I always wish I had access to a doppler for this reason. Sure would make things easier.
- 4Nov 26, '08 by NotReady4PrimeTime Senior ModeratorI sometimes have trouble on smaller kids. I've found though that I can usually find a pulse in the notch over the anterior surface of the ankle.
Try it on your own foot. Feel the area between the superior extensor retinaculum and the inferior extensor retinaculum right about where the dark red rectangle is on the diagram above. If you can feel the pulse there, put your index finger on that spot and line your middle and ring fingers up next to it, resting them on the space between the extensor hallucis longus and the extensor digitorum longus (you should be able to feel them tendons through the skin and even moderate edema). Move your fingers apart very slowly, not pressing too hard, and you should be able to find the dorsalis pedis pulse. Mark it with a Sharpie if you have to. Most patients won't mind, and the ink comes off with a CHG swab.
- 0Nov 26, '08 by csasonWhen I first started, it helped me when I looked on hypertensive
patients first..then I was able to find it easier on normal patients.
Unfortunately, a lot of the 'sicker patients' are the ones that MD's might be looking for pedal pulses..and you will need a doppler.
The doppler is our friend...
It is almost impossible to auscultate those pulses on anybody with PVI, on average..
- 0Nov 26, '08 by SterrenIt was hard for me at first too. With practice you'll get used to where they are "supposed" to be felt and it will be easier. My biggest issue was always looking way too far forward on the foot. You should be at least halfway back on the foot and usually it's darn close to the ankle. Take off the pt's socks, and look at the foot before you feel around, sometimes you can see where you need to press to feel the pulses.
And you're right. A lot of nurses just don't check.
- 0Nov 27, '08 by Angie O'Plasty, RNHere's how I was taught:
Facing the patient, gently place your index finger between the bones of the first and second toes. Run it up the skin toward the patient. The area has a shape like a ^ and you just about get to the point of the ^ and stop. Don't press hard because you'll occlude a weaker pulse, and gently change positions as you search for the pulse inside the ^. You'll usually find it there.
If you cannot find the pulse, you can Doppler for the pulse. Don't neglect to check for cap refill on each of the toes. Can't have good cap refill without some arterial circulation, right?
- 0Nov 29, '08 by Tolle_legeThank you for all the tips! I do find it most of the time, but when I can't find it, I really can't find it. I will have to ask when I get to my first job if they have the doppler. I don't remember the nurses at my preceptorship ever mentioning it. It think these tips will help me in the future, thank you again.