how do you find the fifth intercostal space on a patient who is obese?

Posted on October 22, 2009 by admin

This is for taking the apical pulse. What if you can’t find any of the landmarks?

You may not find it in the morbidly obese, but there’s a little less padding at the sternal border to find the fifth, and the apex should be down the mid-clavicular line. It isn’t uncommon, though, for the morbidly obese to have cardiomegaly, so the apex may not be where you expect, the point of maximal impulse may not be a point at all but diffuse, and it may be very hard to feel if the chest wall is especially thick.

This entry was posted in apical pulse. Bookmark the permalink.

2 Responses to how do you find the fifth intercostal space on a patient who is obese?

  1. vieve0219 says:
    October 22, 2009 at 11:49 am

    Are you trying to auscultate a certain heart tone? What is the purpose of listening at the 5th intercostal space? Start at the clavicle and I would usually start near the sternum where it’s easiest to feel. Usually on obese people it is kind of a good educated guess. So- start at the clavicle just to the right of the sternum- put your thumb right below the clavicle- and spread the rest of your fingers out a fingerwidth apart- around your pinkie should be the 5th intercostal space.
    References :
    NA in ED performing EKG’s for several years. Current RN.

  2. John de Witt says:
    October 22, 2009 at 11:56 am

    You may not find it in the morbidly obese, but there’s a little less padding at the sternal border to find the fifth, and the apex should be down the mid-clavicular line. It isn’t uncommon, though, for the morbidly obese to have cardiomegaly, so the apex may not be where you expect, the point of maximal impulse may not be a point at all but diffuse, and it may be very hard to feel if the chest wall is especially thick.
    References :