How to perform a carotid massage

Topics overview

Vagal maneuvers are used to slow an episode of supraventricular tachycardia (SVT). These simple maneuvers stimulate the vagus nerve, sometimes causing electrical impulses to pass slowly through the heart’s atrioventricular (AV) node. Be sure to speak to your doctor before trying it.

Your doctor can show you how to safely perform these procedures. Your doctor may recommend that you perform these activities while lying on your back.

Vaginal maneuvers you can try to slow your fast heart rate include:

  • Leaning on. Resisting means that you are trying to breathe with your abdominal muscles, but you are not releasing air through your nose or mouth.
  • Apply an ice-cold, damp towel to your face.
  • Coughing or choking.

In addition to this, your doctor may occasionally try another vagus nerve maneuver (called a carotid sinus massage) in the emergency room to slow your heart rate. This technique should only be performed by a doctor.

Related information

Bibliography

Other works consulted

  • Calkins H (2011) Supraventricular tachycardia: reentry into the atrioventricular node and Wolf-Parkinson-White syndrome. W V Fuster et al., eds., Hurst’s the Heart, 13. ed., tom. 1, pp. 987-1005. New York: McGraw-Hill.
  • RL et al. (2015) 2015 ACC / AHA / HRS Guidelines for the Management of Adult Patients with Supraventricular Tachycardia: American College of Cardiology / American Society of Cardiology Report on Clinical Practice Guidelines and the Heart Rhythm Society. Circulation. DOI: 10.1161 / CIR.0000000000000311. Accessed September 23, 2015.

Credits

Current as of: August 31, 2020

Author: Healthwise Staff
Medically reviewed: Rakesh K. Pai MD, FACC – Cardiology, Electrophysiology
Martin J. Gabica MD – Family Medicine
E. Gregory Thompson MD – internal medicine
Adam Husney MD – Family Medicine
John M. Miller MD, FACC – Cardiology, Electrophysiology

Author: David Kent, LMT, NCTMB
2009-5-29

Author: David Kent, LMT, NCTMB
2009-5-29

Regardless of the method chosen and whether you are having a massage on site, a clinic, a spa or elsewhere, it is always important to be aware of the circumstances in which massage may not be beneficial to the client or when additional measures may be needed to be done. take precautions during the session.

For example: the client enters with cervical pain and limited mobility, with pain along the sternocleidomastoid muscle, as well as headache in the temporal, frontal and orbital regions corresponding to the trigger points in this muscle. In such a situation, treatment is likely to consist of working very close to the carotid artery; therefore it is very important to understand the anatomy and physiological responses of the body in this region to ensure positive results.

In this article, I will discuss two conditions that require special care when working around the carotid artery: plaque buildup in the carotid artery and a condition known as carotid sinus hypersensitivity (CSH).

Plate

Plate is made up of fat, cholesterol, calcium and other materials found in the blood. Over time, the plaque hardens and then clogs the arteries, reducing blood flow through the arteries to the heart and brain. This is called atherosclerosis.

In my whole body seminars, I always remove part of the carotid artery; then I cut and peeled the artery wall to expose the plaque “tubes” that line the artery. This tube looks like a primitive shaped plastic straw that is thicker in some places than others. When squeezed, the tube makes a snap and snap similar to a piece of plastic breaking. I show it to my students so that they understand why it is important to palpate carefully and avoid contact with the carotid artery during the massage. Palpation of an artery in which significant plaque has accumulated can pose a serious risk to the client. In the worst case, a piece of plaque can rupture the artery, travel to the brain, and cause a stroke.

Using the correct intake forms can help you identify clients at risk for plaque buildup. Admission forms should ask for information about previous surgeries, medical conditions, and prescription medications. Some procedures to look out for include carotid endarterectomy – a surgical procedure to clear the carotid artery and restore blood flow to the brain. Other related procedures include coronary artery bypass grafting, stinting, or angioplasty. Blood clots are also associated with plaque buildup, so be sure to look for medications that contain blood thinners and blood thinners.

When red flags appear, heed the warnings, even if the client claims they have received a massage previously. In these cases, I will not proceed without a prescription for a massage from a physician who is currently treating the client’s condition. It is a safety for everyone involved and most patients will thank you for your care and professionalism.

