Lactation Consultants - need your advice

  1. Re: Safety of nipple twist as noxious stimuli

    Okay over on the Neuro forum we have a thread/debate going on in relation to appropriate noxious stimuli to apply to patients with decreased levels of consciousness.

    The one stimuli I personally loathe and will speak out against every time I see it is the nipple twist.

    I feel they are not only far too invasive and fraught with sexual overtones but stand a good chance of causing long term damage to the breasts. However finding information to back this is difficult.

    Can anyone help.
  2. Visit gwenith profile page

    About gwenith

    Joined: Jul '02; Posts: 10,260; Likes: 233
    icu nurse


  3. by   SmilingBluEyes
    What on EARTH? Going to go check that out Gwenith. I would think there are lots of BETTER ways. And yes, caution would be a good idea regarding handling of breast tissues.
  4. by   babynurselsa
    I have never seen a nipple twist. I have on occasion pinched some of the skin on the sternum but NEVER breast tissue.
    Just the thought makes me wince a bit.
  5. by   scribblerpnp
    I say, if a nipple twist is OK, why not a kick to the groin? That would definately illicit a resonse to check for LOC! (Obviously, I'm kidding!)
  6. by   babyktchr
    Oh my word. I have been out of critical care nursing for about 12 years now, and we weren't allowed to do nipple twist at all. We had one doc that continued to use it, and he was reprimanded to the point that I think the adminstration told him to look for another job. I can't believe that is still going on. There are many other ways to check for responsiveness to pain.
  7. by   SmilingBluEyes
    never mind.....looking up some info on this. will get back to you.I am not an LC but damaging breast tissue of any sort seems really wrong and unnecessary. Like others said, there are other ways to elicit a pain response.
  8. by   gwenith
    Thank-you everyone - I too cannot believe this still exists - anywhere in the world but it is one of my missions in life to spread the word to STOP IT!!

    I, personally have only seen it attempted twice (I say attempted because they did not get past the first attempt mainly due to my snarled promise of why I would do if they tried again, which, shall we say would have involved considerable pain for those male doctors)

    I just feel that there are a lot better ways of eliciting a response - ways that would do no harm.
  9. by   enfermeraSG
    Oh my! Didn't even know that was a form of noxious stimuli, although it certainly would be noxious! What happened to good old sternal rub?! Seriously though, there are so many things not right with that form of stimuli that I can't believe it is used by anyone. SG
  10. by   prmenrs
    Forget about potential breast tissue damage, it's just plain wrong. Esp since other options exist.
  11. by   mitchsmom
    Quote from scribblerrn
    I say, if a nipple twist is OK, why not a kick to the groin? That would definately illicit a resonse to check for LOC!
    Ummm.. I am tempted to just leave it at that!!!

    But, I am a lactation consultant so I'll just chime in by saying that first of all I had never even heard of this! I looked it up in my general assessment text which states, "If your patient does not respond to tactile stimuli, you will have to resort to painful stimuli. There are acceptable and unacceptable ways to elicit a response to pain. Never perform a nipple twist! " ... "Also remember to rotate sites - repeated stimulation at the same site may cause bruising."
    The sites that my book lists are:
    ...for central stimuli:
    trapezius squeeze, sternal rub, supraorbital pressure, mandibular pressure
    ...for peripheral stimuli:
    nail pressure, achilles tendon squeeze

    Another assessment book I have states "Painful stimuli are used when necessary to obtain eye opening and motor responses. Begin with less painful stimuli such as pinching the skin and progress to squeezing muscle mass or tendons if there is no response."

    I think common sense would dictate to use an area of skin/muscle/bone/fat tissue when possible rather than glandular/ductal/organ tissue, just to be on the safe side.

    Links to my books for reference:
    Nursing Health Assessment: A critical thinking, case studies approach (Dillon)

    Mosby's Guide to Physical Examination (4th edition by Seidel, Ball, Dains, Benedict)

    There is a little bit here about nipple vasospasm secondary to trauma within this write up on nipple blanching and vasospasm in breastfeeding, with references at the bottom of the page. When LC's talk about nipple trauma it is usually as it relates to damage from poor latch/suck by a baby but it can also certainly be from breast surgery or other causes of breast trauma.
    Last edit by mitchsmom on Dec 1, '06
  12. by   prmenrs
    Even if the patient doesn't respond to the painful stimuli @ that time, IMHO, on some level the body remembers that pain. Later, when the woman attempts to breast feed, that 'remembered' pain may interfere. She may experience reluctance to breast feed or pain while breastfeeding disproportionate to any discomfort presented by the actual process.

    Just a thought.
  13. by   Dalzac
    I have seen it once done by an intern. He got an earful from me the second he did it. He tried to explain it to the "dumb nurse" I told him sternal rubs worked just as good. And then I wrote him up and gave it to his attending.
    Next thing I heard that no intern,residents or nurses will use nipple twists for tactile stimulus.