Blood Pressure (Systolic): Palpation - 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

Blood pressure (BP) is the force exerted by blood against the vessel walls.^{undefined#ref1">1} The standard unit for measuring BP is millimeters of mercury (mm Hg).¹ The most common methods for measuring BP are listening for the Korotkoff sounds using a BP cuff with gauge and a stethoscope or using an electronic BP monitor.

BP by palpation (feeling a pulse with the fingers) can be used to determine an estimated systolic BP (not diastolic), especially in certain situations or as a backup method (e.g., automated device is unavailable or malfunctioning, trauma, or critical injuries) or when it is difficult to get an accurate reading while listening via stethoscope (e.g., severe obesity, tremors).

When measuring the BP by palpation, an artery pulse (e.g., radial, brachial) and BP cuff are used. At the point at which the pulse disappears, the cuff is inflated 30 mm Hg above that point to estimate the systolic BP.

While the upper arm is the standard location for palpating BP, it's possible to palpate and measure BP in other locations like the thigh (popliteal artery), forearm (radial artery), or even the lower calf or ankle (dorsalis pedis artery), but the arm is the most common and preferred.

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.
• Explain the equipment and the procedure to the patient.
• Explain that the patient must remain still and quiet during the procedure.

ASSESSMENT AND PREPARATION

Assessment

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 BP by palpation and understanding of the care to be provided.

PROCEDURE

1. Clean hands and put on appropriate personal protective equipment (PPE) based on the risk of exposure to body fluids or infection precautions.
2. Have the patient sit or lie down.
3. Expose and place the patient’s arm, supported at heart level, with the palm facing up.
4. Put the BP cuff in the middle of the patient’s arm and center the cuff bladder over the artery.
5. Wrap the fully deflated BP cuff evenly and snugly around the patient’s arm. Make sure the valve for the inflation bulb on the BP cuff is closed (turn clockwise).
6. Feel for the radial pulse using the fingertips.
7. Slowly inflate the BP cuff until you can no longer feel the radial pulse. Continue to inflate the cuff to 30 mm Hg higher.¹
8. Slowly deflate the inflation bulb valve (turn counterclockwise) at a rate of 2 mm Hg per second.¹
9. Continue to feel for the radial pulse and note the number on the gauge when you can feel the pulse again. This pressure is the systolic BP.
10. Finish deflating the BP cuff rapidly.
11. Remove the cuff from the patient’s arm unless the patient needs repeated measurements.

EXPECTED OUTCOMES

• BP by palpation is obtained

UNEXPECTED OUTCOMES

• BP by palpation reading cannot be obtained

DOCUMENTATION

• BP measurement
• Method used
• Site used for BP measurement
• Unexpected outcomes and related interventions
• Education

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.

Adapted from Perry, A.G. and others (Eds.). (2025). Clinical nursing skills & techniques (11th ed.). St. Louis: Elsevier.

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

Published: May 2025