Pulse Sites

[healthstar]

Hello nurses,

I am a student nurse. I was told in clinicals to check the pulse in all sites. How about in reality, do you check ( Carotid,femoral, popliteal, dorsalis pedis) pulses? During my clinicals, I only seen nurses check apical, radial and dorsalis pedis. I find it extremely hard to feel popliteal pulse, is there a special way to check( feel) it? Thanks so much :)

[Emergency RN]

Hello nurses, I am a student nurse. I was told in clinicals to check the pulse in all sites. How about in reality, do you check ( Carotid,femoral, popliteal, dorsalis pedis) pulses? During my clinicals, I only seen nurses check apical, radial and dorsalis pedis. I find it extremely hard to feel popliteal pulse, is there a special way to check( feel) it? Thanks so much :)

First off, there's a major difference between checking heart rate versus checking circulation. In the ED, most of the time, we never ever check a pulse; that is, we note the heart rate as seen on the pulse oximeter. We will only look at the peripheral circulation if there was a clinical need to. If a patient presented with something that could compromise blood flow, then checking a pulse to the affected area, along with using the contralateral pulse as a comparison is standard.

As for apical pulses, we generally only use that for babies.

Otherwise, if you're going to do that for every patient, then you're just wasting your time.

[MICPEricRN]

As a student, they may be asking you to check all of those pulses to get comfortable with locating them. Like any other psychomotor skill, and certainly assessment skills, you should be practicing all of them as much as you can.

[marty6001, EdD, EMT-P, APRN]

Of course it's easier, the carotid is closer to the heart, therefore more pressure behind it. The radial pulse has to travel through the chest, arm, and down to the wrist. :)

[healthstar, BSN, RN]

Thank you everybody for your help, it means a lot. I know it is important to practice checking all pulse sites during clinicals. That's how we learn.

[CNL2B]

Nevertheless, in postpartum women, diminished or unequal pedal pulses are often found with DVTs, and checking those pulses is something we do as part of our DVT screening.

I was never taught this, I have not read this anywhere, looked at my health assessment book (nothing), did an internet search (nothing) to try to back up what you are saying. Actually, I was taught that the presence/absence of a pedal pulse was one way to differentiate between venous and arterial thrombosis. Could not find anything about diminished pulses in DVT either. I recognize that with DVTs often times extremities get swollen and this may make it more difficult to find the pulse due to edema but that doesn't mean that the pulses are truly diminished. Evidence?

On a personal note, after two childbirths I never had the pulses in my feet checked during my hospital stay. I can't say that based on my experience this is routine practice for OB nurses. I stayed at a 500+ bed urban magnet facility. I do believe that checking pulses is part of a complete clinical assessment on all patients and if you are doing it, you are doing a thorough job.

[Guest27531]

This is an interesting thread. It is important thing for all of us to be confident in our skills, so, keep asking! I have found that the day-to-day on-the-job reality of patient assessment depends on the specialty, the unit, and the situation. Our responsibility as RNs is to have the skills so they can be applied when needed.

Speaking of pulse evaluations, this thread seems a good place to relate information I learned recently about a Traditional Chinese Medicine (TCM) pulse evaluation. It surprised me so much I have been dying to have someone to tell. I believe I'm fairly advanced when it comes to pulse assessments but when I first tried this myself a few weeks ago, I felt like a student nurse all over again due to the complexity and practice required.

Here's what surprised me:

The radial pulse is assessed bilaterally with three fingers, always with the index finger closest to the thumb. Each of the three fingers has data to gather which then relates to the other two (it reminded me of learning to play a musical instrument). This assessment is completed bilaterally with three levels of pressure - light, moderate, and deep - with different information being obtained at each level. Different, no?

[Redhead28]

I was never taught this, I have not read this anywhere, looked at my health assessment book (nothing), did an internet search (nothing) to try to back up what you are saying. Actually, I was taught that the presence/absence of a pedal pulse was one way to differentiate between venous and arterial thrombosis. Could not find anything about diminished pulses in DVT either. I recognize that with DVTs often times extremities get swollen and this may make it more difficult to find the pulse due to edema but that doesn't mean that the pulses are truly diminished. Evidence?

On a personal note, after two childbirths I never had the pulses in my feet checked during my hospital stay. I can't say that based on my experience this is routine practice for OB nurses. I stayed at a 500+ bed urban magnet facility. I do believe that checking pulses is part of a complete clinical assessment on all patients and if you are doing it, you are doing a thorough job.

