Assessment: Radial Pulse

  1. Assess for factors that influence radial pulse rate and rhythm: age, exercise, position changes, fluid balance, medications, temperature, and sympathetic stimulation.
  2. Perform hand hygiene, and ensure patient privacy, if needed.
  3. Place supine patients forearm straight alongside or across lower chest or upper abdomen with wrist extended straight. Or bend seated patients elbow 90 degrees, and support lower arm on chair or on nurses arm. Slightly extend or flex wrist with palm down until strongest pulse is noted.
  4. Place tips of first two or middle three fingers over groove along radial or thumb side of patient's inner wrist.
  5. Lightly compress against radius until pulse becomes easily palpable.
  6. Determine strength of pulse. Note whether it is bounding, strong, weak, or thready.
  7. While looking at watches second hand, count the pulse rate, starting with zero.
  8. If pulse is regular, count rate for 30 seconds and multiply total by 2.
  9. If pulse is irregular, count rate for a full 60 seconds. Also assess frequency and pattern of irregularity, compare radial pulses bilaterally, and assess for pulse deficit.
  10. Perform hand hygiene.
  11. Compare pulse rate and character with patient's previous baseline and acceptable range for patients age. If pulse is assessed for the first time, establish radial pulse as baseline if it is within acceptable range.