If you don’t understand something the customer wrote on the claim form, check it before proceeding. For example, some customers use acronyms to describe their terms; however, it is important not to assume that you know what the acronym means. CSH is one of these acronyms that has many meanings.

Carotid sinus hypersensitivity (CSH)

The carotid sinus plays a key role in regulating blood flow to the brain. Contains baroreceptors sensitive to changes in blood pressure. It is part of the internal carotid artery just after it exits the common carotid artery, located just above the upper edge of the thyroid cartilage (Adam’s apple) at level C3. It is a fascia attached to the sternocleidomastoid muscle (Look at the picture)

Carotid sinus hypersensitivity is an exaggerated response to stimulation of the carotid sinus baroreceptors. Massaging the carotid sinus stimulates nerve endings, which can slow the heart rate. CSH is the most common reported cause of falls and fainting (syncope) in people over the age of 65.

In a study of 1,000 people with no history of syncope, dizziness, or falls, participants received a carotid massage lasting an average of 7.3 seconds while lying down and standing with heart rhythm monitoring. The study found that 39% of the participants had some form of carotid sinus sensitivity; 24% had asystole (no heartbeat) for three seconds or more; and 16% had symptoms including syncope with carotid sinus hypersensitivity. 1

In rare cases, only 1% of patients present with spontaneous carotid sinus syndrome: a situation in which symptoms can clearly be attributed to a history of accidental mechanical manipulation of the carotid sinuses, such as measuring a pulse in the neck or shaving. Therefore, it is imperative that massage therapists are aware of the potential physiological effects during treatment in this region.

Provide a safe and effective massage

There are several ways to ensure safe and effective massage therapy:

  • Use admission forms to check clients’ potential risks before undergoing therapy. Make sure your forms are updated regularly, especially if you haven’t seen the customer for several months. Regularly review your client’s health history. Routinely ask if they are under medical supervision.
  • Explain the meaning of acronyms.
  • Search for strangers before continuing.
  • Use resources such as the Internet, textbooks, medical books, and medical dictionaries to find information.
  • Educate your clients using postural analysis photos and trigger point charts to illustrate problem areas.
  • Do muscle tests to make sure you’re working on the right muscle and avoid critical structures like the carotid artery and carotid sinus.
  • Integrate orthopedic assessments.
  • Continue to broaden your knowledge by investing in DVD programs and other lifelong learning programs that analyze details such as anatomy, contraindications, precautions, trigger points, safe therapy techniques, etc.
  • Attend live seminars to continually refine and refine your practical techniques and strengthen your anatomy.

I am a family doctor.September 15, 1998; 58 (4): 966.

Carotid sinus massage is recommended in the routine examination of all elderly patients suffering from unexplained fainting, dizziness, or falls. 23% of unexplained falls are attributed to carotid sinus hypersensitivity, an abnormal response to carotid sinus massage characterized by a significant slowing of heart rate (more than three seconds asystole; cardioinhibitor type), a decrease in systolic blood pressure (plus of 50 mmHg; vasodepressor type) or a combination of both (mixed hypersensitivity of the carotid sinus) The massage technique involves applying longitudinal digital pressure to the bifurcation of the internal and external carotid arteries for five seconds. This procedure is applied first on the right and then after 120 seconds on the left. It is performed using a tilting table with the patient supine and tilted up to 70 degrees. The risk of carotid sinus sensitivity increases with age. Davies and Kenny present data on the incidence of neurological and cardiac complications of carotid sinus massage in a large cohort of elderly patients evaluated for syncope or falls.

A total of 4,000 patients were evaluated using the previously described technique. Contraindication to carotid sinus massage is the presence of carotid murmur, stroke or myocardial infarction within the last six months and a history of severe cardiac arrhythmias, ventricular tachycardia, or ventricular fibrillation.