Perhaps she means she is checking pedal pulses at the same time she is flexing foot to check for Holman's sign.:redbeathe

[klone, MSN, RN]

I was never taught this, I have not read this anywhere, looked at my health assessment book (nothing), did an internet search (nothing) to try to back up what you are saying. Actually, I was taught that the presence/absence of a pedal pulse was one way to differentiate between venous and arterial thrombosis. Could not find anything about diminished pulses in DVT either. I recognize that with DVTs often times extremities get swollen and this may make it more difficult to find the pulse due to edema but that doesn't mean that the pulses are truly diminished. Evidence?

On a personal note, after two childbirths I never had the pulses in my feet checked during my hospital stay. I can't say that based on my experience this is routine practice for OB nurses. I stayed at a 500+ bed urban magnet facility. I do believe that checking pulses is part of a complete clinical assessment on all patients and if you are doing it, you are doing a thorough job.

Don't know what to tell you. I work for a large university hospital, as well as a large hospital system, and at both places, checking pedal pulses is part of the head to toe assessment. It's grouped with checking Homan's sign and Pratt's sign. There's a specific field in both system's computer charting for it. And when I do a google search of "pedal pulses dvt" I get lots of hits. I'm not sure why you have such a strong need to be right about this. It's no big deal to me. I'm just telling you that this is what I have been taught at five different hospital OB units I've worked for, including a major teaching hospital. Anyway, it seems silly to argue about it, but here are a few things I've found in an off-the-cuff google. If you REALLY care a lot about this, I could look in William's Obstetrics when I get to work tonight.

Taught client s/sx of DVT such as unilateral edema, diminished pulses, parasthesia, and cool extremity.

Peripheral Neurovascular Dysfunction, Vascular Obstruction

Circulation: diminished pulses (though the condition is venous, not arterial) can be affected by edema and/or spasm;

http://www.mrpscience.us/Exercise%20After%20DVT.pdf

Critical care obstetrics - Google Books

faculty.ccri.edu/ssienkiewicz/Postpartum%20Health.ppt

[CNL2B]

Don't know what to tell you. I work for a large university hospital, as well as a large hospital system, and at both places, checking pedal pulses is part of the head to toe assessment. It's grouped with checking Homan's sign and Pratt's sign. There's a specific field in both system's computer charting for it. And when I do a google search of "pedal pulses dvt" I get lots of hits. I'm not sure why you have such a strong need to be right about this. It's no big deal to me. I'm just telling you that this is what I have been taught at five different hospital OB units I've worked for, including a major teaching hospital. Anyway, it seems silly to argue about it, but here are a few things I've found in an off-the-cuff google. If you REALLY care a lot about this, I could look in William's Obstetrics when I get to work tonight.

Peripheral Neurovascular Dysfunction, Vascular Obstruction

http://www.mrpscience.us/Exercise%20After%20DVT.pdf

Critical care obstetrics - Google Books

First reference you linked looks like a student care plan (an assignment?) Would not use as an authority on anything.

I get the edema/spasm thing now...you are right about googling it, there are tons of hits, but very few of them list diminished pulses as a sx of DVT. From your first post I thought you were trying to say that pulses were absent with DVT.

Are Homan's signs really still done as well? I was taught those in school but I thought they had fallen out of favor due to their nonspecificity and the danger of potentially dislodging a clot.

Thread hijack --- sorry --- going to stop posting now.

[klone, MSN, RN]

Are Homan's signs really still done as well? I was taught those in school but I thought they had fallen out of favor due to their nonspecificity and the danger of potentially dislodging a clot..

It's not extremey reliable, but it's still done a lot of the time because it's easy to do. I do it because it's expected of me as part of my assessment, but I find Pratt's sign and just pt reports of leg pain to be a more reliable sign.

[marty6001, EdD, EMT-P, APRN]

Last I read Homan's sign is about 50% accurate. Here's the first article on a google search, which states 8-56% accurate.. eeek.

http://askdrlehman.com/UBDX612/hosp.pdf

[NotFlo]

Pedal pulses are not a screening for DVTs. You will have a pulse in your foot as long as you have adequate arterial flow. It has nothing to do with the venous system at all.

Thank you, thank you, thank you.

At my job, we have a population that is at high risk for DVTs. EVERY time I have been suspicious of DVT due to increased edema on that side, pain in the calf, etc. I have everyone telling me that it CAN'T be a DVT because the patient has a strong pedal pulse and good CMS. I have tried to explain that DVT is deep VEIN thrombosis and that blood is still flowing through the arteries to the effected leg because the possible clot is in the vein, not the artery, and I get told over and over I'm wrong and that pedal pulses and CMS screen for DVT. UGH, very frustrating.