maintaining your feel for the radial pulse

Bedside_Life RN · Mar 7, 2014

If you are taking it for rhythm, regularity, and rate then I would take a few seconds to find that "sweet spot" where you are not occluding the artery but also find a pressure that is palpable. You may want to even try using more than one finger (just not your thumb) and stabilize the patient's arm. If you are in doubt check other cardiovascular indicators, like capillary refill, extremity temp., can you see hair on the arm or fingers (because hair has a hard time growing in places that perfusion is inadequate), compare it to the other side, try to find a brachial. Have someone else listen to the apical pulse at the same time to compare, look at the nail beds (are they pink?), is there any edema? also, you can have the patient make a closed fist while you occlude the radial and ulnar arteries then open their hand (while you are still occluding), let off of one at a time. you should see blood return to the side that you have let pressure off of. for example if you let off of the ulnar artery you should see the little finger and ring finger regain color. And when you let off of the radial, you should see the middle and index finger regain color.

If you are wanting to obtain the most accurate rate then always go apical (just remember that it is mid-clavicular line, not sternal border) and count for a full 60 seconds. Some people will have HR changes upon inspiration and expiration and this may be what you are feeling (or not feeling) as a missed beat. Just because the rhythm is off does not necessarily mean that you are not doing it correctly. Just collect as much data as you can to support whatever it is that you decide to document. But it will never be wrong to take it twice or start over. You are advocating for that patient and that is what matters. So if you have to palpate two or three times, then do that, and you will find the confidence that you are looking for. Good luck to you! and be the nurse that you would want taking care of your loved ones and you won't go wrong. And please, document what you find during your assessment; it doesnt matter what the previous nurse put. Trust your judgement, continue to practice with a questioning attitude, that "little voice" and your intuition will pay off 99% of the time.

Bedside_Life RN · Mar 7, 2014

Also, if you your patient has edematous lower extremities, DON'T put +1 pedal pulses or "thready". Get a doppler, or an order for one. I know that these can be hard to find sometimes, especially the posterior tib. but make sure you verify that they are present. And make sure to mark the area with a surgical marker and document that you found them via doppler. The oncoming nurse will appreciate this and for those who don't; it will give some incentive to maintain that assessment standard.

akulahawkRN, ADN, RN, EMT-P · Mar 7, 2014

When I take a radial pulse, I use a relatively light touch. I just use enough pressure to dimple the skin right where the radial pulse should be. If I have to grip the patient's arm when taking the pulse, I use my thumb, ring finger, and pinkie finger to provide the grasp and limb control, leaving the index and middle fingers available to independently (from the other fingers) search for the pulse. If you use your thumb, you can inadvertently end up taking your own pulse and if you use your index and middle fingers to hold the wrist, you can also easily provide too much pressure and end up occluding the artery and not know it.

Trust what you feel once you've got the "feel" for it. Sometimes you'll find there's something wrong with the patient that either popped up new right then or maybe the regular RN missed it.

nurseprnRN, BSN, RN · Mar 9, 2014

The biggest thing to remember in palpating pulses is to remember the anatomy. If you are trying to palpate a radial pulse, be sure that the joint is NOT extended. When the wrist is bent backwards, the artery slips deeper behind the tendons and bones in the wrist to protect it from injury, as might occur if you were pushing something heavy away from falling on you, or fending off an attack. This concept also applies if you are trying to palpate popliteal pulses and brachial pulses. Flex the joint and the artery will pop right out at you. (Another reason to be sure the arm is partly flexed when trying to listen to a brachial artery when you take a BP.)

Try this on a willing partner-- palpate the pulse in that nice little groove on the thumb side of the big tendons in the middle of the forearm just where they enter the hand with the hand flexed forward. Maintaining your fingertips on the pulse, have your subject slowly extend the wrist. You will feel the artery go away, or at least become harder to feel.