Vital Signs – Radial Pulse

Equipment:

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• Wristwatch with second hand
• Pen
• Vital sign flow sheet in chart or electronic health record (EHR)

Steps:

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1. WIIAPA:
   1. Wash hands
   2. Introduce self
   3. Identify patient (use 2 identifiers)
   4. Allergies – don’t forget food allergies
   5. Plan of care
   6. Assess patient

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2. Determine patient’s previous baseline pulse rate.
3. Provide privacy.
4. Help patient to assume a supine or sitting position.
5. If patient is supine, place his or her forearm straight alongside or across lower chest or upper abdomen.
6. If patient is sitting, bend patient’s elbow 90 degrees and support lower arm on chair or on your arm. Place tips of first two or middle three fingers of hand over groove along radial or thumb side of patient’s inner wrist. Slightly extend or flex wrist with palm down until you note the strongest pulse.
7. Lightly compress finger against radius, losing pulse initially; relax pressure so pulse becomes easily palpable.
8. Determine strength of pulse. Note whether thrust of vessel against fingertips is:
   1. bounding (4+)
   2. full increased, strong (3+)
   3. expected (2+)
   4. barely palpable, diminished (1+)
   5. or absent, not palpable (0).
9. After palpating a regular pulse, look at watch second hand and begin to count rate. Count the first beat after the second hand hits the number on the dial; timing begins with zero; count as one, then two, and so on.
10. If pulse is regular, count rate for 30 seconds and multiply total by 2.
11. If pulse is irregular, count rate for a full 60 seconds. Assess frequency and pattern of irregularity. Compare radial pulses bilaterally.
12. Help patient return to a comfortable position.
13. Discuss findings with the patient.
14. Remove gloves and perform hand hygiene.
15. Document.