Peripheral pulses - I'm not entirely convinced they exist!

[seconddegreebsn]

Hey everyone,

I finished my assessment class this summer and I'm out doing med surg clincals, using the skills I learned there. My problem: I cannot for the life of me find a popliteal, posterior tibial or dorsalis pedis pulse. I've tried on at least 30 people now and have never felt it once. And now that I'm caring for postsurgical hip replacement surgery patients, it's important to find these on the affect side. What am I doing wrong?

[JustBeachyNurse, LPN]

Do you have access to a Doppler? Our clinical instructor had us find by Doppler first then palpation in lab & clinical so that we could learn landmarks. In the ER, staff often marked the skin where pulses were found to make it easier to recheck

[seconddegreebsn]

Do you have access to a Doppler? Our clinical instructor had us find by Doppler first then palpation in lab & clinical so that we could learn landmarks. In the ER, staff often marked the skin where pulses were found to make it easier to recheck

I think there's ONE for the entire floor and it's in a specialty unit, so no They expect us to be able to find them without assistance.

[lhflanurseNP, APRN]

Find the everybody loves her/him nurse and ask them to help you. They can find the pulse then guide you to where and how to palpate. You may be palpating too deeply or not deeply enough. Without being there, can't help you with that. This shows the nurses on the floor and your instructor that you really want to learn...win win situation for all!

[krisiepoo]

can you find them on yourself? I had a hard time with pedal pulses and practiced trying to find them on myself so I had the landmarks on where they should be. I would also find them on friends when they came over (my lucky friends, LOL) and family members. that way I wasn't under any pressure or strain trying to learn how to palpate

[Esme12, ASN, BSN, RN]

For both of them....my guess is that you are not palpating deep enough....it isn't like the radial pulse

[classicdame, MSN, EdD]

are you using a stethescope? You might hear a pulse then feel for it. ALso, if you are anxious you own pulse will be more evident to you than somone else's. My suggestion is to PRACTICE on friends or family

[Twisted Nurse]

Haha I used to have trouble locating lower extremity pulses as well. Thank goodness for Youtube! This short video helped me locate landmarks to make it easier. Start at 40sec mark.

But if you are still in doubt or the pulses are weak to begin with, use the Doppler. Hope this helps!

The DP is pretty easy to find; the PT, not so much. I can only recall one time that anybody's palpated a popliteal in my presence.

Note that our trauma docs regularly use doppler precisely because pedal pulses can be hard to find.

Note also that a doppler is pretty cheap to buy... ~ $150, and can be very helpful in developing your palpation skills.

[akulahawkRN, ADN, RN, EMT-P]

I'm usually able to find the DP fairly easily, without doppler. It's usually right around the gap between the 1st and 2nd metatarsals, usually right near the border of that 1st metatarsal and that gap. Another way to find it is to follow the extensor hallucis longus tendon (the tendon that extends the big toe) right to where it crosses over the top of the arch of the foot and palpate just lateral to that tendon and it should be right there... thumping away happy as a clam.

If I can't find it that way, I'll palpate the 2nd metatarsal and slowly move medially toward the 1st metatarsal. It can be a weak pulse anyway, but usually if the radial pulse is 2+, the DP should be too.

The Posterior tibial pulse is a little more difficult to find, but it's usually right where the video said it is. I normally put my fingers in that hollow "behind" the medial condyle and lightly press in toward the talus, almost like I'm trying to feel the back side of the talus or the underside of that condyle. It usually can be easily located that way. Once you've acquired the feel for how to find the pulses, it's not usually terribly difficult.

With practice, you may find that if you can't feel the pulses, you might only be able to find them using doppler, and there's no shame in that. You just have to be sure that you can't feel the pulses.

[pixiebuddymick]

For dorsalis pedis, I was putting too much pressure and could not find it. I start with the second toe from the big toe, and move down with LIGHT pressure until I find it.

[applesxoranges, BSN, RN]

In all honesty, if you can't find them you should request a doppler or get someone else to show you and then feel to see if you can feel them.