Distal Pulses

[skimainiac]

After the femoral pulse Ihave a hard time find the distal leg pulses. Any ideas or landmarks that work for other people? Knee, ankle and foot. Sometimes I think I may palpate to hard and maybe occlude what I should be feeling.

Thanks for your

Skimainiac

[Daytonite, BSN, RN]

This is what Mosby's Expert 10-Minute Physical Examinations by Cindy Tryniszewski (Editor), Mosby (Manufactured by) 2nd edition, 2004, page 267, has to say (there is a more recent edition of this book in publication now):

• "To help find the pulse in a patient's leg, support and relax any nearby joint with your free hand while palpating with your examining hand. If you can't find the pulse, move your fingers in and around the area, varying the pressure you exert with your finger pads.
  
• Make sure you don't confuse your patient's pulse with your own pulsating finger pads. To make sure, palpate your own carotid pulse to determine your heart rate and then compare it to your patient's. . .Don't palpate with your thumb because it has strong pulsations easily confused with your patient's.
  
• Don't press too hard because you could occlude the artery and stop the pulse you're trying to find."

"To palpate the popliteal pulse, flex your patient's knee so her foot rests on the examination table. Place one hand on each side of the knee with your thumbs near the front of the patella. Curl your fingers around the knee, and rest your fingers in the popliteal fossa. Now gently press your fingers deep into the popliteal fossa. The pulse may be difficult to feel. If it is, try straightening the patient's leg slightly to make the pulse more accessible.

To palpate the posterior tibial pulse, place your fingertips in the grove between the medial malleolus and the Achilles tendon, and feel for the pulse. Sometimes, passive dorsiflexion of the foot will make this pulse easier to palpate.

To palpate the dorsalis pedis pulse, place your fingers between the patients great and first toes and slowly move away from the toes between the extensor tendons until you feel the pulse. Plantar flexing [pointing the toes down] the foot slightly makes the pedal pulses easier to palpate. Keep in mind that, in some patients, the pedal pulse may be congenitally absent or branch high up in the ankle."

http://meded.ucsd.edu/clinicalmed/extremities.htm - UCSD's Practical Guide to Clinical Medicine, Exam of the Lower Extremities. Shows photes of the locations of these pulses along with information on how to palpate for them.

[skimainiac]

Thanks so mcuh. This is an awesome website that I have saved and will reference often.

[teeniebert, LPN]

A lot of people in my class have had trouble finding the posterior tibialis pulse. I've found that it's easier to palpate if you put your palm on the outside of the person's heel and curl your fingers around the back of the heel so that your fingertips are between the Achilles tendon and the medial malleolus (the spot Daytonite mentioned). Coming at the spot from the outside seems to put my fingers in the right spot on the first try, otherwise I'm feeling around for way too long.

[Daytonite, BSN, RN]

The UCSD site was pulled off the Internet once before. Since they put it back up I downloaded all the pages onto a flash drive, so I have them in case that happens again. I can take the flash drive with me anywhere and plug into any computer I happen to be at.