Anatomical Background for Vessel Punctures

The word palpation comes from the Latin word palpatio, onis - to feel. This is the name given to one of the basic examinations carried out by a doctor - the palpation examination. During the examination we look for the pulsing of arteries.

Although there are a huge number of blood vessels on the neck, and especially on the face, only some of them can be really palpated. This topic is definitely linked to first aid treatment for massive bleeding, so it is a good idea to remember not only the passages of the blood vessels, but also their pressure points. Arteries can generally be palpated when they run superficially and aren't obstructed by big muscles, like in the cubital fossa, on the neck, in the popliteal fossa.

A pressure point is a place where we can press the artery against a hard surface (bone, cartilage) and thus significantly reduce or even stop arterial bleeding.

Palpation

The common carotid artery can be palpated against the anterior tubercle of the sixth cervical vertebra - this formation has acquired a special name - carotid tubercle. Palpation is performed by finding the cricoid cartilage. Move the finger laterally and lightly push. Never perform on both sides of the neck at the same time!

The common carotid artery continues upwards to the carotid triangle, where it divides into the internal carotid artery (has no branches in the neck) and the external carotid artery (has 8 branches), which is another artery we can palpate.

We palpate the external carotid artery at the level of gonial angle, by lightly pressing our fingers on the fossa behind the mandible

Facial artery is the third branch of external carotid artery, it runs into the submandibular triangle and passes over the mandible just before the edge of the masseter. At this point we can press the artery against the mandible.

Palpation points

Superficial temporal artery is the terminal branch of the external carotid artery. It passes in front of the auricle, where we can also palpate it at the level of the external acoustic meatus. (but also above).

• Brachial artery is palpatable in the cubital fossa.
• Radial artery is palpatable on the the ventral lateral side of the wrist.
• Popliteal artery is palpatable in the popliteal fossa.
• Posterior tibial artery can be palpated behind the medial malleolus of the ankle.
• A. Dorsalis pedis can be palpated on the dorsal side of the foot

Pressure points

Cervical pressure point is located at the level of the thyroid cartilage at the edge of the sternocleidomastoideus. Here we can compress the artery against the cartilage.

The temporal point is located at the palpation of the superficial temporal artery. We can squeeze both points at the same time.

In case of bleeding from a finger we should squeeze the sides of it due to the location of proper digital arteries.

In case of lower limb arterial bleeding we should apply pressure at the level of femoral triangle.

In case of upper limb arterial bleeding we should apply pressure either at the the interscalene triangle to compress the subclavian artery or on the medial side of the biceps to compress the brachial artery halfway between the shoulder and the elbow.

Vessel punctures

PICC line

In order to administer medication or perform diagnostic tests we often require access to the bloodstream of the patient. To do that we utilize intravenous cannulas or even arterial access. We want to minimize the damage we do while securing the access therefore we choose points where veins or arteries are very superficial. Common points include the dorsal hand for the dorsal venous palmar arch or the cubital fossa. In some cases we also use the dorsal arch of the foot, the small saphenous vein posteriorly to the shin or the superficial temporal vein. The chosen location depends on the state of the patient, in cases where patient suffered burns on a big portion of their body we choose an unaffected site.

Used literature

• ČIHÁK, Radomír. Anatomie I. 2. vydání. Praha : Grada, 2001. 516 s. ISBN 978-80-7169-970-5.

• ČIHÁK, Radomír a Miloš GRIM. Anatomie 3. 2., upr. a dopl vydání. Praha : Grada, 2004. 673 s. sv. 3. ISBN 80-247-1132-X.

• ELIŠKOVÁ, Miloslava a Ondřej NAŇKA. Přehled anatomie. 1. vydání. Praha : Karolinum, 2006. 309 s. ISBN 80-246-1216-X.