During the study, 11 patients had neurological complications and none of the patients had heart complications. Of the patients who developed neurological complications, 10 developed hemiparesis, three developed expressive dysphasia, and one developed hemianopia. Complications occurred within five minutes of the massage in five patients and 10 minutes, 30 minutes and two hours after the massage in the remaining patients. Computed tomography of the head revealed new brain changes in only two patients. Nine patients underwent Doppler ultrasound of the carotid arteries; two patients showed contralateral diameter shrinkage of over 70% and two other patients showed contralateral diameter shrinkage of over 30%. Seven of the 11 patients had carotid sinus hypersensitivity. All had a significant vasodepressive response and one had a circulatory inhibitory response. Nine patients recovered completely and seven of them recovered within 24 hours. Two patients made a full recovery within one month. Hemiparesis persisted in two patients.

The authors concluded that the incidence of neurological complications after carotid sinus massage is low (0.28%) and that most patients recover to full fitness.

Can I, as an RN, perform massages for my clients without an additional CMT license? When I was in school, massage was part of our training and every patient was also expected to have a massage every night as she got ready for bed. How does this affect my private holistic practice?

Nancy Brent replies:

Nursing practice has changed considerably during the past several years, both in terms of the addition of patient care responsibilities that once were seen as only belonging to medicine (e. g., APNs prescribing medications and treatments) and in terms of some patient care responsibilities being “transferred” to other healthcare practitioners. In addition to the example in your question, nurses used to perform respiratory therapy treatments for patients.

Nursing has also introduced additional models of care, including holistic nursing. Additionally, private practice is something many nurses have never had the opportunity to consider.

What is important to evaluate after a transfer of what was once part of nursing practice but is now part of another healthcare provider’s practice is whether the transfer became an “exclusive” one or not. Your state legislature may have granted certified massage therapists the “exclusive” right to do massage therapy. Or, the massage law may provide an exception to allow other providers, such as nurses, to perform massages without the license required by the massage law.

For specific opinions about your holistic nursing practice and the role massage can play in it, consult a legal nurse or attorney in your state who is familiar with the law and understands nursing and massage therapy.

Nancy J. Brent, RN, MS, JD, is a private attorney based in Wilmette, Illinois. This information is for educational purposes only and does not constitute legal or other advice. The reader is encouraged to seek the advice of a lawyer or other professional whenever an opinion is sought.

While the wrong maneuvers may seem easy, they carry risks. And they’re not safe for everyone. You should only do them when your doctor has told you when and how.

Carotid massage can cause a stroke, especially if you’re older or you’ve had a stroke in the last 3 months. It can also be more risky for children. That’s why it’s best left to your doctor.

Reviewed by Nayana Ambardekar on June 14, 2020.

American Heart Association: "Nodo atrioventricolare", "Tachicardia / Polso rapido", "Difetti cardiaci congeniti ed esercizio".

Mayo Clinic: "Tachicardia: sintomi e cause".

Società per l’angiografia e gli interventi cardiovascolari: "Sfida del secchiello del ghiaccio – Per il cuore?"

Cleveland Clinic Wellness: "Cosa sta succedendo a Vagus".

Clinica Chirurgica UCSF: "Aritmie".

Stanford Healthcare: "Trattare la manovra sbagliata".

Medico di famiglia americano: "Gestione delle aritmie cardiache comuni: parte I. Aritmie sopraventricolari", "Massaggio del seno carotideo nei pazienti anziani".

UpToDate: "manovre di peso".

American Heart Association: "Nodo atrioventricolare", "Tachicardia / Polso rapido", "Difetti cardiaci congeniti ed esercizio".

Mayo Clinic: "Tachicardia: sintomi e cause".

Società per l’angiografia e gli interventi cardiovascolari: "Sfida del secchiello del ghiaccio – Per il cuore?"

Cleveland Clinic Wellness: "Cosa sta succedendo a Vagus".

Clinica Chirurgica UCSF: "Aritmie".

Stanford Healthcare: "Trattare la manovra sbagliata".

Medico di famiglia americano: "Gestione delle aritmie cardiache comuni: parte I. Aritmie sopraventricolari", "Massaggio del seno carotideo nei pazienti anziani".

UpToDate: "manovre di peso".

