Peripheral Pulses

General overview: When feeling for a pulse push lightly at first, adding pressure if there is excess subcutaneous fat. If you push too hard, you might occlude the vessel and mistake your own pulse for that of the patient. During palpation, note the following:

1. Quantity: Measure the rate of the pulse (recorded in beats per minute). If the rate is particularly slow or fast, measure for a full 60 seconds.

2. Regularity: Is the time between beats constant? If the pulse is irregular verify the rate by listening over the heart

3. Volume: Pulse volume (i.e. the subjective sense of fullness) reflects changes in stroke volume. In the setting of hypovolemia, for example, the pulse volume is relatively low (aka weak or thready).

Palpation of the pulses forms an important part of the assessment of the arterial blood supply of the lower limb. In clinical practice, this assessment may give clues about a compromised circulation, e.g.intermittent claudication. A patient with intermittent claudication may have weak or absent pulses in the lower limb. On examination the limb may be cold to the touch and cyanosed (blue) and there may be local hair loss. Gentle pressure on the toes may lead to prolonged skin blanching.

Femoral: Locate the superior border pubic symphysis. Feel the anterior limit of the iliac crest. The femoral pulse can be found midway between these two bony points (the mid-inguinal point). See figure a.

Popliteal: Gently clasp the sides of the knee and press your fingers into the popliteal fossa. The popliteal pulse is deeply placed and is thus diffuse in character and less distinctly felt. See figure b.
a. b.

Posterior Tibial: Locate the medial malleolus. 2-3cm below and behind it you should find the posterior tibial pulse. The artery is slightly deeper placed. See figure c.

Dorsalis Pedis: Located half way down the dorsum of the foot on the bony area in the line between the first and second toes. See figure d.

c. d.

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