{"id":270,"date":"2021-08-28T02:34:15","date_gmt":"2021-08-28T06:34:15","guid":{"rendered":"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/chapter\/carotid-arteries\/"},"modified":"2024-06-28T17:56:44","modified_gmt":"2024-06-28T21:56:44","slug":"carotid-arteries","status":"publish","type":"chapter","link":"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/chapter\/carotid-arteries\/","title":{"raw":"Carotid Arteries","rendered":"Carotid Arteries"},"content":{"raw":"<p style=\"text-align: left\"><span style=\"color: #000000\">Assessment of the carotid arteries involves <strong>auscultation<\/strong> followed by <strong>palpation<\/strong>. This assessment provides information about cardiac function and the quality of blood flow through the artery.<\/span><\/p>\r\n<p style=\"text-align: left\"><span style=\"color: #000000\"> Unobstructed blood flow is silent, whereas partial obstruction of blood flow (due to <strong>[pb_glossary id=\"544\"]carotid stenosis[\/pb_glossary]<\/strong>) creates turbulent blood flow, leading to vascular sounds. These sounds are called bruits: blowing\/swooshing noises. Following auscultation, if you do not hear bruits, proceed to palpating the carotid pulses. Be aware that complete obstruction of blood flow will also be silent, as there is no blood flowing through the artery.<\/span><\/p>\r\n<p style=\"text-align: left\"><span style=\"color: #000000\">This assessment is done in the seated position or in the high-fowlers position with the client looking straight ahead. Make sure they do not flex or extend their neck.<\/span><\/p>\r\n\r\n<h2 style=\"text-align: left\"><span style=\"color: #000000\">Auscultation of Carotid Arteries<\/span><\/h2>\r\n<span style=\"color: #000000\">1. <strong>Cleanse<\/strong> the stethoscope. See <strong>Video 2<\/strong>.<\/span>\r\n\r\n<span style=\"color: #000000\">2. Ask the client to breathe in, breathe out, and then <strong>hold their breath<\/strong>.<\/span>\r\n<ul>\r\n \t<li><span style=\"color: #000000\">This is important because normal tracheal breath sounds can resemble a bruit and limit the nurse\u2019s ability to hear the bruit. Note that some clients are unable to hold their breath for long: tell them to breathe if they feel they need to or if they become lightheaded.<\/span><\/li>\r\n<\/ul>\r\n<span style=\"color: #000000\">3. With light pressure, place the <strong>stethoscope\u2019s bell<\/strong> over the right carotid artery in the middle third of the neck, just medial to the sternomastoid muscle, but closer to the muscle than the trachea. This location is anatomically determined, see <strong>Figure 2<\/strong>.<\/span>\r\n<ul>\r\n \t<li><span style=\"color: #000000\">The bell should be used because vascular sounds are low-pitched.<\/span><\/li>\r\n \t<li><span style=\"color: #000000\">Usually, listening at one location on each side of the neck is sufficient. Some practitioners listen to three locations on the neck, but this is usually not needed because sound radiates. If you have concerns, you can listen to three locations on each side of the neck: at the base of the neck closer to the origin of the carotid artery; in the middle third of the neck just medial to the sternomastoid muscle, but closer to the muscle than the trachea; and inferior to the angle of the mandible.<\/span><\/li>\r\n<\/ul>\r\n<span style=\"color: #000000\">4. Repeat the steps two and three on the left carotid artery.\u00a0<\/span>\r\n\r\n<span style=\"color: #000000\">5. Note the <strong>findings<\/strong><\/span>\r\n<ul>\r\n \t<li><span style=\"color: #000000\">Normal findings might be documented as: \u201cNo carotid bruit present, bilaterally.