During the nursing head-to-toe assessment the nurse will assess the carotid artery and vessels of the neck for distention.
This assessment is particularly important in middle-aged to older adults, especially those who have a history of cardiac disease.
The nurse assesses for a bruit which can be a sign of atherosclerotic narrowing, the amplitude/contour of the carotid artery, and for external jugular distention.
This article will highlight:
- How to auscultate the carotid artery
- What a carotid bruit sounds like
- How to palpate the carotid artery
- How to assess for distention of the neck vessels
Video Demonstration on How to Assess the Carotid Artery & Neck Vessels
Auscultating the Carotid Artery
Goal: Assess for a Carotid Bruit
What does a carotid bruit sound like? It is a turbulence of blood flow which sounds like a blowing or swishing noise
- Auscultate with the bell of the stethoscope
- Use the bell to listen at the following three positions:
- Angle of the Jaw
- Mid-cervical area
- Base of the Neck
- Press lightly so you don’t create a false bruit or compromise circulation
- Have the patient take a breath and exhale and hold it for a second while you listen. This prevents you from hearing breath sounds.
- Then compare sides.
Palpating the Carotid Artery
- Feel on one side at a time and lightly palpate. This prevents too much pressure on the carotid sinus area. If too much pressure is applied to this area you could cause vagal stimulation (which is more likely to happen in older adults). Vagal stimulation will cause the heart rate to slow down.
- Therefore, palpate on the lower half of the neck to avoid the carotid sinus area.
- Find the trachea and sternocleidomastoid muscle…in the groove of these two locations you will find the carotid artery.
- Use your index finger and middle finger (avoid using the thumb)
- Note the carotid artery’s amplitude and contour. You should feel a smooth, rapid upstroke with a slower downstroke.
- Grade the carotid artery pulsation:
- 4+ or 3+: bounding
- 2+: NORMAL
- 1+: diminished
How to Assess the External Jugular for Distention
This assessment will look for increased central venous pressure. Increase central venous pressure may be present in patients with congestive heart failure, fluid volume overload, cardiac tamponade, pulmonary hypertension etc.
- Place the patient at a 45 degree angle in the supine positon
- Have the patient turn their head to the left…so you can assess the right side
- Find the sternomastoid muscle where the external jugular vessel rests
- Note if the vessel is bulging or large (watch the video to see an abnormal finding of the external jugular vessel)
- Normal: it is flat or slightly noticeable