Learning from Experience and sharing knowledge: Doppler training for nurses to improve pedal pulse assessments

Kate Houghton1, Jonathan Greenwood2, Teresa Robinson1, 1Vascular Science, Bristol Royal Infirmary, 2Coronary Care Unit, Bristol Royal Infirmary


Transcatheter aortic valve implantation (TAVI) requires a puncture to be made in the femoral artery. Post procedure patients are monitored on the ward for complications which involves assessment of the pedal arteries. 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. To ensure the accurate use of Doppler by nursing staff, the Vascular Science department were contacted to request training and assessment.


For cardiac nursing staff to accurately assess pedal pulses with Doppler.


  • Locate three pedal arteries,
  • Apply an accurate technique of probe positioning to interrogate the pedal arteries,
  • Recognise the Doppler pulse sound as either healthy or abnormal


A training plan and competency assessment was developed by a Clinical Vascular Scientist. An explanation and demonstration of technique was provided by the Scientist allowing one-to-one training sessions. Nursing staff were provided with a competency log to document their learning. To achieve a certificate of competency, a satisfactory technique and thorough understanding of the test without assistance was demonstrated.


Between March and July 2018, 17 nurses received one-to-one training and are currently completing their competency logs. The training is ongoing with the remaining 8 nurses scheduled to have training in the coming weeks.


Although 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. Nurses have been trained to recognise differences in healthy and abnormal Doppler signals. 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.

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