\u201d<\/span>\r\n<ul>\r\n \t<li><span style=\"color: #000000\">NOTE: You may hear the beating of the heart because sound travels.<\/span><\/li>\r\n<\/ul>\r\n<\/li>\r\n \t<li><span style=\"color: #000000\">Abnormal findings might be documented as: \u201cCarotid artery bruit present\u201d (on left or right side or bilaterally).<\/span><\/li>\r\n<\/ul>\r\n[embed]https:\/\/youtu.be\/2DKucnJo2P4[\/embed]\r\n\r\n<strong>Video 2<\/strong>: Auscultation of the carotid arteries.\r\n\r\n&nbsp;\r\n<div class=\"textbox textbox--learning-objectives\"><header class=\"textbox__header\">\r\n<h2 class=\"textbox__title\" style=\"text-align: center\">Priorities of Care<\/h2>\r\n<\/header>\r\n<div class=\"textbox__content\">\r\n<p style=\"text-align: left\"><span style=\"color: #000000\"><strong>Do NOT<\/strong> palpate the carotid artery if you hear a bruit when auscultating the carotid arteries. A bruit can be a critical finding and is suggestive of carotid stenosis and partial obstruction of the artery. It is therefore important to not palpate (compress the artery) when the blood flow is already compromised. You should measure the client\u2019s vital signs (specifically pulse, blood pressure, oxygen saturation, respiration) and continue the cardiac assessment. Then, report your findings to the physician\/nurse practitioner.<\/span><\/p>\r\n\r\n<\/div>\r\n<\/div>\r\n<h2 style=\"text-align: left\"><span style=\"color: #000000\">Palpation of Carotid Arteries<\/span><\/h2>\r\n<span style=\"color: #000000\">1. First, if you hear a bruit when auscultating the carotid arteries, do not palpate the carotid artery. <strong>Only proceed with palpation if you do not hear a bruit.\u00a0<\/strong>See <strong>Video 3<\/strong>.<\/span>\r\n\r\n<span style=\"color: #000000\">2. Place the pads of your three fingers gently over ONE carotid artery (right or left) in the middle third of the neck, just medial to the sternomastoid muscle. Then, repeat on the opposite artery.<\/span>\r\n<ul>\r\n \t<li><span style=\"color: #000000\">Do NOT palpate the left and right carotid arteries at the same time, because this can compromise blood flow superior to the location you are palpating (the brain).<\/span><\/li>\r\n \t<li><span style=\"color: #000000\">Do NOT place the pads of your finger high on the neck, because this area is the location of the baroreceptors of the carotid sinus. These receptors are medial to the sternomastoid muscle, inferior to the angle of the jaw, and just superior to the thyroid cartilage. They play a role in mediating heart rate and blood pressure, and increased pressure on this area can lead to bradycardia and a drop in blood pressure.<\/span><\/li>\r\n<\/ul>\r\n<span style=\"color: #000000\">3. Palpate for the following:<\/span>\r\n<ul>\r\n \t<li><span style=\"color: #000000\">Force (strength of pulsation). <span style=\"text-align: initial;font-size: 1em\">Pulse force is recorded using a four-point scale:<\/span><\/span><\/li>\r\n<\/ul>\r\n<ul>\r\n \t<li style=\"list-style-type: none\">\r\n<ul>\r\n \t<li><span style=\"color: #000000\">3+ Full, bounding<\/span><\/li>\r\n \t<li><span style=\"color: #000000\">2+ Normal\/strong<\/span><\/li>\r\n \t<li><span style=\"color: #000000\">1+ Weak, diminished, thready<\/span><\/li>\r\n \t<li><span style=\"color: #000000\">0 Absent\/non-palpable<\/span><\/li>\r\n<\/ul>\r\n<\/li>\r\n<\/ul>\r\n<p style=\"padding-left: 40px\"><span style=\"color: #000000\">(Adapted from:<\/span>\u00a0<a href=\"https:\/\/pressbooks.library.ryerson.ca\/vitalsign2nd\/chapter\/what-pulse-qualities-are-assessed\/\" target=\"_blank\" rel=\"noopener\">Vital S<\/a><a href=\"https:\/\/pressbooks.library.ryerson.ca\/vitalsign2nd\/chapter\/what-pulse-qualities-are-assessed\/\" target=\"_blank\" rel=\"noopener\">ign Measurement Across the Lifespan, 2nd Canadian edition<\/a>)<\/p>\r\n\r\n<ul>\r\n \t<li style=\"text-align: left\"><span style=\"color: #000000\">Symmetry (compare force between left and right side).