Where to take an infant's pulse

  1. I am a first year student. Can someone please tell me the best place to take an infant's pulse? Is it the brachial or apical? Also, at what age can you take a child's radial pulse? We were asked this question in class, and I just assumed you could take a child's radial pulse at any age. Any comments will be appreciated. Thanks
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  2. 12 Comments

  3. by   caliotter3
    On the job, I record the apical pulse and verify the distal pulses as present. Whether or not this is accepted practice, I do not remember precisely being told to do it this way.
  4. by   HeartsOpenWide
    Apical always for babies. Children? I don't do children...apical is most accurate, but I imagine with some children any pulse without pitching a total fit is something.
  5. by   NotReady4PrimeTime
    In a normal, healthy infant by all means record the apical pulse as it's the most accurate. PALS protocol is to assess the brachial pulse in infants. (How are you going to get an apical pulse during a resus? The brachial is easy to find and allows you to be "out of the way".)
  6. by   cjcsoon2bnp
    I work in a Peds. ED and we always do apical pulses in all of our patients (newborns - 17 year olds) and we usually just confirm for the presence of the other peripheral pulses. In a trauma situation this can be different, we follow PALS protocol.

    !Chris
  7. by   wkucu1
    In infants, I do brachial. But the most important thing is to remember to compare all four extremities to assess for an undetected heart condition in infants.
  8. by   Redhead28
    To count the pulse Apical is the most accurate. Brachial pulse can be felt from newborn up but you cannot count as accurately they are used during code situations. I can usually count a radial at about 4 depends on the child holding still.
  9. by   latebloomer74
    Any tips on how to count an apical rate in infants or small children? I find it difficult to keep count with the more rapid heart rates
  10. by   NotReady4PrimeTime
    Tap your finger the edge of the mattress. It helps focus your counting.
  11. by   tewdles
    Quote from studentkk
    Any tips on how to count an apical rate in infants or small children? I find it difficult to keep count with the more rapid heart rates
    First off, you have to be quick in peds...
    as opposed to neonatology where the patients are often quiet enough to assess, you may only have brief periods to count a pulse...think about the outpatient or clinic nurse in a well child visit. Children are not always cooperative in assessment, toddlers are tough in the outpatient setting...lol

    Do as much of your nursing exam in the mother's arms as possible...in the hospital parents should be bedside other than in critical situations.

    Of course, as others have stressed, assessing the apical heart sounds is essential in all settings but not necessarily high priority in some situations.

    If the HR is regular count for 15 sec...but be prepared to remember what number you had at 6 and 10 secs...do the math to get your hr...confirm with same process using a peripheral pulse. I prefer the brachial pulse in the outpatient setting because it is easy to perform without requiring that the child's distal extremity be restrained. You can get by with this for rate...commenting on rhythm requires a more thorough assessment requiring more time.

    I agree that tapping your finger or similar can help...
  12. by   HRM672
    I had trouble with the fast infant HR at first. With practice you'll get better. Our practice (inpatient cardiac unit) is to count apical pulse for 1 full minute and verify pulses in all extremities with initial assessment. I check central and peripheral pulses with the initial assessment. In a code or emergency I use the brachial or femoral, whichever I can get to easier.
  13. by   jknicuRN
    I have been a NICU nurse for 10yrs, from the start I have found that tapping my foot keeps me focused. Counting for a full minute for their assessment is always required so we don't have the luxury of counting for 15 seconds and multiplying by 4. For this reason, I don't count using double digits. Can't finish saying "47" in my brain before the next beat hits, so I count from 1-9 and then say "1", then 1-9 and then say "2". End up mult by 10 in the end. Works well for me. But definite foot tapping, lol, keeps me concentrated on the beat and not the fussinf or the respers.
  14. by   turnforthenurse
    Apical. Brachial for BLS/PALS standards.

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