NICU assessment question

[RNporvida]

Today I was floating to NICU. On first assessment of one of my assigned infants, I could not palpate a brachial pulse on the left, although the right brachial pulse was immediately palpable. After moving my fingers up, down, side to side, repositioning the arm several times, completely removing the sleeve, I was finally embarrassed, as the infant's parents were watching me continue to attempt to find a pulse in vain! I later tried again, when parents were not at the bedside, and try as I might I could not find the left brachial pulse, even though the right brachial pulse was strong and could be felt on first attempt. Femoral pulses were 2+ and equal bilaterally. I called a tried-and-true NICU nurse to the bedside and told her what I was finding (or rather, not finding); she checked the brachial pulses herself and said she was having trouble feeling it as well but that feeling pulses through gloves can sometimes be challenging for her and suggested asking a third nurse, which I hesitated to do because she (#3) was very busy. I judged my finding not to be reason for great concern because the arm and hand were warm and well-perfused, with good cap refill, so I simply passed on my finding in change-of-shift report. However, I am still unsure of the clinical significance. Could it simply be the anatomy just happens to be a bit different on that side, as in, the artery running deeper? Or is this potentially indicative of a serious cardiac problem that I should have communicated to the doctor? The infant does have a heart murmur and is having a genetic workup for some [other] known anomalies.

[TheCommuter, BSN, RN]

Moved to the NICU forum.