<\/span><\/li>\r\n \t<li style=\"text-align: left\"><span style=\"color: #000000\">Quality (describe the pulsation) in terms of the wave form. The carotid pulsation is described as a quick upstroke (one cursory\/brisk outward movement felt against your fingers) and a slow downstroke (a more gradual inward movement away from your fingers).<\/span><\/li>\r\n<\/ul>\r\n<p style=\"text-align: left\"><span style=\"color: #000000\">4. Note the <strong>findings<\/strong><\/span><\/p>\r\n\r\n<ul style=\"text-align: left\">\r\n \t<li><span style=\"color: #000000\">Normal findings may be documented as: \u201c2+ carotid pulsation equal bilaterally, smooth contour with a quick upstroke and gradual downstroke.\u201d<\/span><\/li>\r\n \t<li><span style=\"color: #000000\">Abnormal findings may be documented as (example): \u201c1+ carotid pulsation bilateral with <strong>[pb_glossary id=\"422\"]dicrotic upstroke[\/pb_glossary]<\/strong> and gradual downstroke\u201d (reduced amplitudes can be common in conditions with low stroke volume, while dicrotic upstrokes can be common with increased peripheral vascular resistance, for example in situations of heart failure).<\/span><\/li>\r\n<\/ul>\r\n<img src=\"http:\/\/pressbooks.library.ryerson.ca\/assessmentnursing\/wp-content\/uploads\/sites\/192\/2021\/09\/1.-Neck-Vessels-1024x396.png\" alt=\"A man's neck with the jugular veins, carotid arteries, muscles, trachea and clavicle drwwn on top of the body.\" width=\"600\" height=\"230\" class=\"alignnone wp-image-581\" \/>\r\n\r\n<strong>Figure 2<\/strong><span>: Carotid artery anatomy.<\/span>\r\n\r\n<span style=\"color: #000000\">Photo by<\/span> <a href=\"https:\/\/unsplash.com\/@enginakyurt\">engin akyurt<\/a> <span style=\"color: #000000\">on<\/span> <a href=\"https:\/\/unsplash.com\/\">Unsplash<\/a><span style=\"color: #000000\"> (image was cropped and illustrated upon for the purposes of this chapter)<\/span>\r\n\r\n&nbsp;\r\n\r\n[embed]https:\/\/youtu.be\/ybgCWWGxbGo[\/embed]\r\n\r\n<strong>Video 3<\/strong>: Palpation of carotid arteries.\r\n\r\n&nbsp;\r\n<p style=\"text-align: left\"><span style=\"font-family: 'Cormorant Garamond', serif;font-size: 1.602em;font-weight: bold;color: #000000\">Activity: Check Your Understanding<\/span><\/p>\r\n<p style=\"text-align: left\"><span>[h5p id=\"216\"]<\/span><\/p>","rendered":"<p style=\"text-align: left\"><span style=\"color: #000000\">Assessment of the carotid arteries involves <strong>auscultation<\/strong> followed by <strong>palpation<\/strong>. This assessment provides information about cardiac function and the quality of blood flow through the artery.<\/span><\/p>\n<p style=\"text-align: left\"><span style=\"color: #000000\"> Unobstructed blood flow is silent, whereas partial obstruction of blood flow (due to <strong><button class=\"glossary-term\" aria-describedby=\"270-544\">carotid stenosis<\/button><\/strong>) creates turbulent blood flow, leading to vascular sounds. These sounds are called bruits: blowing\/swooshing noises. Following auscultation, if you do not hear bruits, proceed to palpating the carotid pulses. Be aware that complete obstruction of blood flow will also be silent, as there is no blood flowing through the artery.<\/span><\/p>\n<p style=\"text-align: left\"><span style=\"color: #000000\">This assessment is done in the seated position or in the high-fowlers position with the client looking straight ahead. Make sure they do not flex or extend their neck.