I stink at peripheral pulses

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Specializes in Step-down, cardiac.

I am *terrible* at feeling peripheral pulses. I just cannot feel brachial and femoral pulses. I'm a first-year student, and I very rarely can feel a brachial pulse, and I've never been able to feel a femoral, even on my husband. I have no problem with carotid, radial, posterior tibialis, or pedal pulses, but femoral and brachial ones just make me feel like a total imbecile. Am I the only one? Are there any secrets I should know about to feeling them?

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I was having a hard time with brachial at first, so I had to get the teacher to help out a little. She told me if I was having a a hard time finding it I should hyperextend their arm a bit. Now I can find it easy! I'm not sure if it's just taught this way some places, but they never told us to do this... maybe this is your problem.

As for femoral.. I can't help you there. We didn't pay much attention to that area. :(

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First of all, can you feel it on yourself?

Don't be afraid to take a little bit of time and really look for it. Patients don't notice, care, or perceive time the way we do in clinicals. What feels to you like "forever" might really only be 10 seconds.

Just keep practicing. Grab people you know and see if they'll let you find theirs!

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Specializes in Trauma, Teaching.

Femorals are not close to the surface, you have to push down really deep. It looks like you are pushing all the way through, 2 or 3 inches down! In reality, maybe not that deep, but it sure looks like it. Have your husband flex the hip a little so the skin isn't quite so tight, and just keep practicing.

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Specializes in Step-down, cardiac.
First of all, can you feel it on yourself?

No, but that's not too surprising--nobody else can either. Apparently my veins and arteries are really deep and hard to feel.

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Specializes in Step-down, cardiac.
Femorals are not close to the surface, you have to push down really deep. It looks like you are pushing all the way through, 2 or 3 inches down! In reality, maybe not that deep, but it sure looks like it. Have your husband flex the hip a little so the skin isn't quite so tight, and just keep practicing.

Cool, I'll try pressing harder. We weren't allowed to practice them in class at all, because they're so close to the genitals. I found some pictures online that make it look like I'm in the wrong place--http://www.ehow.com/how_5626581_check-femoral-artery.html makes it sound like it's way up on the lower abdomen. I thought it was either right next to the lady parts or member, in the fold where the leg meets the body, or a couple of inches further down and down on the thigh. Is it closer to the hipbone, on the pelvis? Maybe I'm checking the wrong place!

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Specializes in Step-down, cardiac.
She told me if I was having a a hard time finding it I should hyperextend their arm a bit. Now I can find it easy!

I got it! They never told us to hyperextend, but I tried it on myself and it worked perfectly!!

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Specializes in Step-down, cardiac.

I FOUND IT! I wasn't pressing hard enough, and I wasn't close to the genitals enough! First time ever, and I'm almost halfway through nursing school. How embarrassing. :) But yay!! I'm so excited! Hopefully I wasn't just feeling my pulse in my fingers, but I'm pretty sure it wasn't--it was so strong, I can't believe I didn't just find it by accident before! :) I'll try it on my husband when he gets home. You guys are awesome!

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Peripheral pulses are weaker pulses as a good rule of thumb so they're going to be harder to feel. I've been feeling for pulses for about 11 years now (started out as an EMT then Paramedic), and it's gotten a lot easier. As another noted, you usually have to push down a lot to feel the femoral. What I spent about two years learning is that you don't always have to push down hard though. I eventually found that I was occluding some light pulses in my effort to palpate them, i.e. I was pushing down too hard. Granted, I've NEVER felt a popiliteal pulse. Never. Can't find mine. Can't find girl friend's. Can't find patients's. Can't find people in my nursing class.

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Specializes in Step-down, cardiac.
I eventually found that I was occluding some light pulses in my effort to palpate them, i.e. I was pushing down too hard. Granted, I've NEVER felt a popiliteal pulse. Never. Can't find mine. Can't find girl friend's. Can't find patients's. Can't find people in my nursing class.

LOL--I find popliteal pretty easy, but the other two are almost totally beyond me. :) Glad to hear I'm not the only one! (If it helps at all, it takes me two hands for popliteal, one on each side of the back of the knee.)

I think I press too lightly a lot of the time, because I'm always worried about occluding them and hurting the patient and cutting off their circulation. I probably need to be more assertive with that.

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For femoral pulses, ask your patient to do extend their leg in a sort of frog-leg fashion.

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