Having Problems finding pulses

ocb_dave_ocb, LPN · Mar 16, 2005

If you will feel around there is a bone protruding.. after you feel that move slightly downward.. Use 2 fingers...and you should feel it..

career seeker · Mar 16, 2005

When I first started doing vitals I found myself trying so hard that I was pushing in the vein and restricting it...start out with a light touch..if it goes away ask yourself if you are pushing down on it.

zacarias, ASN, RN · Mar 17, 2005

Hello. I'm a CNA in training, and one of the skills that I have to do is to take the radial pulse. I've practiced many times during the classes, but it seems that my counts are off. On some of the people, it takes me a while to even find the radial pulse, and on others, when I find it, I sometimes "lose" it. And at other times, I find it, lose it, and then it comes back again. We have to count it for a full minute for our skills test. Also, some of my classmates are having similar problems with this skill, as well. I feel terrible about this, and I'm wondering if I'm doing something wrong. Does anyone have any tips about how to accurately count the radial pulse?

Are you practicing on fellow students or on actual patients? Many older folks have what's called atrial fibrillation where there heart may beat very fast. When you take the radial pulse of these folks, it can be very irregular and the beats can be alternate between strong, weak, and non-existent sometimes.

Another tip is to feel that main tendon first and then slide your fingers every so slightly laterally ever so slightly (towards the thumb side of the arm) and find it that way. You also may alternate pressure. Press hard and then ease on the pressure to see if it comes that way.

Alicia18 · Mar 17, 2005

Wait till you have to try taking blood pressure! That was a favorite when I took my CNA class several months ago. :rotfl: I still have to practice whenever I get the chance, and its kind of hard to do on a confused older patient! :rolleyes:

Career Seeker is right; sometimes pressing to hard makes the pulse go away, although you might also want to find out if the patient has had a certain arm affected by disease before -- I believe that might make finding it difficult as well.

It can only get easier with practice. I'm lucky that where I work I have an older CNA looking out for me. She obviously remembers what it was like to keep up with practicing vitals, and when we need to do some on night shift, she lets me do them so I can get the practice.

If you don't practice on your class mates, bribe your friends and family into becoming "patients". It can only get easier, right? :)

NurseFirst · Mar 17, 2005

Wait till you have to try taking blood pressure! That was a favorite when I took my CNA class several months ago. :rotfl: I still have to practice whenever I get the chance, and its kind of hard to do on a confused older patient!
Career Seeker is right; sometimes pressing to hard makes the pulse go away, although you might also want to find out if the patient has had a certain arm affected by disease before -- I believe that might make finding it difficult as well.
It can only get easier with practice. I'm lucky that where I work I have an older CNA looking out for me. She obviously remembers what it was like to keep up with practicing vitals, and when we need to do some on night shift, she lets me do them so I can get the practice.
If you don't practice on your class mates, bribe your friends and family into becoming "patients". It can only get easier, right? :)

The "standard" suggestion for finding pulses is to compress the artery against a bone. This is possible with the radial pulse, but less so, say, with the brachial pulse. I find I have better luck if I take the person's wrist and wrap my hand around their wrist, so my palm is in contact with the back of their hand. So, if I am trying to take my own pulse on the left hand, I would:

1. take my right hand, palm up, and place it on the back of the hand at the wrist, with my right hand thumb pointing in the same direction of the left hand fingers.

2. a. Then I curl my fingers--I notice that I tend to use the middle and ring fingers--and, about 3/4" below the crease of the wrist, I place them just to the little finger side of the radius--and press down and toward the bone.

b. Another way that I might do this is to curl my fingers around the wrist, but lay the fingertips (same ones: middle & ring finger) along the palm side of the forearm, with the fingertips touching the tendons. Usually, the pulse is found between the radius and the tendons.

Hope this helps!

NurseFirst

PS -- I also tend to use the "flat finger technique" for finding the brachial pulse in the antecubital; I lay my fingers flat across the antecubital (not pressing in), halfway across, and press down moderately. The brachial pulse tends to vary in position from close to the little-finger side to almost the middle of the antecubital area.

chilloutrelax · Mar 17, 2005

Practice on yourself. Place 3 fingers where your pulse is. Notice how when you press one finger down harder than the others you feel that the pulse is stronger? Don't start counting until you have it for certain, it's ok to wait 10 seconds or so and make sure you have it. If I have trouble w/it, I"ll usually do the 3 finger thing. And also, I know where the pulses are supposed to be..that helps. You'll be able to do it, trust me! It was hard at first for me too.

Fiona59 · Mar 17, 2005

Pedal pulses are the WORST for me. There are days I swear my patients dont have blood flow to their feet:chuckle , I mean I see the suckers but can't feel them....

elkpark · Mar 18, 2005

In addition to all the excellent suggestions above, try closing your eyes. (You will also notice, if you pay attention, that it's easier to find the pulse in a quiet setting than in a noisy one.) The less stimulation coming in through your other senses, the more your brain can focus on what your fingertips are feeling.

Plagueis · Mar 18, 2005

Thanks, everyone, for your suggestions. So far, I've been practicing the pulse-taking on fellow students. However, whenever two of us did it on one other person, our counts would be off by 8-10 beats, which is why I was worried. Plus, I just took the CNA skills test yesterday, and, of course, one of the random skills that I had to perform was taking the radial pulse! :smackingf I was already nervous before the skills test, and that particular skill was the one I was hoping not to get, so now I think I failed the exam. I won't know for two weeks. I am still practicing the skill just so I can get better at it. Thank you all again.

All_Smiles_RN · Mar 18, 2005

Since we're talking about pulses, any tips on finding the femoral? Thanks.

Nurseinthemaking · Mar 18, 2005

Radial pulses can be hard but my trick is to not just use the tips of my fingers, lay the 3 fingers in the vicinity and push down, the pulse will show up, but if you are pushing to hard it will go away, so you kind of have to try it a couple times to really get it. I was a maniac, I would go out to the football field and be taking pulses on everyone I saw or talked too, they would all just laugh at me. Put your hands on as many people as possible, young and old, you will get it.

Just remember, fingers are our friends, don't be afraid to use them to get what you need for VS.