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THIS INSTRUMENT DOES NOT PROVIDE MEDICAL ADVICE. It is intended for general information purposes only and does not concern individual circumstances. It is not a substitute for professional medical advice, diagnosis or treatment and should not be trusted when making decisions about your health. Never ignore professional medical advice when seeking treatment because of something you have read on the WebMD site. If you think you have a medical emergency, call your doctor right away or call the emergency health services.

Can I, as an RN, perform massages for my clients without an additional CMT license? When I was in school, massage was part of our training and every patient was also expected to have a massage every night as she got ready for bed. How does this affect my private holistic practice?

Nancy Brent replies:

Nursing practice has changed considerably during the past several years, both in terms of the addition of patient care responsibilities that once were seen as only belonging to medicine (e. g., APNs prescribing medications and treatments) and in terms of some patient care responsibilities being “transferred” to other healthcare practitioners. In addition to the example in your question, nurses used to perform respiratory therapy treatments for patients.

Nursing has also introduced additional models of care, including holistic nursing. Additionally, private practice is something many nurses have never had the opportunity to consider.

What is important to evaluate after a transfer of what was once part of nursing practice but is now part of another healthcare provider’s practice is whether the transfer became an “exclusive” one or not. Your state legislature may have granted certified massage therapists the “exclusive” right to do massage therapy. Or, the massage law may provide an exception to allow other providers, such as nurses, to perform massages without the license required by the massage law.

For specific opinions about your holistic nursing practice and the role massage can play in it, consult a legal nurse or attorney in your state who is familiar with the law and understands nursing and massage therapy.

Nancy J. Brent, RN, MS, JD, is a private attorney based in Wilmette, Illinois. This information is for educational purposes only and does not constitute legal or other advice. The reader is encouraged to seek the advice of a lawyer or other professional whenever an opinion is sought.

Eliminate blood pressure in 5 minutes with this simple technique

The carotid sinus is a blood vessel in the neck just below the jaw. In this article, the area larger than the rest of a blood vessel is called the sinus. For many years, people suffering from hypertension have used carotid sinus massage to eliminate hypertension.

Method: Zakończenia nerwowe znajdujące się w tętnicy, delikatnie pocierając zatokę szyjną, reagują na zmianę ciśnienia i z kolei spowalniają tętno. It is used primarily for the treatment of carotid sinus syncope and should be the first line of treatment provided the patient is haemodynamically stable.

History of carotid sinus hypersensitivity

There are three types of CSH:

inhibiting circulation

This is about 70 to 75 percent of cases. This is mainly associated with a decrease in heart rate, which leads to sinus bradycardia. This type of response can be eliminated by the use of atropine.

vasodepressor

This is about 5-10 percent of cases. Doctors notice a significant drop in blood pressure without changing heart rate, this is mainly due to a change in the balance in the peripheral blood vessels. This type of response cannot be eliminated with atropine.

Mixed type

This is 20 to 25 percent of the time. Doctors are able to notice a drop in heart rate during the onset of vasomotor tone.

How carotid sinus massage is performed

First of all, the doctor should monitor the patient’s blood pressure at least five to ten minutes before starting the procedure and should record the baseline diastolic and systolic blood pressure.

Since this is a potentially dangerous procedure, doctors usually perform it under conditions that take the sensitivity of the test into account. For example, a massage table would be tilted 70 degrees. The explanation of the possible side effects to the patient and the control of contraindications should be done before the announcement.

The doctor asked the patient to relax and lie on his back, stretching his neck and turning his head so that the rubbed side was facing up. The patient will also be connected to a heart rate monitor to monitor heart rate. The massage can be performed when the patient is in this position for five minutes. He imagines a horizontal line starting about an inch and a half below the earlobe. He places the tips of his index and middle fingers here. Applying the amount of pressure you would use to push a tennis ball in, massage the area counterclockwise. Identify the cervical sinus and gently massage with constant pressure as you move in a circular motion for 5-10 seconds. Repeat this procedure for the other side.

Having a heart monitor with printing devices, such as a Portapres device, is very necessary because when the blood pressure drops, it would not be detectable by the normal method.

Contraindications

Therapeutic carotid sinus massage should be avoided at all costs if the patient has suffered a stroke, myocardial infarction, or transient ischemic attack in the last three months prior to the massage. This also applies to patients who have previously had a bad reaction to a carotid sinus massage.

