Apical Pulse Rate

[healthstar]

Do you use place your hand at the left 5th intercostal space midclavicular ( using the watch) or do you use the stethoscope and using the watch to take the apical pulse rate? I have seen some nurses use the sterthoscope and others their hand, which one is better? ( ex. giving digoxin)

Might be a very dumb question but I am curious :)

[mommy.19, MSN, RN, APRN]

Only last fall the clinical instructor in a local ICU showed us the importance of being able to assess things in more than one way, i.e. being able to palpate the PMI and derive an apical HR in this way. Now, she said, 99/100 you're going to be using a stethoscope, but there may be a time when it is better to palpate the apical and the radial simultaneously in lieu of listening to one and palpating the other. Just my

[cjcsoon2bnp, MSN, RN, NP]

I have heard of palpating an apical pulse rate but honestly I feel more comfortable listening for it with my stethoscope. But that's just me...

!Chris

[SWS RN, ASN, RN]

For my 2 cents...I have been doing this 18 years, many years of ICU, ER and PICU experience and it has never been suggested to count an apical pulse without using a stethoscope. I would doubt the accuracy mainly b/c of anatomical features on patient and the sensitivity of the nurses hands.

Now, I always feel for the apical pulse before ascultating but I would not rely on the count.

Interesting that they are teaching this in nursing school.

Just never came up.

But hey, you live and learn...or practice and learn.

I am anxious to read what other nurses have to say.

s

PS, Miss Becky, I LOVED what you said about theory vs actually doing the job. So true, so true.

and as much as they would like to think they are, Nursing instructors are not God...and many times they are so out of touch with the real world of practice.

[Meema, LPN]

Highlandlass 1592... Were you saying in your post that on a pt with PEA you would pace them? I thought CPR, EPI and possibly Atropine were the only choices.

[freefalr]

i listen to apical rate w/my stethoscope w/my right hand & palpate radial pulse simultaneously w/my left pointer & third finger (or the other way around, if necessary, which always feels weird!). learned to do this because of afib, ectopy, etc.

[GilaRRT]

Ok, bit confused here...you talk about using the same monitor for everybody in this post...are you talking about something like a dinamap? And, if you are giving a BP med..unless it's a beta blocker, why are you counting an apical pulse rate? And honestly, making the statement to "never trust the monitor" like it's gospel, is one of those generalizations I'd have to say you need to back up with some evidence.

GilaRN brings up PEA....and says not to ever trust the monitor for a heart rate. I couldn't disagree more...that is where experience, assessment and common sense come into play. I better not be giving BP meds to a pt in PEA....unless it's a med to RAISE bp! At that point, when I've got an unresponsive patient, I'm doing compressions and getting ready to do all kinds of fun things like trying to pace.

You know, stating an absolute like this can be dangerous...what makes patients interesting is that no two are alike. If you can show me data that states I MUST not trust the monitor when I'm doing assessments, then I might believe it. If you want to do this in your practice..that's fine. But doing it just because your instructor said to do it...uh, uh, no way.

What evidence do you need? This boils down to basic anatomy and physiology. Cardiac conduction and the movement of sodium and potassium ions does not always equate to actual muscle contraction. This is well known and well demonstrated. As other people stated, PVC's among many other types of electrical activity may not result in mechanical activity. Therefore, the only safe course of action is to assume the electrical activity on the monitor and myocardial contraction do not coorelate until proven otherwise.

Barbara Kuhn Timby, Nancy Ellen Smith, Nursing: Care of Adults and Children. (2004). Page 354: "A cardiac monitor does not reveal the heart's mechanical activity. The health care provider must palpate a peripheral pulse or auscultate apical heart rate to obtain this information."

[SWS RN, ASN, RN]

Barbara Kuhn Timby, Nancy Ellen Smith, Nursing: Care of Adults and Children. (2004). Page 354: "A cardiac monitor does not reveal the heart's mechanical activity. The health care provider must palpate a peripheral pulse or auscultate apical heart rate to obtain this information."[/quote]

Right, I go along with this...palpate a peripheral and auscultate the apical.

Just can't see feeling and counting the apical as accurate.

Nor can I see how you could assess for a murmur or gallop accurately.

s