Popliteal pulse, I can't find it in a friends leg.

PsychNurseWannaBe, BSN, RN · Nov 16, 2011

No popliteal pulse! That's never good! :) His vein maybe deeper or you may be applying too much pressure and occluding the vein or, maybe God did move his vein a little to the right or left. :) But I don't think God did it to you personally. :lol2:

TheCommuter, BSN, RN · Nov 16, 2011

Most of my peripheral pulses are not palpable because my blood vessels are extremely deep. You can barely palpate my radial artery after a few minutes of feeling around to locate it. My temporal and carotid pulses are barely palpable. That's about it.

My popliteal, pedal, femoral, ulnar, brachial, apical, and axillary pulses are not palpable, even to the most trained fingertips. When I was in the hospital for an overnight stay, the nurse who performed my initial assessment had to use a doppler to locate my peripheral pulses. The moral of the story is that you are not going to be able to palpate everyone's pulses.

ImThatGuy, BSN, RN · Nov 17, 2011

No sweat. I can't even find it in my leg.

RKpianoman, APRN · Nov 17, 2011

Sounds like it's time to amputate! No time for the trip to the hospital, just tourniquet above the knee and grab a steak knife! Your friend will understand

Haha bending the knee slightly helps a little, but I can only find that pulse about a fourth of the time.

Somewherenear · Nov 17, 2011

If the distal pulses are palpable most likely your friend is perfectly fine... check for temperature, dorsalis pedis, posterior tibial, cap refil in toes, sensation, temperature bilaterally... I can honestly say that in my three years as a nursing student, I have only been able to palpate one patient's popliteal pulse. The popliteal and the ulnar are the two most difficult to palpate... so don't have a heart attack over it.... you're good to go as long as you can critically think of other ways to determine if the patient has circulation beyond the popliteal (like what I outlined above) or if there really is a blockage there and maybe then you'd break out the doppler and have a listen? Just my thoughts on the matter.

EricJRN, MSN, RN · Nov 17, 2011

If he's lying down, elevate his head a little bit and have him bend up his knee to around 90 degrees. Encircle the knee with your hands. Find the two tendons at the back of the knee, sliding your fingers to the inside of those tendons. The pulse should be felt by the fingers on the outside of the knee. Try using more pressure to palpate, then letting up a little bit.

turnforthenurse, MSN, NP · Nov 21, 2011

I always have a hard time finding the popliteal pulse...it's a deeper vessel therefore harder to palpate. If the distal pulses (pedal/post tib) are palpable and strong, then chances are the patient (or your friend, for that matter) has adequate circulation.

Thujone · Nov 21, 2011

I was able to get their popliteal pulse by using a very light touch. I think I was pressing to hard before. Although when I found the other persons popliteal pulse I pretty much had the entire weight of their leg pressing against my finger tips, lol, but I felt his REALLY good. I found both of their dorsalis pedis pulse with ease, so I know circulation has to be good.

nurseprnRN, BSN, RN · Nov 21, 2011

"no popliteal pulse! that's never good! :) his vein maybe deeper or you may be applying too much pressure and occluding the vein or, maybe god did move his vein a little to the right or left"

popliteal (and almost all other*) pulses are arterial.

as a general rule, arterial pulses are hard to find when the joint they pass by is extended or hyperextended. to see why, let's look at the easiest ones to find, the radial artery in the wrist and the brachial in the upper arm.

imagine you are pushing something away from you, but it snaps back and hits your wrist. or you are fighting off the predator that wants to eat you, arms extended to push it off. in these and similar cases it would be in the best interest of your long-term survival to protect that artery from easy (ier) trauma, so it sorta slides back behind the bones/ligaments/tendons in the joint.

you can always tell when someone is trying hard to get a pulse and they bend the hand backwards thinking that will make it easier. not. try it now-- locate your radial pulse, then slowly hyperextend the wrist and feel that artery just...slip away.

same applies when trying to palpate popliteals (good technique nicely described by ericjrn above :up: ) or bracheals at the elbow. if the joint is relaxed and slightly flexed, the artery will be there for the feeling...assuming there is a decent bp in it and its walls aren't badly sclerosed.

* you can see a-waves in the jugular veins with atrial contraction, useful to see if you wonder if your patient is in atrial fib or not. you can also measure them in the pulmonary veins, but that's not something most folks need to do often)

loveoutloud · Nov 22, 2011

OMG maybe they are dead!