<\/span><\/p>\n<h2 style=\"text-align: left\"><span style=\"color: #000000\">Auscultation of Carotid Arteries<\/span><\/h2>\n<p><span style=\"color: #000000\">1. <strong>Cleanse<\/strong> the stethoscope. See <strong>Video 2<\/strong>.<\/span><\/p>\n<p><span style=\"color: #000000\">2. Ask the client to breathe in, breathe out, and then <strong>hold their breath<\/strong>.<\/span><\/p>\n<ul>\n<li><span style=\"color: #000000\">This is important because normal tracheal breath sounds can resemble a bruit and limit the nurse\u2019s ability to hear the bruit. Note that some clients are unable to hold their breath for long: tell them to breathe if they feel they need to or if they become lightheaded.<\/span><\/li>\n<\/ul>\n<p><span style=\"color: #000000\">3. With light pressure, place the <strong>stethoscope\u2019s bell<\/strong> over the right carotid artery in the middle third of the neck, just medial to the sternomastoid muscle, but closer to the muscle than the trachea. This location is anatomically determined, see <strong>Figure 2<\/strong>.<\/span><\/p>\n<ul>\n<li><span style=\"color: #000000\">The bell should be used because vascular sounds are low-pitched.<\/span><\/li>\n<li><span style=\"color: #000000\">Usually, listening at one location on each side of the neck is sufficient. Some practitioners listen to three locations on the neck, but this is usually not needed because sound radiates. If you have concerns, you can listen to three locations on each side of the neck: at the base of the neck closer to the origin of the carotid artery; in the middle third of the neck just medial to the sternomastoid muscle, but closer to the muscle than the trachea; and inferior to the angle of the mandible.<\/span><\/li>\n<\/ul>\n<p><span style=\"color: #000000\">4. Repeat the steps two and three on the left carotid artery.\u00a0<\/span><\/p>\n<p><span style=\"color: #000000\">5. Note the <strong>findings<\/strong><\/span><\/p>\n<ul>\n<li><span style=\"color: #000000\">Normal findings might be documented as: \u201cNo carotid bruit present, bilaterally.\u201d<\/span>\n<ul>\n<li><span style=\"color: #000000\">NOTE: You may hear the beating of the heart because sound travels.<\/span><\/li>\n<\/ul>\n<\/li>\n<li><span style=\"color: #000000\">Abnormal findings might be documented as: \u201cCarotid artery bruit present\u201d (on left or right side or bilaterally).<\/span><\/li>\n<\/ul>\n<p><iframe loading=\"lazy\" id=\"oembed-1\" title=\"Auscultation of Carotid Arteries\" width=\"500\" height=\"281\" src=\"https:\/\/www.youtube.com\/embed\/2DKucnJo2P4?feature=oembed&#38;rel=0\" frameborder=\"0\" allowfullscreen=\"allowfullscreen\"><\/iframe><\/p>\n<p><strong>Video 2<\/strong>: Auscultation of the carotid arteries.<\/p>\n<p>&nbsp;<\/p>\n<div class=\"textbox textbox--learning-objectives\">\n<header class=\"textbox__header\">\n<h2 class=\"textbox__title\" style=\"text-align: center\">Priorities of Care<\/h2>\n<\/header>\n<div class=\"textbox__content\">\n<p style=\"text-align: left\"><span style=\"color: #000000\"><strong>Do NOT<\/strong> palpate the carotid artery if you hear a bruit when auscultating the carotid arteries. A bruit can be a critical finding and is suggestive of carotid stenosis and partial obstruction of the artery. It is therefore important to not palpate (compress the artery) when the blood flow is already compromised. You should measure the client\u2019s vital signs (specifically pulse, blood pressure, oxygen saturation, respiration) and continue the cardiac assessment. Then, report your findings to the physician\/nurse practitioner.<\/span><\/p>\n<\/div>\n<\/div>\n<h2 style=\"text-align: left\"><span style=\"color: #000000\">Palpation of Carotid Arteries<\/span><\/h2>\n<p><span style=\"color: #000000\">1. First, if you hear a bruit when auscultating the carotid arteries, do not palpate the carotid artery. <strong>Only proceed with palpation if you do not hear a bruit.