Places on the body where it is possible to feel the arterial pulse are also commonly called pulse points. You can feel the pulse of the artery at some places on the body where the artery is close enough to the surface of the skin that you can feel the pulse of blood as the heart muscle contracts.
Depending on the pulse site being assessed, a different amount of pressure can be necessary to feel the pulse. For example, the radial artery lies closer to the skin surface than the femoral artery, so it requires less pressure to feel. Additionally, the nurse should be aware that holding too much pressure on the artery can obstruct blood flow, making it impossible to feel a pulse. Therefore, if the nurse has difficulty feeling the pulse, they should try lighter then deeper palpation to find the pulse.
Once the pulse is found, the nurse should assess for the following pulse characteristics1
- Rate: A normal rate for an adult is between 60-100 beats per minute. However, depending on patient history this may differ. Therefore, it is important to watch a pulse rate trend over time.
- Rhythm: Patients without underlying arrhythmias should have a regular pulse.
- Symmetry: Pulse strength should be equal bilaterally.
- Contour: The pulse should feel smooth and wavelike
- Strength: Normal pulses should be easily felt with gentle palpation
The pulse strength is described either numerically or by using the descriptions of 4+ (bounding), 3+ (increased), 2+ (normal), 1 + (weak), or 0 (absent). Pulses that are stronger or weaker than normal may be signs of underlying pathology.
Possible causes of stronger than normal pulses include anxiety, fever, hyperthyroid disease, and fluid overload, among others. Some causes of a weak pulse include poor perfusion to the extremity, shock or dehydration among others.
How To Take A Pulse
If the heartbeat is regular, 30 seconds is sufficient to assess the pulse. After counting for 30 seconds, the nurse multiplies that number by two to get the pulse rate. However, if the pulse is irregular, the nurse should count for a full minute to ensure an accurate pulse rate.
The 9 Pulse Points And Their Locations
Carotid
The carotid pulse is located below the jaw angle and beside the trachea. The trachea is made of rings of cartilage. Feel the side of the trachea and gently press down with two fingers. The carotid artery is close to the skin surface and should be palpable with relatively light pressure. Never press on both carotids at the same time. This can reduce blood flow to the brain.
Radial
The radial pulse is located on the bottom of the wrist near the base of the thumb. To locate the pulse, press the soft space between the wrist bone (radius) and the flexor tendons on the bottom of the wrist. The radial pulse is also located near the skin’s surface, so it usually needs light pressure to palpate. The radial pulse is the most commonly used pulse point for assessing pulse rate in adults.
Apical
The apical pulse is slightly different from other pulse points because it is located at the apex of the heart rather than an artery. The apical pulse is usually found in the fifth intercostal space at or just medial to the midclavicular line on the left side of the chest. If the patient has an enlarged heart, it may be located lower. In thin adults and children, there may be pulsations at this point, but in most cases, the nurse will need a stethoscope to assess the apical pulse and will auscultate rather than palpate the apical pulse.
Femoral
The femoral pulse is located just below the inguinal ligament. For most people, this is in the groin crease between the pubic bone and the anterior iliac crest. The femoral pulse is located deeper in the tissue, so it takes more pressure to palpate than the radial or carotid pulses.
Popliteal
The popliteal pulse is located on the back of the knee in the popliteal fossa. It is important to keep the knee bent to feel this pulse. Similar to the femoral pulse, it is not near the skin surface, so it requires firm pressure to palpate. In some patients the popliteal pulse may be very difficult to palpate. In this case, assess the pulse sites distal to the knee to ensure blood flow (Posterior Tibial and Dorsalis Pedis).
Temporal
The temporal pulse is somewhat less commonly assessed but should be assessed during a comprehensive examination of the head. To find the temporal pulse point, run two fingers along the top of the cheekbone up to the hairline. The pulse point will be located in front of the tragus. The temporal pulse point is close to the skin, so it takes light pressure to palpate. It is easy to obstruct this pulse point with too much pressure.
Brachial
The brachial pulse is found on the inner side of the bicep muscle. This is the arterial pressure that is measured when using a blood pressure cuff on the arm. The pulse can be assessed at multiple points along the arm but is easier to feel near the elbow crease. This pulse point requires firm pressure to palpate because it is not near the skin surface.
Posterior Tibial
The posterior tibial pulse can be palpated on the inside of the ankle, just behind and below the malleolus (ankle bone). To find this pulse, use two fingers between the medial malleolus and the Achilles tendon and press down. Moderate pressure is required to feel the posterior tibial pulse. This is an important pulse point to evaluate peripheral perfusion.
Dorsalis Pedis
Similarly, the dorsalis pedis pulse point can also be used to assess peripheral vasculature and perfusion of the lower extremities. The pulse point of the dorsalis pedis is located at the top of the foot in the first intermetatarsal space on the side of the tendon that moves the large toe. If the patient is able, ask them to extend their big toe upwards and run two fingers along the tendon to find the dorsalis pedis pulse.
Pulse Point Practice Tips
- Use a sharpy! If the patient has pulses that are somewhat difficult to find or will need repeated evaluation, draw an X over the pulse point with a marker to facilitate future location.
- If pulse points are a new skill, practice finding your own pulse points, then practice on friends and family!
References
- Gersch CJ, Heimgartner NM, Rebar CR, Willis LM, eBook Nursing Collection – Worldwide, Books@Ovid Purchased eBooks. Medical-Surgical Nursing Made Incredibly Easy! Fourth;4; Wolters Kluwer; 2016. https://go.exlibris.link/M02mGY9N
