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I am having a little trouble with finding peripheral pulses. I can find the ones in the arms, neck, and face, but have problems with the lower extremities. I can only palpate them sometimes. Any advice?
I don't know which ones you're doing since we were taught that the peripherals were just the radials and dorsalis pedalis because they have the most distance from the heart but I help you find all of the major ones on the legs. I use two fingers so they will all apply to using two fingers.
Femoral- feel for the tendon that runs inside of the thigh by the groin. There will be a little indent under it and just push. It might not be under the tips of your fingers but you should feel it somewhere on you finger just push harder or softer before you give up searching for it because you may have cut off the supply.
Popliteal-Have pt put foot flat on the bed (easier to find if you put the head up so they're more in a sitting position and use both hands to find the tendons that run behind the knee. Push in with both hands using same concept as femoral (harder then let up) and you should feel it in what ever hand is on the outside of the knee.
Posterior Tibial- Find the inside ankle bone and push in between 6 and 9 o'clock (with the clock being you looking at the bone and twelve being the top) push hard and let up until you feel it
Anterior Tibial- Find outside ankle bone and push between 12 and 3 o'clock (with the clock being you looking at the bone and twelve being the top) push hard and let up until you feel it
Dorsalis pedis- take each hand and put the thumbs on the ankle bones then make a V with your index fingers on the top of the foot. The pulse site should be right around where the fingers meet but more on the outside finger. Adjust the pressure because it's easy to cut the circulation off and have patient put foot on bed if you can't find it when they're laying down.
If you can't feel the ones on the foot or ankles get a doppler (and you may have to grab some KY jelly to lubricate the transducer to slide it better) because the pressure is lower and that makes it difficult.
Wow, I can't improve on the last poster, but perhaps you could have someone check the pedals and then show you where she/he felt them and then you could feel them too. Sometimes they are very faint, but once you get used to feeling for a very faint (sometimes) pulse you will catch on fast.
It helps when people put an X on the pedals with a sharpie, then you know where to palpate.
Thank you for this thread! Could someone offer a little explanation about the numerical rating of peripheral pulses? For instance, I have a hard time determining whether I should rate a pedal pulse a 1+, 2+, etc. Thank you for any help!
thank you for this thread! could someone offer a little explanation about the numerical rating of peripheral pulses? for instance, i have a hard time determining whether i should rate a pedal pulse a 1+, 2+, etc. thank you for any help!
pulses are graded on the following scale [page 330, textbook of physical diagnosis: history and examination, third edition, by mark h. swartz, william schmitt (editor)]:
health assessment made incredibly visual uses + signs in the back of each of the numbers. it doesn't matter whether you use the plus signs or not as long as you are consistent in your charting over the years of your career in the event that you ever need to read and interpret your documentation years later. read h&ps of doctors and see how they document pulses as well.
on the health assessment resources, techniques, and forms sticky thread you will find a number of websites that you can go to for free physical assessment information. my personal favorite for this type of information is the ucsd practical guide to clinical medicine which is almost a physical exam book online: http://meded.ucsd.edu/clinicalmed/introduction.htm.
Also if you press too hard you obliterate the pulse. Gentle, gentle, move your fingers around by sliding them, not lifting and replacing them on the skin. Try your own pulses and your family first. Get used to where they are. Close your eyes if you are distracted easily as you practice your new skill. Relax!
Also, remember that dorsalis pedis is absent in 5-10% of the healthy population, and posterior tibial is absent in 15% of healthy pts. In lab last week, my DNP instructor spent 15 mins searching for my pedal pulse, first by palpating, then w/a doppler, and simply couldn't find one. It sure made my lab partner feel better!