Radial Pulse (Home Health Care) - CE/NCPD

The content in Clinical Skills is evidence based and intended to be a guide to clinical practice. Always follow your organization’s practice.

OVERVIEW

The pulse is the beating sensation felt in the arteries as blood flows from the heart. It creates a wave that travels quickly through the body, and it can be felt by gently pressing on an artery near a bone or muscle. The number of beats felt in a minute is the pulse (heart) rate (HR). Adults usually have a heart rate between 60 to 100 beats per minutes.^{undefined#ref1">1}

Checking the HR in different areas of the body can give important information about the heart and blood flow. A slow, fast, or irregular HR may show that the heart is not pumping blood effectively to the body.

HR can be checked in various arteries (Table 1), but the radial artery in the wrist is commonly used (Figure 1), as it is easy to feel. If the HR is weak or not felt in the wrist during a critical situation, like a heart emergency, a more central artery like the carotid in the neck should be checked as it may be the last pulse felt in a cardiac arrest scenario.

HR measurement can be delegated if a patient’s condition is stable. HR measurement cannot be delegated when a patient’s condition is unstable because the patient is at high risk for acute or serious cardiac problems, or when the nurse is evaluating a patient’s response to a treatment or medication.¹

SUPPLIES

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EDUCATION

• Give developmentally and culturally appropriate education based on the desire for knowledge, readiness to learn, preferred learning style, and overall neurologic and psychosocial state.
• Teach a patient starting a prescribed exercise plan (e.g., cardiac rehabilitation) how to take and monitor HR via radial and carotid sites to determine the response to exercise.
• Teach patients taking heart medications how to take and monitor HR via radial and carotid sites.

PROCEDURE

1. Determine if the patient has health literacy needs or requires tools or assistance to effectively communicate. Be sure these needs can be met without compromising safety.
2. Review the patient’s previous experience and knowledge of HR measurement and understanding of the care to be provided.
3. Review the patient’s medical record to determine the need to take the radial pulse, such as:¹
   1. History of heart disease
   2. History of peripheral vascular disease (PVD)
   3. Cardiac dysrhythmia
   4. Onset of sudden chest pain or acute pain from any location
   5. Invasive cardiovascular (CV) diagnostic tests
   6. Surgery
   7. Large volume of IV fluids
   8. Internal or external blood loss
   9. Administration of medications that alter cardiac function
4. Determine the patient’s previous baseline HR measurement from the patient’s medical record, if available.
5. Review patient factors that may influence HR and rhythm (Table 2).
6. Assess the patient for signs and symptoms of changes in cardiac function (e.g., dyspnea, fatigue, chest pain, syncope, palpitations, skin edema, pallor, or cyanosis).¹
7. Clean hands and don appropriate personal protective equipment (PPE) based on the risk of exposure to bodily fluids or infection precautions.
8. If the patient is supine, place the forearm straight alongside the body or across the lower chest or upper abdomen with the wrist extended straight (Figure 2). If the patient is sitting, bend the elbow 90 degrees and support the lower arm on a chair or the health care team member’s arm.¹
9. Place the tips of the first two or three fingertips over the groove along the thumb side of the patient’s inner wrist (Figure 2) to feel the radial artery. Slightly extend the patient’s wrist with the palm down until the pulse is strongest.

   Rationale: The relaxed position of the lower arm and the extension of the wrist permit full exposure of the artery to palpation.

10. Use fingertips to lightly push the artery against the radius. Occlude the pulse initially, then ease the pressure to feel the pulse easier.

    Rationale: HR assessment is more accurate when using moderate pressure.

11. If taking the patient’s HR for the first time, establish a baseline if it is within the acceptable range for the patient’s age.
12. Determine the strength of the HR (e.g., 0, 1+, 2+, 3+, 4+).¹ Feel if the pulse against the fingertips is absent, thready, weak, strong, or bounding (Box 1). If repeating HR assessment, observe for any changes in the intensity of the HR.

    Rationale: HR strength reflects the volume of blood pushed out against the arterial wall with each contraction of the heart.¹

    Use the HR scale as accurately as possible, especially if the presence or absence of pulses is a concern.

13. After feeling for a regular pulse, look at the position of the second hand on a wristwatch or clock and then count the HR. Begin counting with the first beat felt after the second hand has moved toward the next number on the dial; count as one, then two, and so on.¹

    Rationale: The rate is determined accurately only after palpating the pulse. Timing begins with zero. The count of one is the first beat palpated after timing begins.¹

14. If the pulse is regular, count the rate for 30 seconds and multiply the total by two.¹
15. If the pulse is irregular, count the rate for a full 60 seconds.¹ Assess the frequency and pattern of irregularity. Compare the patient’s pulses in both wrists.

    Rationale: Inefficient contraction of the heart fails to send a pulse wave, resulting in an irregular pulse.

    A notable difference in the patient’s HR between wrists may indicate that arterial flow is compromised to one wrist, and the practitioner must be notified.¹

16. Compare the patient’s HR, rhythm, and strength with the patient’s previous baseline, as applicable.
17. Discuss the HR findings with the patient.

EXPECTED OUTCOMES

• Radial pulse is palpable and within normal range for the patient’s age.
• Heart rate rhythm is regular.
• Radial pulse is strong, firm, and regular.

UNEXPECTED OUTCOMES

• Pulse is weak, thready, difficult to palpate, or absent.
• Pulse is abnormally fast.
• Pulse is abnormally slow.
• Pulse is irregular.

DOCUMENTATION

• Pulse rate, rhythm, strength
• Unexpected outcomes and related interventions

OLDER ADULT CONSIDERATIONS

• Palpating the pulse of an older adult or patient with obesity can be difficult.
• Older adults’ arteries may feel stiff and knotty because of decreased elasticity.
• In older adults, the heart rate takes longer to rise to meet sudden increased demands caused by stress, illness, or excitement. Once an older adult’s pulse rate is elevated, it takes longer to return to a normal resting rate than that of a younger patient.¹

REFERENCES

1. Perry, A.G. (2025). Chapter 5: Vital signs. In A.G. Perry and others (Eds.), Clinical nursing skills & techniques (11th ed., pp. 70-109). St. Louis: Elsevier.

ADDITIONAL READING

Gerhard-Herman, M. (2023). Chapter 55: Peripheral artery disease. In G.N. Levine (Ed.), Cardiology secrets (6th ed., pp. 449-458). Philadelphia: Elsevier.

Clinical Review: Kerrie L. Chambers, MSN, RN, CNOR, CNS-CP(E)

Published: September 2024