Care should be taken in the presence of carotid sinus, although this should be confirmed by Doppler ultrasound; the physician should explain the risks and benefits of massage to the patient. After surgery, the patient should be observed lying down for 10 minutes before discharge.

Application

Medical practice has changed in recent years. Doctors have found that taking midodrin increases blood pressure and causes arteries to narrow. The use of this therapeutic massage has been accepted and accepted by society.

Why do nurses practice massage? Massage can aid in healing and make you feel better. According to a survey by the American Massage Therapy Association (AMTA), 43% of the population underwent the most recent massage for medical reasons (https: // www. Amtamassage. Org / career_guidance / detail / 193? TypeId = 10)

AMTA indicates numerous studies that have shown improvement in symptoms. The effects go beyond relieving sore muscles. Massage can lower blood pressure and improve cardiovascular health (https: // www. Amtamassage. Org / research / Massage-Therapy-Research-Roundup / Research-Roundup – Cardiovascular-Health – Massage. Html) A 2013 study found found a reduction in fatigue in cancer patients (https: // www. amtamassage. org / articles / 1 / News / detail / 3257) When there is no cure, massage can give a greater sense of well-being. Among those who may feel comfortable are hospice patients at the end of their life.

Nurses generally respond to therapies that promote well-being, even when this is difficult to quantify. Noreen Frisch, PhD and RN, notes that nursing is, in essence, a holistic discipline (http: // nursingworld. Org / MainMenuCategories / ANAMarketplace / ANAPriodicals / OJIN / TableofContents / Volume62001 / No2May01 / AlternativeComplementaryModalities. Html)

The Louisiana State Board of Nursing noted in a statement on complementary therapies a long history of massage use in healthcare, a history dating back to 1815 (http: // www. Lsbn. State. La. Us /) L art of massage, a practical manual for nurses, students and doctors was written in 1895.

Nurses today are seizing an opportunity that their predecessors often did not have: the opportunity to get formal education and training in massage.

The scope of practical matters

In many cases, nurses are allowed to perform certain massages. Details vary by state. In some cases, a distinction can be made between a relaxing massage and a more targeted therapy. Several issues arise, including limitations on practice, informed consent requirements, and adherence to written guidelines. The Louisiana board of directors said an RN can provide massage as part of a care plan for purposes such as pain relief or stress relief. The New Hampshire Board has stated that massage, as a nursing intervention, is within the scope of registered nurses, licensed practical nurses, and licensed nursing assistants if they have the competency, and if the intervention is performed as part of a care plan (http://www. nh. gov/nursing/faq/reiki. htm) The Oregon Board has stated that it may be within a nurse’s scope of practice to provide massage as an element of care within a broader plan of care (https://www. oregon. gov/osbn/Documents/IS_ComplementaryModalities. pdf)

Studying massage as a discipline

Regulations and policies are subject to change. But whatever theoretically may be in a nurse’s scope of practice, one is limited by one’s own competency. The Oregon Board notes that with complementary modalities, it is important to understand theoretical underpinnings, practical applications, and risks — and to be able to document competency if it’s called into question.

The training acquired in the nursing program can be minimal, especially if the nurse has not studied at the university level. Most people know how to perform a simple back or shoulder rub, but they don’t know how to use massage to its full healing potential. Massage therapists typically have 600 hours or more of initial training; this includes concepts such as indications and contraindications, as well as tips on how to use specific modalities. Techniques used to decrease agitation in Alzheimer’s patients might be relatively simple. However, the techniques used to relieve symptoms in other conditions are difficult to master. Massage is a separate discipline. Qualified and licensed massage therapists continue their training in their areas of specialization and may eventually have significantly longer hours than required to obtain a license.

Forging new career paths

Becoming an RN requires more formal education than a massage therapist. However, this doesn’t mean that a career in massage is a step backwards. Sometimes experienced healthcare professionals become leaders in integrating massage into medical / medical facilities. Those who undertake an independent practice can also benefit from double training. Massage therapy is an area where many people do business for themselves, but the levels of success and earnings vary widely.