Taking vitals - what to do when you can't feel radial pulse?

[newuser321]

Hi guys! I just started a job as a CNA at a nursing home. I've had to take vitals a few times and there are a few residents that I've had a lot of trouble finding a radial pulse on. What do you do in this situation? I tried finding the carotid pulse on one resident but I couldn't find that either!!

I ended up using an electronic wrist BP cuff that one of my coworker CNAs brings from home and I got the heart rate that way but I'm wondering what to do if I don't have one of those available! I know some people have a really hard to find radial pulse - including myself. Most people can't feel mine.

Also - how do you take a BP on someone whose arms are contracted and cannot be moved from the side of their body and cannot be straightened? Once again, I used the electronic wrist BP cuff on this resident but my nurse said those are not as accurate as the manual cuffs so I shouldn't use them. She said that in general before I took any vitals. Maybe I should ask her what I should do for this resident next time.

Thank you for any tips and advice!

[JollyGreenGiant]

I guess I got off topic a little. I'm glad you are taking your time and trying to learn the best way to get accurate vitals on patients. Just keep practicing it gets easier.

[newuser321]

Your facility is legally obligated to provide you with the equipment you need to do your job. You shouldn't have to bring in your own equipment.

It actually puts you in a funny spot because the equipment you bring in is not approved by the company. If a surveyor were to see you using that equipment it could be an issue.

You make a great point. I'll have to give it some thought and ask around more. It seems like nobody likes to do vitals the real way. The CNA who trained me never even does respirations, he just writes down numbers for it...

[BuckyBadgerRN, ASN, RN]

I WISH CNA's could do vitals where I work =(

[shasbus]

Check if they are breathing first?

[Princess Bubblegum]

For the patients with contracted arms, can you take their BP on their calf or thigh? Document the location you used to check the BP.

Sometimes the HR displayed on the automatic BP cuffs or SpO2 sensors can be thrown off by a-fib/PVCs/other things so I really prefer to check pulses manually or by listening. I taught myself to listen for pulses by practicing on my cats. It's not easy. They purr, they squirm, and their heart rates are really high at rest. Once I mastered that, human patients were a piece of cake.

[stephatron289]

Perhaps next time you have to take this particular patient's pulse, ask the nurse for a quick aside to see if she can feel it. If she can, ask for her to show you (or ask another CNA). Practice, practice, practice! When I started as a CNA, I had a heck of a time getting blood pressures, because I could never hear them. I practiced on everyone I could get my hands on, until I figured out a few things I had been doing wrong and a few tricks that I learned from my instructors. Now, 3 years later, since I have to do it on 30 patients a day at the clinic, I have it down pat. I like to use my manual cuff and stopwatch instead of the machines, because I'm afraid if I don't practice, I'll forget!

[vintagemother, BSN, CNA, LVN, RN]

Practice. Practice. When I was a CNA, I practiced taking pulse and BP measurements on everyone around me--my kids, my ex husband, my nieces and nephews, my mom, etc. with practice, you'll get it.

As far as bringing equipment that you bought: I did this. No nurse mgr had a problem with it. I bought my own electronic BP cuff when I was a CNA and LVN student.

I currently use my own BP cuff and stethoscope.

Some facilities simply don't have enough supplies.

[chris21sn, BSN, RN]

If I can offer a cheat trick that I do: I usually wrap the palm of my hand on the side of their hand that is opposite to their pulse. I wrap my hand around their wrist, almost in a squeeze. Then, with my first two fingers press down, feel for the pulse, (don't reposition your fingers or anything) and it's almost 99% on that exact spot.

And if that really doesn't work, placing your stetoscope on their apical pulse (left side, just above their nipple) and counting for 30 seconds, and then multiplying by 2, will give you the same value.

Hoped, I could help :)

[NurseGirl525, ASN, RN]

It just takes lots of practice. I have always taken my own BP cuff and stethoscope. Companies buy the cheap ones and I cannot tell jack with those things. Radial pulses can be difficult on the elderly. Since their thirst and hunger senses are diminished, they often do not drink enough and that can affect the strength of pulses. I can almost always get a temporal pulse on anyone. You may just be pushing too hard. That was often my problem in the beginning. Pedal pulse are the hardest for me. I practiced at home a lot on my son and boyfriend. It is now easier for me to find. But if you are in a jam for time, try the temporal.

Don't worry, it will come in time.