Pedal pulses and posterior tibial

[zzyzx]

If you can feel or Doppler a pedal pulse, is there really any need to find a posterior tibial pulse? Likewise, if you can get a posterior tibial pulse, any need to feel for a pedal pulse?

[ptier_MNMurse, BSN, RN]

Generally speaking, there is a collateral circulation between the two. The dorsalis pedis provides circulation to the top of the foot and the dorsalis pedis to the bottom of the foot, having collateralization in the deep plantar artery. If one gets occulded for one reason or another, the other aspect of foot is dependent on the collateralization.

In my opinion: In most healthy people, if their foot isn't mottled/cool/pale/gangrenous/burned/etc, it probably doesn't make a whole lot of difference. However the term "healthy" is not exactly the definition of the standard ICU patient. haha!

But we are also there to be meticulous and notice small discrepancies. It also probably only takes another few seconds, so just do it!

[zzyzx]

Thanks for the reply. My understanding is that we are mainly checking pedal or posterior tibial pulses to make sure the patient hasn't developed an arterial clot higher up in the leg, in which case we would find neither pulse. So, as long as we are finding one pulse, it is safe practice to not bother checking for the other pulse, correct?

On my unit everyone automatically documents both, and I'm quite sure hardly anyone consistently checks both pulses. It is awfully time consuming when you can feel one of the pulses but can't feel the other, and then have to spend time trying to find it when you already know that there is good circulation.

[ptier_MNMurse, BSN, RN]

Yeah, I agree it can sometimes be a little tedious.

The popliteal artery bifurcates just below the knee into the anterior and posterior tibial arteries (also the peroneal/fibular artery) and the anterior eventually becomes the dorsalis pedis. So you have two primary branches that may have some collateralization, but that's why we check both.

Interesting that you bring this up as we don't check ulnar pulses, though the ulnar artery provides a majority of the hands perfusion. So why we don't check and document on this is also interesting.

[PaSSiNGaS, MSN]

This question can easily be answered by reviewing simple anatomy. Both arteries are branches of other vessels so knowing if one is present and one isn't is a good idea to know where ischemia is coming from. Might want to refresh yourself on anatomy.

[zzyzx]

I get that, but my understand is that an arterial occlusion of the leg is going to happen in the femoral artery, or in the popliteal artery proximal to the knee. In either case, you'd have no circulation to the lower leg, and thus neither a pedal pulse nor a posterior tibial pulse.

[dianah, ASN]

In my experience, a patient with sudden arterial occlusion will experience TREMENDOUS, SEVERE PAIN. Nothing but removing the source of the occlusion (i.e., taking the patient to surgery stat) will relieve that pain.

Gradual occlusion (PVD) has its own pains and presentation, e.g.: the complaint of "my leg really hurts in bed at night, feels better when I sit up on the edge of the bed" and allow the legs to be dependent.

Identifying the DP and PT pulses should not take long. Usually if I have to think about it: "Is that a pulse? Hmmm, maybe not..." lift up fingers slightly, in case I am occluding the pulse, then pause again to allow the pulse to transmit to my fingers," for more than 30 sec or so, means I will get the doppler and not spend an inordinate amount of time on the task.

Appreciate all the input in this thread, very helpful!