![]() ![]() Proper lower extremity pulse examination techniqueĮach pulse has a specific technique that is optimal for its palpation. A Doppler can help locate the correct pulse location as well as corroborate pulse quality. If you are not sure about a pulse location or about the quality of your pulse examination, using a handheld Doppler machine can be useful. In this case the examiner should note that an aneurysm is either palpated or suspected. * – If a pulse can be palpated stronger than normal, an aneurysm may be present. 1 – A weaker than normal pulse is palpated.There are several common methods including a scale of 0-4 and a scale of 0-2. Pulse description is a recurrent theme in the vascular examination. How should lower extremity pulses be described? Figure from ‘Peripheral Vascular Disease, 1st Ed. In my opinion every adult patient should have these pulses documented at least once in their chart for baseline, and then again if lower extremity symptoms appear: Lower extremity pulses. The following few paragraphs will summarize the appropriate lower extremity pulse examination: Which pulses should be examined in the legs?įour pulses should be examined in the legs. For instance the term ‘pedal pulses intact’ may be used instead of describing which pulses exactly were palpated and what their quality was. ![]() It is even more common to see charts with inaccurate descriptions of the pulse examination. It is not uncommon to see medical charts in which only specific pulses are palpated (e.g. This allows them to identify a potential reduction of blood flow to the foot at an earlier stage than occlusion, therefore prompting earlier medical attention in the aim to prevent major complications.A vital part of the vascular physical examination is the pulse examination. Nurses have been trained to recognise differences in healthy and abnormal Doppler signals. Discussion:Īlthough most nurses were confident in their Doppler technique prior to training, on reflection recognised they were unaware of the correct location of the pedal arteries and unaware of the importance of probe angle positioning. The training is ongoing with the remaining 8 nurses scheduled to have training in the coming weeks. Outcomes:īetween March and July 2018, 17 nurses received one-to-one training and are currently completing their competency logs. To achieve a certificate of competency, a satisfactory technique and thorough understanding of the test without assistance was demonstrated. Nursing staff were provided with a competency log to document their learning. An explanation and demonstration of technique was provided by the Scientist allowing one-to-one training sessions. Recognise the Doppler pulse sound as either healthy or abnormalĪ training plan and competency assessment was developed by a Clinical Vascular Scientist.Apply an accurate technique of probe positioning to interrogate the pedal arteries,.Aim:įor cardiac nursing staff to accurately assess pedal pulses with Doppler. To ensure the accurate use of Doppler by nursing staff, the Vascular Science department were contacted to request training and assessment. Following a clinical incident where a patient suffered an occlusion, practice in our Trust has recently changed so that pedal pulses are assessed by Doppler rather than manual palpation. Post procedure patients are monitored on the ward for complications which involves assessment of the pedal arteries. Transcatheter aortic valve implantation (TAVI) requires a puncture to be made in the femoral artery. Kate Houghton 1, Jonathan Greenwood 2, Teresa Robinson 1, 1Vascular Science, Bristol Royal Infirmary, 2Coronary Care Unit, Bristol Royal Infirmary Background:
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