Pulse assessment is a vital sign evaluation technique that provides critical insights into cardiovascular health by measuring heart rate, rhythm, strength, and arterial elasticity—essential for detecting abnormalities like tachycardia, bradycardia, and arrhythmias.
Definition
Checking pulse rate, rhythm, volume, for assessing the circulatory status.
Purposes
- To establish baseline data.
- To check abnormalities in rate, rhythm, and volume
- To monitor any change in health status of the patient.
- To check the peripheral circulation.
| Common sites for checking pulse | |||
| Site | Location | Reason for use | |
| 1 | Radial | Inner aspect of the wrist on thumb side | Easily accessible |
| 2 | Temporal | Site superior (above) and lateral to (away from the midline) the eye | Used when radial pulse is not accessible. Easily accessible pulse in children |
| 3 | Carotid | At the side of the trachea where the carotid artery runs between the trachea and the sternocleidomastoid muscle | To assess cerebral perfusion |
| 4 | Apical | Left side of the chest in the 4th, 5th, or 6th intercostal space in the midclavicular line | Used to find out discrepancies with radial pulse |
| 5 | Brachial | Medially in the antecubital space | Used to monitor blood pressure and assess the lower arm circulation |
| 6 | Femoral | Below inguinal ligament, midway between symphysis pubis and anterosuperior iliac spine. | To assess circulation to lower limbs |
| 7 | Popliteal | Medial or lateral to the popliteal fossa with knees slightly flexed. | Used to monitor blood pressure and assess the circulation |
| 8 | Posterior tibia | On the medial surface of the ankle behind the medial malleolus. | To assess circulation to the foot. |
| 9 | Dorsalis pedis | Along dorsum of foot between extensor tendons of great and first toe. | To assess circulation to the foot. |
| 10 | Ulnar pulse | On the little finger side, outer aspect of the wrist | To assess circulation to ulnar side of hand. To perform Allen’s test |
Articles
Following articles are required.
- Wristwatch with second’s hand.
- Pen (colour as per agency policy).
- Vital signs chart and flow sheets.
Procedure
| Nursing action | Rational | |
| 1 | Before procedure Explain the procedure to the patient and inquire about patient’s recent activity. If the patient was involved in a strenuous activity. Allow the patient to rest for 10 min before taking pulse | Activities can increase the pulse rate |
| 2 | During procedure Sanitize hands or wash hands as per hospital policy. Select the pulse site. | Prevents cross infection Usually radial pube is selected. Choice of site depends on the particular extremity to be assessed. |
| 3 | Assist the patient to a comfortable position. For radial pulse, keep the arm resting over chest or on the sides with palm facing downward. | |
| 4 | Palpate and check pulse. Place tips of 3 fingers (except thumb) lightly over the site where pulse needs to be assessed. After getting the pulse regularly, count the pulse for one whole minute looking at the second hand on the wristwatch. Assess for rate, rhythm, and volume of pulse, and condition of blood vessel. | Thumb is not used for assessing pulse as it has its own pulse which can be mistaken for patient’s pulse Irregularities can be noticed only if pulse is counted for one whole minute Normal pulse is regular and the rate is 70-90 bpm |
| 5 | After procedure Wash hands | |
| 6 | Document and report pertinent data in the appropriate record. |
Special Considerations
- Never press both carotids at the same time, as this can cause reflex drop in blood pressure/pulse rate.
- Carotid pulse is used for victims of shock and cardiac arrest when pulse is not palpable at other sites
- Brachial and femoral sites are used with cardiac arrest in infant.
Paediatric Variations
- Apical pulse heard through a stethoscope held to the chest at the apex of the heart is more reliable in case of infants and young children.
- In older children (>3 years), radial pulse is taken.
- Count the pulse for one full minute, especially in infants and young children, because of the possible irregularities in rhythm
- Apical pulse is more accurate when the child is asleep.
Normal Pulse Rate for Infants and Children
| AGE | PULSE RATE (resting beats per minutes) |
| Newborn | 100-170 |
| 1 year | 80-170 |
| 3 years | 80-130 |
| 6 years | 70-116 |
| 10 years | 70-110 |
| 14 years | 60-110 |
| 18 years | 60-100 |
REFERENCES
- Annamma Jacob, Rekha, Jhadav Sonali Tarachand: Clinical Nursing Procedures: The Art of Nursing Practice, 5th Edition, March 2023, Jaypee Publishers, ISBN-13: 978-9356961845 ISBN-10: 9356961840
- Omayalachi CON, Manual of Nursing Procedures and Practice, Vol 1, 3 Edition 2023, Published by Wolters Kluwer’s, ISBN: 978-9393553294
- Sandra Nettina, Lippincott Manual of Nursing Practice, 11th Edition, January 2019, Published by Wolters Kluwer’s, ISBN-13:978-9388313285
- Sapra A, Malik A, Bhandari P. Vital Sign Assessment. [Updated 2023 May 1]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK553213/
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