Brachial pulse on an obese patient

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For my nursing 101 class, we are required to do the 2 step method for measuring bp. I had the most difficult time finding a brachial pulse and a even a radial pulse on my lab partner (who is obese). Even my instructor had a difficult time! I work in healthcare, but direct patient care is all new to me (I have never measured bp or pulses). As time went on, I became even more nervous the longer it took me to find her pulse (my instuctor sitting there observing me didn't help much either!). By the time I finally found her brachial pulse (which was weak, and I was afraid to lose it again), I was incredibly nervous, fumbling, and lost most of my confidence. When I measured her BP, I was right on (thankfully!). Any tips on finding pulses on obese patients and building up confidence? I definitely lost some and I was dreaming about bp's and pulses all night. :eek:

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Specializes in CNA.
Any tips on finding pulses on obese patients and building up confidence? I definitely lost some and I was dreaming about bp's and pulses all night. :eek:

Make sure their arm is relaxed and supported. Start at the inside of the arm antecubital area and push the tissue and biceps muscle toward the midline of the arm away from the artery. You are sort of pushing all the stuff in your way aside so you can feel the pulse.

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Specializes in Emergency.

Along with what 2ndyearstudent mentioned, I find it helps to start there and with my 2nd 3rd and 4th fingers I make circular motions while applying downward pressure. Then slowly release the pressure while palpating for pulse. At least this is what helped me with a patient who was 295 lbs. with a +1 pulse.

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Will try that guys! thanks!

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Specializes in LDRP.

What helps me find a brachial pulse is to have the patient hyper-extend their arm so they're pushing the antecubital space out, as opposed to having it bent in when the arm is relaxed. This provides a little more bloodflow to the area and makes the pulse easier to palpate.

Also, when you're in the hospital and having trouble finding a patient's pulse, you can always go grab the Doppler! :D

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What helps me find a brachial pulse is to have the patient hyper-extend their arm so they're pushing the antecubital space out, as opposed to having it bent in when the arm is relaxed. This provides a little more bloodflow to the area and makes the pulse easier to palpate.

Also, when you're in the hospital and having trouble finding a patient's pulse, you can always go grab the Doppler! :D

Yup, unless their completely hyper-extended is very difficult for me to find it.

Me :nurse:

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