infants apical pulse

Specialties Ob/Gyn

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i am having a hard time taking newborns apical pulses. i start ok but then i get fuster around 15 secs in and lose my count because there heart rate is so fast. i am asking for help from experience ob nurses on trick of the trade. this is my only vital sign i struggle with.

Specializes in NICU.
I am sorry, but you really cannot often pick up murmurs and other abnormal sounds/rhythms with just 15 seconds oftentimes; try to do apical pulse auscultation for at least one minute on all babies every shift, and every time for kids who have audible murmurs or irregular rhythms.

With healthy kids in the normal newborn nursery, maybe it is easy to get a full minute. I'm just saying that when you're trying to get an apical pulse on a 400 gram baby that desaturates the second you touch it, you don't really have that option.

But these are students with normal newborns that we're talking about - so yeah, a full minute is a better idea. Closing your eyes and tapping your finger or toes, and asking for the family to be quiet for a minute - those are all really good tips to try and get a full minute. Maybe try putting a pacifier in the baby's mouth, if it's allowed by the parents - the baby will probably be less squirmy then and you will be able to concentrate on listening and counting rather than keeping the baby calm.

Also ask the nurses in the nursery if any of the babies has a murmur and see if you can listen to it. The more abnormalities you hear, the easier it gets to pick up problems.

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Specializes in NICU, PICU, educator.

We do 6 seconds on our itsy bitsy ones that tol. nothing and then add a zero. In NBN we do one minute...it is easier to do the 15 sec in NICU because you can pick up things on the monitor. For resp, if it is a known high RR we do one minute in NBN, otherwise 30 sec is fine.

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I close my eyes and tap my finger to count apicals, especially with infants and adults with fib or flutter.

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Specializes in NICU.

We do a full minute in the well baby nursery. I second (or is that seventh?) closing the eyes. I try to breathe very slowly and just focussssss. I'm still a student too, so it's hard sometimes.

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Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.
With healthy kids in the normal newborn nursery, maybe it is easy to get a full minute. I'm just saying that when you're trying to get an apical pulse on a 400 gram baby that desaturates the second you touch it, you don't really have that option.

But these are students with normal newborns that we're talking about - so yeah, a full minute is a better idea. Closing your eyes and tapping your finger or toes, and asking for the family to be quiet for a minute - those are all really good tips to try and get a full minute. Maybe try putting a pacifier in the baby's mouth, if it's allowed by the parents - the baby will probably be less squirmy then and you will be able to concentrate on listening and counting rather than keeping the baby calm.

Also ask the nurses in the nursery if any of the babies has a murmur and see if you can listen to it. The more abnormalities you hear, the easier it gets to pick up problems.

Naturally and obviously, I am not talking about a NICU kid here. I am talking about newborns who are well or presumed well, or feeder-growers in our SCN----you still can pick some abnormalities on these kids....ones even the dr may miss in his/her rush to get them all seen. And some cardiac problems do not present for 12-24 hours after birth, as you know.

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Specializes in NICU.
Naturally and obviously, I am not talking about a NICU kid here. I am talking about newborns who are well or presumed well, or feeder-growers in our SCN----you still can pick some abnormalities on these kids....ones even the dr may miss in his/her rush to get them all seen. And some cardiac problems do not present for 12-24 hours after birth, as you know.

Right, and I agree that in NBN it's more important to monitor for at least a minute or so when listening to heart sounds. What scares me is that some docs discharge babies home sometimes at

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Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.

Agreed, gompers.

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Specializes in NICU.
Agreed, gompers.

Thanks. I'm sorry for the big debate - had a bug up my butt this morning, I suppose. :(

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Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.

NO problem. I took ZERO offense at what you wrote. I am not a NICU nurse and I do rely on you "experts" for that perspective. No worries my friend.

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Another silly hint that helps me, close your eyes, I dont know why but I can only listen if I cant see.

Me too! I often catch myself closing my eyes, esp. if an arrhythmia or I am trying to count for the whole minute!

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I count the 15 secs thing too, then wait and do another 15 seconds, until I have a full minute. I was taught on babies you always do a full minute, no exceptions. No taking 15 and just x 4.

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I've worked NICU for almost 26 years and counting apical heart rates can be difficult for beginners (and sometimes seasoned veterans!). It is not uncommon to have rates of 180 plus for preemies... what works best for me is to close my eyes as I'm listening, and get with the rhythm of the rate, for maybe 10 sec. or so, also a good time to start noting any murmers or irregular rhythms. After you're in the "groove" of the rhythm, then start counting. One full minute will give you the most accurate HR, but in the real world, 15 second X 4 works. If it's a brand new baby, or one with a history of an irregular heart rate, better listen for a full minute.

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