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

MendedHeart · Nov 28, 2013

Actually, try not to press hard, the harder you press the less you will feel. Also, try only using one finger. There is no excuse for a hospital floor not to have an available doppler. I agrees with previous post to doppler then msrk and feel. All pts do not have palpable pedal or PT pulses amd a doppler must be used.

cardiacfreak, ADN · Nov 28, 2013

I had the same problem, I use 3 fingers across the foot and press ever so lightly because some people's are very strong, if I don't feel it then I use a little more pressure. If you are assessing someone with a lot of edema it does get trickier and you may have to use a Doppler. I agree with PP, I can not for the life of me understand why any unit in the hospital does not have a Doppler. I have only found a Popliteal with a Doppler.

Oh, I just thought of something else, sometimes I close my eyes, I don't know why it works except that it makes me depend on my sense of touch a little bit more. Sometimes I use this technique to start an IV, the new nurses think I can do anything with my eyes closed. :cool:

Been there,done that, ASN, RN · Nov 28, 2013

Practice finding them on yourself. Find and use that Doppler!

Good luck it's a tough skill to learn.. but you will.

ThePrincessBride, MSN, RN, NP · Nov 28, 2013

What kind of people have you been assessing? Larger, more edematous patients are typically more difficult to assess along with cardiac patients with poor perfusion. A trick: when finding the dorsalis pulse, have your patient point their toes upward and feel about an inch away from the big toe. Don't use your index finger as it has a pulse of its own. Posterior tibialis and popliteal pulses are much ore difficult but as long as you can feel the more distal pulses such as the dorsalis pulse you don't need to worry so much about the popliteal.

I wish you were here. I have crazy strong pulses along with a pounding carotid that can be seen upclose without palpation.

PerfectlyPlump, ADN, RN · Nov 29, 2013

It helps me to use two hands to feel for the dorsal pedal pulses. I lay my second and third fingers from both hands on 'the spot', and I can often feel it quite quickly.

Editorial Team / Admin · Nov 29, 2013

Appreciated the video. :up:

Speaking as a cath lab nurse that assesses DP and PT pulses several times a day, here's my technique:

I lightly place three fingers on mid-dorsum of the foot. It can be there, can be higher, to medial or lateral of there. But there's where I start.

Let your fingers just rest and feel the pulse coming up to the fingers, rather than pressing down to locate it.

Locating PT pulse is different. As akulahawk describes, slide your fingers over the "ankle bone" and behind it. Rest fingers there lightly and feel the pulse come up to meet your fingers.

If the pulse is very light or weak, I grade it a +1.

Strong pulse is +2.

If I can't feel the pulses I do use a Doppler.

If I can't get the DP on the dorsum of the foot, I move the Doppler distally, towards the two small toes. Sometimes there is a pulse there from the dorsal metatarsals.

Agree, try to feel yours or family's. Let us know how it's going!

ausrnurse · Nov 29, 2013

The title of your post made me laugh! Honestly, for the first month that I worked in ICU I couldn't find anybody's pedal pulses - but since I had to do it every day, I eventually got a feel for it. It just takes a bit of practice. :)

elkpark · Nov 29, 2013

Another helpful trick is to close your eyes (and try to be in as quiet a setting as possible). The less sensory info coming into your brain at once, the more you are able to focus on the sensory input you're most interested in (your fingertips). I know that sounds really dorky and dumb (not nearly as glamorous and high tech as a doppler :)), but it really does help.

seconddegreebsn · Nov 29, 2013

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

No! I had no idea that was something you could do--will try that next time.

My poor husband is tired of me poking around at his ankles and (very ticklish) feet

seconddegreebsn · Nov 29, 2013

What kind of people have you been assessing? Larger, more edematous patients are typically more difficult to assess along with cardiac patients with poor perfusion. A trick: when finding the dorsalis pulse, have your patient point their toes upward and feel about an inch away from the big toe. Don't use your index finger as it has a pulse of its own. Posterior tibialis and popliteal pulses are much ore difficult but as long as you can feel the more distal pulses such as the dorsalis pulse you don't need to worry so much about the popliteal.
I wish you were here. I have crazy strong pulses along with a pounding carotid that can be seen upclose without palpation.

Almost 100% of my patients are elderly, usually DM, LOTS of edema. Apparently they've got me on a strong learning curve here!

NursingNewbie21 · Nov 30, 2013

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[/quote']
NO NO NO!!!! You should NEVER be able to hear a pulse!!!! That was drilled into our head by our assessment instructor. If you HEAR a pulse, something is seriously wrong (stenosis of the artery)!!! Think about taking BP. You don't hear the brachial artery until you constrict the arm, right? You have to feel them or use a Doppler. YouTube videos helped me find landmarks.

SopranoKris, MSN, RN, NP · Nov 30, 2013

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?

Have you ever asked your clinical instructor to assist you with this? That would be a great learning opportunity. As others have stated above, practice on everyone that will let you. It sure takes the stress out of doing it with real patients :)