\u00a0<\/strong>See <strong>Video 3<\/strong>.<\/span><\/p>\n<p><span style=\"color: #000000\">2. Place the pads of your three fingers gently over ONE carotid artery (right or left) in the middle third of the neck, just medial to the sternomastoid muscle. Then, repeat on the opposite artery.<\/span><\/p>\n<ul>\n<li><span style=\"color: #000000\">Do NOT palpate the left and right carotid arteries at the same time, because this can compromise blood flow superior to the location you are palpating (the brain).<\/span><\/li>\n<li><span style=\"color: #000000\">Do NOT place the pads of your finger high on the neck, because this area is the location of the baroreceptors of the carotid sinus. These receptors are medial to the sternomastoid muscle, inferior to the angle of the jaw, and just superior to the thyroid cartilage. They play a role in mediating heart rate and blood pressure, and increased pressure on this area can lead to bradycardia and a drop in blood pressure.<\/span><\/li>\n<\/ul>\n<p><span style=\"color: #000000\">3. Palpate for the following:<\/span><\/p>\n<ul>\n<li><span style=\"color: #000000\">Force (strength of pulsation). <span style=\"text-align: initial;font-size: 1em\">Pulse force is recorded using a four-point scale:<\/span><\/span><\/li>\n<\/ul>\n<ul>\n<li style=\"list-style-type: none\">\n<ul>\n<li><span style=\"color: #000000\">3+ Full, bounding<\/span><\/li>\n<li><span style=\"color: #000000\">2+ Normal\/strong<\/span><\/li>\n<li><span style=\"color: #000000\">1+ Weak, diminished, thready<\/span><\/li>\n<li><span style=\"color: #000000\">0 Absent\/non-palpable<\/span><\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p style=\"padding-left: 40px\"><span style=\"color: #000000\">(Adapted from:<\/span>\u00a0<a href=\"https:\/\/pressbooks.library.ryerson.ca\/vitalsign2nd\/chapter\/what-pulse-qualities-are-assessed\/\" target=\"_blank\" rel=\"noopener\">Vital S<\/a><a href=\"https:\/\/pressbooks.library.ryerson.ca\/vitalsign2nd\/chapter\/what-pulse-qualities-are-assessed\/\" target=\"_blank\" rel=\"noopener\">ign Measurement Across the Lifespan, 2nd Canadian edition<\/a>)<\/p>\n<ul>\n<li style=\"text-align: left\"><span style=\"color: #000000\">Symmetry (compare force between left and right side).<\/span><\/li>\n<li style=\"text-align: left\"><span style=\"color: #000000\">Quality (describe the pulsation) in terms of the wave form. The carotid pulsation is described as a quick upstroke (one cursory\/brisk outward movement felt against your fingers) and a slow downstroke (a more gradual inward movement away from your fingers).<\/span><\/li>\n<\/ul>\n<p style=\"text-align: left\"><span style=\"color: #000000\">4. Note the <strong>findings<\/strong><\/span><\/p>\n<ul style=\"text-align: left\">\n<li><span style=\"color: #000000\">Normal findings may be documented as: \u201c2+ carotid pulsation equal bilaterally, smooth contour with a quick upstroke and gradual downstroke.\u201d<\/span><\/li>\n<li><span style=\"color: #000000\">Abnormal findings may be documented as (example): \u201c1+ carotid pulsation bilateral with <strong><button class=\"glossary-term\" aria-describedby=\"270-422\">dicrotic upstroke<\/button><\/strong> and gradual downstroke\u201d (reduced amplitudes can be common in conditions with low stroke volume, while dicrotic upstrokes can be common with increased peripheral vascular resistance, for example in situations of heart failure).<\/span><\/li>\n<\/ul>\n<p><img loading=\"lazy\" decoding=\"async\" src=\"http:\/\/pressbooks.library.ryerson.ca\/assessmentnursing\/wp-content\/uploads\/sites\/192\/2021\/09\/1.