It is the movement of blood during the contraction of the heart’s left ventricle.
It is a throbbing sensation below the skin.
It may be palpated over the peripheral artery or auscultated over the apex of the heart.
It may be the distention or pulsation of arteries.
A wave can be felt when direct pressure is applied at certain points/pulse sites of the body.
Pulse Sites
Temporal
Carotid
Apical
Brachial
Radial
Femoral
Popliteal
Posterior Tibial
Dorsalis Pedis/Pedal
Pulse Sites
Temporal
Superior and lateral to the eye.
Indication of Use:
When the radial pulse is not accessible.
Pulse Sites
Carotid
Side of the neck between the trachea and sternocleidomastoid muscle.
Indication of Use:
During cardiac arrest/shock in adults.
To determine circulation of blood to the brain
Pulse Sites
Apical
Apex of the heart
Routinely used for infants and children up to 3-years-old
Indication of Use:
To determine discrepancies with radial pulse.
In conjunction with some medications.
Pulse Sites
Apical
Locations:
Adult: 5th Intercostal Space Left Midclavicular Line
Infant (less than 4-years-old): 4th Intercostal Space Left Midclavicular Line
4 to 6 years old: 5th Intercostal Space Left Midclavicular Line
7 to 9 years old: 4th or 5th Intercostal Space Left Midclavicular Line
Pulse Sites
Brachial
Inner aspect of the biceps muscle of the arm or medially in the antecubital space.
Indication of Use:
To measure bloodpressure.
During cardiac arrest for infants.
Pulse Sites
Radial
Thumb side of the inner aspect of the wrist.
Readily accessible and routinely used.
Pulse Sites
Femoral
Inguinal Region
Indication of Use:
In cases of cardiac arrest or shock.
To determine circulation in the legs.
Pulse Sites
Popliteal
Behind the knees.
Can be easily palpated with client’s knee flexed slightly.
Indication of Use:
To determine circulation to the lower leg.
To measure high blood pressure.
Pulse Sites
Posterior Tibial
Medial surface of the ankle.
Indication of Use:
To measure circulation of the foot.
Pulse Sites
Dorsalis Pedis/Pedal
Dorsum of the Foot
Indication of Use:
To determine circulation to the foot.
Peripheral Pulse
Collective term for pulse sites.
Distant from the heart.
Pulse located in the periphery (usually limbs).
Assessing a Peripheral Pulse (1-6)
Wash hands.
Introduce self.
Explain the purpose and procedure to the client.
Prepare the client.
Provide privacy.
Select the pulse site.
Assessing a Peripheral Pulse (7-8)
Assist the client in a comfortable resting position, either in a lying or sitting position.
If the client is made to lie down, their arm rests alongside the body, palm down; or the forearm can rest at a 90-degree angle across teh chest with palm facing downward.
For clients who can sit, the forearm can rest across the thigh with the palm of the hand facing downward.
Palpate and Count the pulse.
Place two (2) or more middle fingertips lightly and squarely over the pulse site. Never use the thumb, because it has a pulse on its own.
Assessing a Peripheral Pulse (9-10)
Assess the pulse quality (rhythm) and volume
Note the pattern of the intervals between the beats. Normally, it should have equal time periods between the beats.
Normally a pulse volume can be felt with moderate pressure and pressure is equal with each beat. A forceful pulse volume is full; an easily obliterated pulse is weak.
Document and Report pertinent data.
Positions of Fingers in Assessing Various Pulses
Carotid pulse
Positions of Fingers in Assessing Various Pulses
Radial pulse
Positions of Fingers in Assessing Various Pulses
Posterior tibial pulse
Positions of Fingers in Assessing Various Pulses
Brachial pulse
Positions of Fingers in Assessing Various Pulses
Femoral pulse
Positions of Fingers in Assessing Various Pulses
Dorsalis pedis pulse
Positions of Fingers in Assessing Various Pulses
Popliteal pulse
Pulse Rate
Number of pulse beats in one full minute.
Corresponds to the rate of the heartbeat.
Unit: Beats Per Minute (BPM)
Normal range in adult and adolescence at rest: 60-100 bpm
It increases and decreases in response to a variety of physiologic mechanisms
Pulse Alterations
Tachycardia
Bradycardia
Palpation
Pulse Alterations
Tachycardia
Tachy → Fast / Rapid, Cardia → Heart
Rapid Pulse Rate
> 100 bpm at rest
It tends to overwork the heart and may not oxygenate cells adequately.
Monitored closely and results are reported and recorded.
Pulse Alterations
Bradycardia
Brady → Slow / Delayed, Cardia → Heart
<100 bpm
Less common than tachycardia
Needs prompt reporting and continued monitoring
Pulse Alterations
Palpation
Awareness of one’s own heart contraction and can accompany tachycardia.
Feelings or sensations that your heart is pounding or racing.
Pulse Rhythm and Regularity
Pattern by which the heart beats are spaces, normally regular with each beat.
Rhythm is regular, beats are felt by the finger at a regular interval and are of equal force.
Pulse Rhythm and Regularity Alterations
Dysrhythmia or Arrhythmia
Bigeminal
Pulse Rhythm and Regularity Alterations
Dysrhythmia or Arrhythmia
IrregularPattern of Irregular Rhythm of Heartbeats.
Apical pulse should be assessed.
Should be reported promptly.
Pulse Rhythm and Regularity Alterations
Bigeminal
Pulse as occasional premature beats.
Results in a shorter interval between beats followed by a longer interval.
Pulse Volume and Amplitude
reflects the strength of left ventricular contraction.
Quality of pulsation felt usually is related to the amount of blood pumped with each heartbeat, or the force of heart contraction.
Normally strong when it can be felt with mild pressure over the artery.
Types of Pulse Volume
Absent Pulse
Thready Pulse
Weak Pulse
Normal Pulse
Bounding Pulse
Types of Pulse Volume
Absent Pulse
No pulsation is felt despite of extreme pressure.
Types of Pulse Volume
Thready Pulse
Pulsation is not easily felt.
Slight pressure causes it to disappear.
Types of Pulse Volume
Weak Pulse
Pulse is stronger than thready.
Light pressure causes it to disappear.
Types of Pulse Volume
Normal Pulse
Pulsation is felt easily.
Moderate pressure causes it to disappear.
Types of Pulse Volume
Bounding Pulse
Pulsation is strong and does not disappear with moderate pressure.