Why we should check a pulse

Evidence base

Checking the pulse has been a diagnostic tool for millennia, and is noted in ancient Chinese, Egyptian, Greek and Roman medical texts. A great deal of practical experience has accumulated since then. However, it is not a topic that has had extensive clinical trials, so the evidence base is mainly the result of taught experiential learning.

There have been studies of the accuracy of timing the heart rate for 15 seconds, 30 seconds or one minute. A 15-second check may be sufficient for a patient who is well and where the heart rate appears to be within the normal range (Hwu et al 2000). A longer check is recommended to ensure accuracy in unwell patients, or where bradycardia, tachycardia or irregularity is detected (Hollerbach and Sneed 1990, Sneed and Hollerbach 1992).

Learning points

1. Always explain the reason for checking the radial pulse and gain verbal consent from the patient. Resting pulse can be checked after the patient recovers from exertion or emotional imbalance.
2. To locate the radial pulse, press firmly a few centimetres back from the tip of the base of the thumb, around a third of the way across the wrist, using the first and second fingers of your hand.
3. To calculate the heart rate, count the number of beats that occur in one minute. Alternatively, beats could be counted for 30 seconds and then doubled, or counted for 15 seconds and quadrupled. Follow the organisation’s policy for reporting abnormal findings and taking action.
4. The carotid and brachial arteries give the best information on the volume and character of the pulse. The character of the pulse could be a normal up and down stroke, or the pulse might be prolonged, collapsing or jerky. The volume of the pulse is not a direct measure of the stroke volume, but informs you whether the pulse is normal, weak or abnormally strong.

Disclaimer: please note that information provided by RCNi Learning is not sufficient to make the reader competent to perform the task. All clinical skills should be formally assessed at the bedside by a nurse educator or mentor. It is the nurse’s responsibility to ensure their practice remains up to date and reflects the latest evidence.

Useful resources

• Moran JF (1990) Pulse. In Walker HK, Hall WD, Hurst JW (Eds) Clinical Methods: The History, Physical, and Laboratory Examinations. Third edition. Butterworths, Boston MA, 98-100.
• Santry C (2010) Manual Observation Push to Prevent Deterioration. http://www.nursingtimes.net/whats-new-in-nursing/acute/manual-observation-push-to-prevent-deterioration/5015358.article (Last accessed: April 25 2016.)
• Talley NJ, O’Conner S (2014) Clinical Examination: A Systematic Guide to Physical Diagnosis. Seventh edition. Churchill Livingstone Elsevier, Chatswood NSW, Australia.

References

Douglas G, Nicol F, Robertson C (Eds) (2013) Macleod’s Clinical Examination. 13th edition. Churchill Livingston/Elsevier, Oxford.

Hollerbach AD, Sneed NV (1990) Accuracy of radial pulse assessment by length of counting interval. Heart and Lung. 19, 3, 258-264. MEDLINE

Hwu YJ, Coates VE, Lin FY (2000) A study of the effectiveness of different measuring times and counting methods of human radial pulse rates. Journal of Clinical Nursing. 9, 1, 146-152. MEDLINE •CROSSREF

Levick JR (2010) An Introduction to Cardiovascular Physiology. Fifth edition. Hodder Arnold, London.

Sneed NV, Hollerbach AD (1992) Accuracy of heart rate assessment in atrial fibrillation. Heart and Lung. 21, 5, 427-433. MEDLINE