-Neck-Vessels-1024x396.png\" alt=\"A man's neck with the jugular veins, carotid arteries, muscles, trachea and clavicle drwwn on top of the body.\" width=\"600\" height=\"230\" class=\"alignnone wp-image-581\" \/><\/p>\n<p><strong>Figure 2<\/strong><span>: Carotid artery anatomy.<\/span><\/p>\n<p><span style=\"color: #000000\">Photo by<\/span> <a href=\"https:\/\/unsplash.com\/@enginakyurt\">engin akyurt<\/a> <span style=\"color: #000000\">on<\/span> <a href=\"https:\/\/unsplash.com\/\">Unsplash<\/a><span style=\"color: #000000\"> (image was cropped and illustrated upon for the purposes of this chapter)<\/span><\/p>\n<p>&nbsp;<\/p>\n<p><iframe loading=\"lazy\" id=\"oembed-2\" title=\"Palpation of Carotid Arteries\" width=\"500\" height=\"281\" src=\"https:\/\/www.youtube.com\/embed\/ybgCWWGxbGo?feature=oembed&#38;rel=0\" frameborder=\"0\" allowfullscreen=\"allowfullscreen\"><\/iframe><\/p>\n<p><strong>Video 3<\/strong>: Palpation of carotid arteries.<\/p>\n<p>&nbsp;<\/p>\n<p style=\"text-align: left\"><span style=\"font-family: 'Cormorant Garamond', serif;font-size: 1.602em;font-weight: bold;color: #000000\">Activity: Check Your Understanding<\/span><\/p>\n<p style=\"text-align: left\"><span><\/p>\n<div id=\"h5p-216\">\n<div class=\"h5p-iframe-wrapper\"><iframe id=\"h5p-iframe-216\" class=\"h5p-iframe\" data-content-id=\"216\" style=\"height:1px\" src=\"about:blank\" frameBorder=\"0\" scrolling=\"no\" title=\"Ch 4 - Carotid Arteries\"><\/iframe><\/div>\n<\/div>\n<p><\/span><\/p>\n<div class=\"glossary\"><div class=\"glossary__tooltip\" id=\"270-544\" hidden><p>is the narrowing of the carotid artery.<\/p>\n<\/div><div class=\"glossary__tooltip\" id=\"270-422\" hidden><p>is an abnormal double beat of the carotid artery.<\/p>\n<\/div><\/div>","protected":false},"author":34,"menu_order":6,"template":"","meta":{"pb_show_title":"on","pb_short_title":"","pb_subtitle":"","pb_authors":[],"pb_section_license":"cc-by-nc"},"chapter-type":[],"contributor":[72],"license":[56],"class_list":["post-270","chapter","type-chapter","status-publish","hentry","contributor-december-2021","license-cc-by-nc"],"part":260,"_links":{"self":[{"href":"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-json\/pressbooks\/v2\/chapters\/270","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-json\/pressbooks\/v2\/chapters"}],"about":[{"href":"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-json\/wp\/v2\/types\/chapter"}],"author":[{"embeddable":true,"href":"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-json\/wp\/v2\/users\/34"}],"version-history":[{"count":7,"href":"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-json\/pressbooks\/v2\/chapters\/270\/revisions"}],"predecessor-version":[{"id":2818,"href":"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-json\/pressbooks\/v2\/chapters\/270\/revisions\/2818"}],"part":[{"href":"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-json\/pressbooks\/v2\/parts\/260"}],"metadata":[{"href":"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-json\/pressbooks\/v2\/chapters\/270\/metadata\/"}],"wp:attachment":[{"href":"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-json\/wp\/v2\/media?parent=270"}],"wp:term":[{"taxonomy":"chapter-type","embeddable":true,"href":"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-json\/pressbooks\/v2\/chapter-type?post=270"},{"taxonomy":"contributor","embeddable":true,"href":"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-json\/wp\/v2\/contributor?post=270"},{"taxonomy":"license","embeddable":true,"href":"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-json\/wp\/v2\/license?post=270"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}