Perform a Carotid Massage

A carotid massage, often called a carotid sinus massage or CSM, is a medical maneuver used to slow down a dangerously rapid heartbeat in patients. Medical professionals can also use a CSM to investigate a patient’s inconsistent blood pressure, and other potentially serious symptoms. To perform a carotid massage, you’ll need to massage the area at the base of the patient’s neck, where the carotid artery enters the head. The carotid artery carries blood to the brain, and an incorrectly performed CSM can cause serious health repercussions, especially in elderly patients. Do not perform this maneuver on yourself or another person unless you are a physician or have been directed to do so by a physician.

Steps

Preparing the Patient

1. Ask the patient to lie on their back. For safety purposes, a CSM should only be performed on a reclining patient. If you’re in a medical office, you can ask the patient to lie on an examination bed. If you’re performing the CSM at someone’s home, ask the patient to lie on a couch or bed.
   • It’s important that the patient be lying down, in case they experience any lightheadedness or loss of consciousness (unlikely but possible) from the CSM.
2. Place an electrocardiograph (ECG) on the patient. This medical tool will monitor the electrical activity of the patient’s heart while the CSM is administered. Since the CSM is primarily a diagnostic measure, the ECG is valuable in determining the cause of the patient’s dizziness, falls, faints, or other unusual mishaps related to abnormal heart activity.
   • Even if you’re performing a CSM to reduce a patient’s excessively rapid heartbeat (super ventricular tachycardia, or SVT), you should still monitor the heart’s electrical activity via ECG.
3. Monitor the patient’s blood pressure. A correctly performed CSM will yield information about a patient’s heart rate and blood pressure, and may also correct an ongoing accelerated heart rate. Record the patient’s systolic and diastolic blood pressure after each massage. If you find that the patient’s heart rate or blood pressure are increasing, stop performing the CSM.
   • Once the patient has lain down, and you have applied the ECG and began monitoring blood pressure, wait about five minutes before beginning the procedure. This will allow the patient’s heart to slow to a resting rate.

Performing the Massage

1. Find the carotid sinus massage point. There are two carotid sinuses, and you’ll need to perform a CSM on each. The carotid sinus is located in the patient’s neck. Find the front mid-point of the patient’s neck (near their Adam’s apple), and identify the angle of the patient’s jaw. Then trace your finger around the side of the patient’s neck, until it’s directly below the angle of their jaw. Your finger should be resting on the patient’s carotid sinus.
   • The angle of the jaw should be the location at which their jawbone bends, about 4 inches (10 centimeters) back from the tip of their chin.
   • The second carotid sinus will be located in the identical position on the other side of the patient’s neck.
2. Massage the right carotid sinus for 5–10 seconds. A CSM is usually first performed on the right side of a patient’s neck. Press firmly on the patient’s carotid sinus massage point. Using a circular motion, rub and massage the carotid sinus for a period of 5–10 seconds.
   • Avoid pressing too hard, or you may risk reducing the flow of oxygen to the patient’s brain. As a rule of thumb, use the amount of pressure that you would need to indent the surface of a tennis ball.
3. Massage the patient’s left carotid sinus. After performing the carotid massage on the right side of a patient’s neck, repeat the massage on the patient’s left carotid sinus. Massage in a circular motion for 5–10 seconds.
   • After each portion of the CSM has been administered, you or a medical assistant should record the patient’s heart rate and baseline systolic and diastolic blood pressure.
4. Direct the patient to lay still for 10 minutes. Following the completion of the CSM, the patient may experience some light headedness, or may feel mildly dizzy. Ask them to continue lying supine for another 10 minutes. This will allow their heart rate to return to regular (if it was abnormally high to begin with) and will allow a healthy level of oxygen to return to their brain.

Discontinuing the Massage

1. Stop performing a CSM if the ECG shows asystole. Asystole is a serious form of cardiac arrest (heart attack) which may be caused by the CSM. If the ECG monitor shows asystole for over 3 seconds, stop performing the maneuver immediately.
   • If the patient’s cardiac arrest continues once you’ve stopped administering the CSM, you may need to begin performing live-saving measures.
2. Stop the CSM if the patient faints. If the patient loses consciousness in any way while you’re performing a CSM—even if it’s only for a brief period—stop administering the massage. You or a medical assistant should record that the patient experienced syncope (loss of consciousness) or pre-syncope (dizziness or lightheadedness immediately preceding unconsciousness).
   • If you’re performing the CSM for diagnostic purposes, ask the patient if the lightheadedness or fainting that they just experienced is similar to other symptoms they commonly experience.
3. Do not administer CSM to patients with carotid sinus hypersensitivity. Patients with carotid sinus hypersensitivity, or CSH, are acutely sensitive to pressure on their carotid sinus. This condition most commonly afflicts men older than 50, although women over 50 can experience CSH as well. Administering a CSM to a patient with CSH can lead to cardiac arrest or other serious heart and blood-pressure conditions.
   • Ask your patient if a physician has diagnosed them with CSH, or if they have ever had a negative reaction to—or lost consciousness during—a carotid sinus massage.

Tips

• The Carotid Artery Massage is one of a number of medical procedures called “Vagal maneuvers.” Vagal maneuvers stimulate the vagus nerve (located along the side of the head) and prompt it to release chemicals which slow a patient’s heart rate.

Warnings

• The massage can cause a stroke in elderly patients (due to a loss of oxygen to the brain). Consequently, a CSM should only be performed in a medical facility with resuscitation facilities.
• Do not perform a CSM in a primary care medical office, unless the office contains full resuscitation facilities.

Sources and Citations

See also

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