Palpating blood pressures?

[Duflinkka]

Hello all!

Okay, so yesterday my friend was orienting a new nurse. She asked if VS were completed for one particular resident. This client's BPs are always low, as in 90/60 for example, and they can be very difficult to hear. The new nurse replied that she had "palpated the blood pressure." No scope, no cuff. My question is this: Has anyone else ever heard of palpating a BP? I know you can somewhat palpate the brachial artery to properly place the scope, but I have never hear of anyone having this skill.

[nici1978]

i have heard of it, when you use the cuff and if you do not have a stethoscope

but without a cuff, something seems odd

nici

[NurseCherlove]

My former charge nurse is HOH, even a bit with her aides in, and she can did this (with the cuff of course). She said she used to could get usually within like a few mmHg of the actual reading. I thought it was pretty cool.

[canoehead, BSN, RN]

No cuff? puh-leeze.

You can palpate the systolic, and guess at the diastolic by watching the needle, but without a cuff you are just looking at the patient and guessing.

[Christie RN2006]

We are taught to do this in the field if there is too much background noise. What you do is place the BP cuff on, find the radial pulse, blow up the BP cuff like normal and palpate for the radial pulse until you feel it come back. Palpating a BP works, but it isn't the most accurate (it can be off by around 10mmHg). You can only get get the systolic number if you use palpation and it is generally written like 90/palpation. A better way to get BPs on patients that are hard to hear is by using a dopplar. You place the dopplar over the brachial artery, blow the BP cuff up and listen for the pulse to come back.

You have to use a cuff to get a BP. The only way to get a BP without a cuff is if the patient has an A-line.

[Burnt Out, ASN, RN]

I've palpated a BP several times and you do have to have a cuff.

[snowfreeze, BSN, RN]

A palpated pulse is systolic over palp as you do not get an acurate diastolic. exp.(110/P)

A field palpated pressure in a trauma patient is usually 90 at radial, 60 at brachial and 40 at carotid, these are systolic pressures these are pressures estimated from palpable pulses.

In emergency situations in hospital when I have many goals I usually go for the palpated field pulse.

[XB9S, BSN, MSN, EdD, RN, APN]

I have been taught and teach to palpate BP using the radial pulse (with a cuff) pre-hospital when you are unable to hear due to background noise.

If this is not possible of if you are struggling to hear or feel then I teach:

If there is a radial pulse present then you have a systolic greater than 80

Brachial greater than 70

Carotid is greater than 60 mmhg (this is what is taught in PHTLS)

[getoverit, BSN, RN, EMT-P]

I have heard the same thing in BTLS/PHTLS, we had this discussion at work and one of the docs said that it was more accurately a reflection of the MAP to produce a pulse at the different sites. the patient had a systolic BP

But like ChristieRN2006 posted, in the field we use palpated pressures a lot for our initial pressure. If we have a severely traumatized patient, I don't really care on the initial assessment what the actual systolic and diastolic bp is (e.g. thready radial vs strong carotid or no radial and thready carotid), I want to know the presence and quality of the pulses while we address the airway and breathing, try to control any bleed and establish some vascular access. Once we feel the ABCs are managed, then I"ll hook them up to the monitor and get a pressure.

What does anyone else think?

[Duflinkka]

Thank you all so very much - I'm learning a lot by listening/reading.

[Medic/Nurse, BSN, RN]

You can palpate a blood pressure.

You HAVE to use the cuff.

1. Find a strong radial pulse.

2. Inflate cuff 10-20 past the point where the radial disappears

3. Release the pressure (slowly!) on the cuff while palpating the radial pulse.

4. At the point that the radial resumes that is the presumed systolic.

5. There is no way to get an accurate diastole by this method.

* I feel (the radial) on the inflation as a marker of accuracy, but the deflation # is usually real close. I generally check both arms as time and clinical presentation allows.

Now, other options.

I always use a doppler at the brachial in a manual pressure if possible. The doppler that we carry on the aircraft plugs into the ICS and allows us to hear via our helmet headsets. If you are not in the HEMS environment, it should be fairly straightforward with an available doppler. This would kinda render the Reading/Palp a bit useless.

Now, as to rules of thumb for perfusion and assumption of SBP.

IF I have a Radial Pulse, I generally have a SBP of at least 80.

IF I have a Femoral Pulse, I generally have a SBP of at least 70.

IF I have a Carotid Pulse, I generally have a SBP of at least 60.

None of these "assumptions" are exceptional, but a "quick and dirty" measure. I still try and get an accurate baseline. Now, in actual practice IF I am missing a radial I generally need to proceed to immediate intervention to maintain perfusion. Also, ALWAYS, compare and check L & R at the same time. Also, remember that elevated HR in the presence of a low BP is not a reassuring finding - generally, (not always) you need to move a bit faster. The main thing to remember is to treat the PATIENT not any # - good assessment is the key to good patient management!

Hope this helps!

Practice SAFE!

[CHATSDALE]

palpitating a b/p requires a cuff

NG tube placement can be detected as easily with palpitation as with a stethoscope