Painful Stimuli

[gwenith, BSN, RN]

I have always been very careful about which painful or noxious stimuli I use to elicit a patient response but I have seen some strange assessments.

Possibly the one that makes me maddest is the "nipple twist" oddly - most often attempted by young male MD's on female patients :angryfire

Mind you I use the word "attempted" wisely - the resident (intern) who stated he would use this assessment got told that "fair is fair - if you are going to start doing nipple twists on females we will start doing scrotal squeezes on males - starting with you." Funny he lost interest in doing this form of painful stimuli after that and every other young resident who suggested painful stimuli tended to be very respectful and stand at the other side of the bed - guess word got around:chuckle

What do you use though?? Sternal pressure? Trapezius squeeze??? TMJ pressure??

Do you put pressure at the base of the nails or at the side of the fingers???

[Hellllllo Nurse, BSN, RN]

Sternal rub, only. I have never heard of the "nipple twist."

You would think that docs would avoid this, they could be accused of sexual battery.

[suzanne4, RN]

I used to use the side of a pen at the base of the toes or fingers. Usually able to elcit a response with this when there was something to be gotten.

I find that we did not always get a response from a sternal rub, but the pressure from the pen did work. I think it is much kinder than many other tortures that I have seen done by many neuro docs. I have never seen bruises or marks left by my way.

[suzanne4, RN]

Sternal rub, only. I have never heard of the "nipple twist."

You would think that docs would avoid this, they could be accused of sexual battery.

Nipple twist has been around since before I became a nurse, and that was a long time ago. That is one of the oldest still being used, unfortunately.

[MandyInMS]

Nipple twist???anyone doing this to ME had better kiss me first!! haha ..j/k ~winks~....Sternal rub is all I have ever done for painful stimuli.....at work

[JACALA_CL]

i use nail bed pressure with edge of tongue depressor. it helps decrease cross contamination of patients by NOT using your pen.

[gwenith, BSN, RN]

There is some thought here that side of the finger is better as it does not bruise under the nail and that we should only be doing sternal pressure not sternal rubs - again because of bruising.

[suzanne4, RN]

I actually used to place my pen in a glove. I don't like pressure to the nailbed because you can cause permanent damamge to the nailbed. I still like the pen to the base of the finger or toe on the side at the base. After 25 years, it still works for me, and I have never seen any bruising afterwards.

I have just had the best ersults with this technique.

Remember, gloves are a wonderful thing. :balloons:

[NeuroICURN]

How strange you would post this....We were just discussing (teaching the residents) this the other day......

The only TRUE ways to apply and check for a response from a central, painful stimuli are these: 1. Sternal rub 2. Applying periorbital pressure or 3. squeezing the trapezius muscle.

Although it is easy to do, and will elicit a response out of many...nipple twisting is not technically an appropriate testing method (and I've seen it done to men and women).

As for checking for a response to peripheral stimuli, I take my pen or whatever, and apply pressure to the inner end of the nailbed.

[gwenith, BSN, RN]

Pressure at the Temporo-mandibular joint was one I saw in a paper from Sweden and I have tried it out where there was little opportunity for others and it does work and it is effective. As I said before there is some talk of making the sternal rub - sternal pressure only as there have been cases of severe bruising from over enthusiatic personnel.