Can't get accurate radial pulse

[Pepperony]

Hi, i am having trouble with getting accurate radial pulse count. I am not even sure why that is as I just recently found out that at times my vitals are 10-20 beats off from the machine and from my classmates. Sometimes I get the exact same number as the machine but other times I am way off from the accurate number. I either a) can't count (which I tried to improve by counting to the metronome) b) wasn't locating the strongest pulse sites which is why I lost count. Anyways, It scared me to death that I still can't do proper vitals. Any tips??? Thanks!

[Bruce_Wayne, ASN, RN]

I wouldn't worry about being off from the machine, counting out the radial pulse is superior to the machine.

Try palpating the radial pulse and listening for heart sounds with your stethoscope at the same time so you can feel and hear the beat at the same time.

[netglow, ASN, RN]

Try a different wrist hold. Think of a guitar neck and grab the wrist by cupping the palm of your hand around the top side of their wrist. Wrap your fingers around what would be the side round to just inside the underside of the patient's wrist. let your index finger and your middle finger rest just there in a row right up at the base of the thumb where the wrist begins (the whole first joint of your two fingers lay on the skin there, no less no further in on the wrist) Chances are here if you give slight pressure from one finger or the other, you will pick up a strong pulse if there is one. It's easy to stop blood flow too, so not much pressure or you'll feel nothing.

[nurseprnRN, BSN, RN]

Also, a very common cause of inability to feel a radial (or any peripheral) pulse is the positioning of the artery. You will find, if you experiment with your own brachial and radial or those of a friend, that when the joints are extended to their maximal range of motion, the artery slips back behind the bones and other supporting joint structures. This is because if you are fighting off the sharp-toothed or -clawed predator or weapon or are active in a dangerous environment, protecting the artery like that decreases the chance of serious arterial injury.

To feel a radial pulse the best, the wrist must be flexed (bent inward). Try it now-- put your pointer and middle fingers in the little depression just proximal to the thumb where you normally feel a pulse, and don't move them as you do the range of motion for the wrist. Feel the pulse disappear or almost disappear when you bend the wrist backwards, and spring right up to your fingertips when you flex it? There ya go.

Same thing when you want to listen to BPs at the brachial. If the elbow is bent, you'll feel and hear it much better. Also the same at the popliteals-- flex those knees before you palpate in the groove for the arteries.

[tewdles, RN]

P R A C T I C E

everyone you know with an arm has a radial pulse

try feeling their brachial pulse or carotid pulse with the radial...or auscultating while palpating the radial artery

do whatever it takes as this is an important skill...

in fact, proficiency in palpating pulses in general is a critical skill for nurses, IMHO

[brownbook]

As GrnTea mentioned practice, practice, practice....on your self and your friends. Get used to feeling the beat without looking at a second hand, just feel and count ten beats over and over and over.

It can be hard to time your count with the second hand on your watch. First get a good feel for the beat....at least ten beats....then start watching the second hand and when it is on the quarter or half hour mark start counting. I honestly don't know but I think I have heard that counting for 15 seconds and then multiplying times four is as accurate if not more accurate than a full 60 second count.

[ComeTogether, LPN]

everyone you know with an arm has a radial pulse

He He

Cute. :-)

[Rhi007]

Sometimes it can just be the patient. I had one patient who would skip every third beat and it did my head in so I had to rely on the machine

[nurseprnRN, BSN, RN]

Sometimes it can just be the patient. I had one patient who would skip every third beat and it did my head in so I had to rely on the machine

Do you know why that happens? Do you know if it was really a skipped beat or a premature one that didn't have enough blood in the ventricle to generate a radial pulse? Did you check an apical-radial?

[chrisrn24]

Also, a very common cause of inability to feel a radial (or any peripheral) pulse is the positioning of the artery. You will find, if you experiment with your own brachial and radial or those of a friend, that when the joints are extended to their maximal range of motion, the artery slips back behind the bones and other supporting joint structures. This is because if you are fighting off the sharp-toothed or -clawed predator or weapon or are active in a dangerous environment, protecting the artery like that decreases the chance of serious arterial injury.

To feel a radial pulse the best, the wrist must be flexed (bent inward). Try it now-- put your pointer and middle fingers in the little depression just proximal to the thumb where you normally feel a pulse, and don't move them as you do the range of motion for the wrist. Feel the pulse disappear or almost disappear when you bend the wrist backwards, and spring right up to your fingertips when you flex it? There ya go.

Same thing when you want to listen to BPs at the brachial. If the elbow is bent, you'll feel and hear it much better. Also the same at the popliteals-- flex those knees before you palpate in the groove for the arteries.

I just tried flexing my wrist. So cool!! I'm gonna use that in the future with my patients!