Assessing Radial Pulse

Assessing Radial Pulse

Equipment
■ Watch with a second hand or digital readout.
■ Pen.
■ Pencil.
■ Flowsheet or personal digital assistant.

Assessment
■ Determine why assessment of pulses is indicated.
■ Assess factors that may alter the pulse, such as activity and medications.
■ Be Smart! If the client has been recently active, wait 5 to 10 minutes before measuring.
■ Be Smart! When analyzing findings, compare pulses bilaterally.

Post-Procedure Reassessment
■ Be Safe! If pulse is not normal, observe for other indications of inadequate circulation, such as cool skin, decreased capillary refill, and bluish or ashen skin tone.
■ Complete absence of pulse requires immediate intervention.

Key Points
■ Make sure the client is resting while you assess the pulse.
■ With client sitting or supine, flex the client’s arm, and place the
client’s forearm across his chest.
■ Palpate the radial artery.
■ Place the pads of your index or middle fingers (or both) in the groove on the thumb side of the client’s wrist, over the radial artery.
■ Press lightly but firmly until you are able to feel the radial pulse. Start with light pressure to prevent occluding the pulse, and gradually increase the pressure until you feel the pulse well.
■ Note the pulse rhythm (regular, irregular). Compare bilaterally.
■ Note the quality of the pulse (bounding, strong, weak, or thready). Compare bilaterally.
■ Be Smart! Count the pulse. The first time you take the client’s pulse, count for 60 seconds. After that:
■ For a regular pulse: Count for 15 or 30 seconds and multiply by 4 or 2, respectively.
■ For an irregular pulse: Count for 60 seconds.
■ Begin timing with the count of the first beat that you feel.
■ For an admission assessment or peripheral vascular check, palpate the radial pulses on both wrists simultaneously.
■ For pedal, femoral, or temporal pulses, refer to the photos at the end of this procedure.

Documentation
■ Usually you will document the pulse rate on a flowsheet or graphic.
■ If you record it in a nursing note, document the rate, rhythm, quality, and site (e.g., “radial pulse 64 beats/min, regular, and strong bilaterally.”)
■ Provide supporting evidence (e.g., “cool, pale skin”) if you chart that pulses are decreased or absent.

Radial pulse

Pedal pulse.

Femoral pulse

Temporal pulse