Pulse Sites

[healthstar, BSN, RN]

Hello nurses,

I am a student nurse. I was told in clinicals to check the pulse in all sites. How about in reality, do you check ( Carotid,femoral, popliteal, dorsalis pedis) pulses? During my clinicals, I only seen nurses check apical, radial and dorsalis pedis. I find it extremely hard to feel popliteal pulse, is there a special way to check( feel) it? Thanks so much :)

[klone, MSN, RN]

I think the answer will depend on what area of nursing and why the person is in the hospital. Where I work (OB) the only pulse we routinely check is pedal, as part of screening for DVTs, which women who have just given birth are at greater risk for.

In newborns, we also check femoral pulse.

[Carrie9RN]

In the real world you generally only check apical, radial, and dorsalis pedis unless there is something going on that warrants further assessment. In some circumstances you have to check the post tibial also (sometimes requiring a doppler) if they've had leg surgery or circulation issues. I haven't had to check any others at this point.

As far as popliteal pulse goes, I don't have any suggestions. I always had a really hard time with it too

[mamamerlee, LPN]

Generally speaking, if there is a good dorsalis pedis, then the popliteal should be okay.

The leg should be straight - extended - and you should find the notch in the inner aspect behind the knee. While pressing firmly, you may need to slowly move your hand to the outer aspect. Pops are sometimes difficult to plapate in obese people.

[cardiacmadeline, RN]

It depends on why the patient is there. I check ulnars if their radial was harvested for a CABG, DP and PT if they are there with PVD/vascular surgery/any procedure involving a groin puncture site. I actually check DP on everyone, it is kind of a habit. If they had an amp, I check either the popliteal or femoral. Radials if they have a DVT or some kind of ortho surgery on their arm.

[brownbook]

Even though a bedside floor nurse may seldom check any pulse other than an occasional radial, as a student nurse now is the time to learn to find all the other pulse sites. Ask your instructor, (no such thing as a dumb question), or ask on this site, how do you find the ______ pulse. Now is the time, as a student, to "play" with the human body, if you have a slow day on clinicals find various pulses on your patients bodies. Listen to lung sounds, listen to heart sounds, things a busy floor nurse doesn't necessarily need to do on a daily basis, but in an emergency, it is good to know you kind of sort of remember how to do these things. Listening to "normal" lungs and hearts, finding "normal" pulses a thousand times is how you learn that "wow, that is an abnormal lung sound, heart sound, or pulse", etc. I wouldn't be surprised if your instructor wasn't just waiting for a student to say "actually I can't find the popliteal pulse," with the knowledge that the other students may just be "faking" it because it is tricky to find.

[CNL2B]

I think the answer will depend on what area of nursing and why the person is in the hospital. Where I work (OB) the only pulse we routinely check is pedal, as part of screening for DVTs, which women who have just given birth are at greater risk for.

In newborns, we also check femoral pulse.

Pedal pulses are not a screening for DVTs. You will have a pulse in your foot as long as you have adequate arterial flow. It has nothing to do with the venous system at all.

[marty6001, EdD, EMT-P, APRN]

Every patient in the hospital should have their radial/pedal pulses checked on every assessment. There are situations when the others should be checked, therefore, every nurse should know where they all are. So when I teach my students, they learn the carotid, apicap, brachial, radial, femoral, popliteal, and pedals.

Carotid pulse is necessary on the unresponsive patient where you cannot feel distal pulses to ensure they are not coding

Apical should be matched up to the radial pulse, especially in the patient with afib to ensure perfusion

Popliteal/Femoral should be checked in a patient with absent pedal pulses even prior to getting the dopplar to ensure perfusion

Radial/Pedal should be checked in every patient on every assessment. Early signs of decompensating shock are bounding/thready distal pulses to weak to absent distal pulses.

There are plenty more reasons, this is just an off the cuff response. I would argue any bedside nurse not routinely checking at distal pulses is not doing their job.

[klone, MSN, RN]

Pedal pulses are not a screening for DVTs. You will have a pulse in your foot as long as you have adequate arterial flow. It has nothing to do with the venous system at all.

Nevertheless, in postpartum women, diminished or unequal pedal pulses are often found with DVTs, and checking those pulses is something we do as part of our DVT screening.

[hearts895, RN BSN]

Maybe I'm weird lol, but I find it way, way easier to check & find a carotid pulse than a radial pulse. But for check offs in my CNA class it has to be radial pulse. Does anyone else agree with me?

[healthstar, BSN, RN]

Maybe I'm weird lol, but I find it way, way easier to check & find a carotid pulse than a radial pulse. But for check offs in my CNA class it has to be radial pulse. Does anyone else agree with me?

I can easily find radial and carotid pulse, popliteal pulse is so hard for me to find.

[shiccy]

Think about it this way - arterial blood flows distally, which is what you're palpating...

If you check for radial and dorsalis pedis and posterial tibialis, you've essentially checked without checking the others. Of course if you have a palpable DPF/PT you're going to have a fem and a pop. Ditto for radial/ulnar.

The thing that is important, however, is that you get used to feeling for a pop and a fem because when push comes to shove and you get patients that DON'T have these pulses, you need to be able to find these pulses without a doubt. ... So check and check again. Finding pulses were super hard to develop, technique wise.

As far as finding a pop, take both hands and wrap your fingers around their knee, have them kink the knee slightly with YOU holding it up. You'll never find it if they have ANY leg muscles flexed. Most times people don't know they're flexing so you have to have them relax, shake the knee a few times, and say, "No no ... no helping at all. Let your leg go limp." The pop is very important for amp patients.