Doppler during Code

Nurses General Nursing

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I have a burning question for my fellow nurses. Is the use of a doppler, for finding a pulse, acceptable practice during a code blue? The reason I ask is because I got into a debate with a "very seasoned" ICU nurse and we just do not agree. Every single time there is a code blue in the ICU nurses routinely grab the doppler and I could not be more opposed to it. If my patient coded and it took longer than 10 seconds to find a pulse because of using a doppler I would have a huge issue with that. When the ER doctor responds he says what I am thinking, "remove the doppler, it does not belong in a code". I was so happy to hear the doc tell the nurses that! I would appreciate any and all ideas. Thank you.

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Specializes in Hematology-oncology.

Use of a doppler is not mentioned in ACLS or BLS algorithms for what it's worth.... AHA teaches that if you cannot definitely *Palpate* a pulse within 10 seconds, start CPR. A carotid pulse weak enough to necessitate doppler is probably not providing adequate circulation to vital organs.

I've used a doppler before (with a manual b/p cuff) to get a b/p reading on a patient who was circling the drain. SBP was 60, DBP was unreadable (even with doppler). She was quickly transferred to ICU.

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Exactly! It is not a part of ACLS guidelines. So why do nurses insist on using it in codes? And I am wondering if other ICUs also have this practice.

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The seasoned ICU nurse said it was disappointing to him that I was unable to think outside of the box and he told me I thought like a student. I have been a nurse for 13 plus years.

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The seasoned ICU nurse said it was disappointing to him that I was unable to think outside of the box and he told me I thought like a student. I have been a nurse for 13 plus years.

Well that was rude. Dontcha think after 13 years YOU are kinda seasoned. I've been one for 30+. I'm well past seasoned and on into crunchy and overdone.

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Specializes in Critical Care.

It's long been known that palpating pulses during a code is unreliable and can cause excessive delays in pulse checks and can lead the cessation of CPR when no pulse has actually returned. When used properly, the use of a Doppler or even better a bedside ultrasound can reduce time spent unnecessarily off the chest, and avoid the potential for a false finding of a pulse.

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My hospital routinely uses a Doppler on the femoral artery in codes. HOWEVER, we would never delay CPR to get one. Normally once CPR is already in progress, somebody grabs one for the next pulse check. I second MunoRN's comment about palpation of a pulse in a code being unreliable. I feel like it's more helpful and quicker to Doppler a pulse, and the person running the code can listen for it as well.

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My hospital routinely uses a Doppler on the femoral artery in codes. HOWEVER, we would never delay CPR to get one. Normally once CPR is already in progress, somebody grabs one for the next pulse check. I second MunoRN's comment about palpation of a pulse in a code being unreliable. I feel like it's more helpful and quicker to Doppler a pulse, and the person running the code can listen for it as well.

I get your point and don't disagree but the caveat is it depends on the skill level of the person wielding the doppler. I've seen staff futz around for an eternity trying to find a doppler pulse. And everything else comes to a standstill.

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Specializes in Critical Care and ED.
Exactly! It is not a part of ACLS guidelines. So why do nurses insist on using it in codes? And I am wondering if other ICUs also have this practice.

In the cardiac ICU there's always a doppler on hand because we use it to assess peripheral lower extremity pulses after harvesting vessels during a CABG, so I can understand someone grabbing one as an adjunct test during a code, but it's not part of the ACLS protocol as others have mentioned. It's not a standard of care and I think we'd have to defer to the literature as to it's relevance in a code situation. It might help determine that there is some kind of perfusion but it would likely be insufficient if you needed a doppler to find it.

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In the ED, we take for granted that there's always an ultrasound machine nearby to look at the cardiac windows. There are definitely patients whose pulses are physiologically or morphologically hard to palpate, and I occasionally will toggle the ultrasound over to the linear probe to look at the carotid to actually see the pulse or to assess effectiveness of CPR. It's VERY effective if you're comfortable with vessel anatomy but I don't think it should be how the initial pulse check should be done: looking like mad for a piece of equipment and trying to doppler a pulse that some couldnt even find by hand if it WAS there. Shaming another nurse for not embracing something that isn't yet the standard of care is just rudeness and superiority.

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