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Measuring the Radial Pulse

Written by Amanda R. McDaniel, MS, BSN, RN
Amanda is a BSN/RN with a MS in Physiology and a BA in English. She worked as a medical writer in the pharmaceutical industry for 11 years before pursuing a career in nursing. She now works as a nurse on a NeuroTelemetry unit and continues to write and edit on a freelance basis. Amanda’s LinkedIn

The radial artery, located in the wrist, is easy to feel and an efficient location to measure heart rate. Changes to the rhythm or strength of the radial pulse can indicate heart disease, damage to the arm, or body fluid status. It is important to remember to check the radial pulse on both sides as differences between left and right can indicate injury or disease processes.

How to Measure the Radial Pulse

  1. Perform hand hygiene and introduce yourself to the patient. Close the curtain or door to protect patient privacy.
  2. Ensure that the patient is prepared for the assessment:
    • Wait five to ten minutes after patient activity.
    • Wait 15 minutes after the patient has smoked or consumed caffeine.
    • The patient should be calm.
  3. Position the patient for accurate measurement of the radial pulse.
    • The patient should be sitting or lying supine.
    • If lying, the patient’s arms should be relaxed along the side of their body or across their lower chest or abdomen.
    • If sitting, the patient’s elbow should be bent at 90 degrees and the lower arm should be supported by the nurse or the arm of a chair.
    • The wrist should be straight with the palm of the hand facing down.
  4. Gently place the first two fingers of your hand over the groove on the thumb side of the patient’s inner wrist. Gently bend or straighten the patient’s wrist until you feel the pulse. You may need to adjust the pressure of your fingers, as it is easy to press too hard and close off the artery.
  5. Observe the feel of the pulse. Is it barely there? Is it practically leaping out of the patient’s arm? Are there stutters to it?
  6. Look at a clock with a second hand or a digital clock with seconds displayed. Note the second and begin counting the pulse for one full minute.
  7. Measure the radial pulse on the other wrist. Pay attention to differences between the two sides.
    • Measurement of both radial pulses may not be required by institutional or unit policy, but is good practice for new patients or if abnormalities are detected on the first side measured.
  8. Assist the patient back to a more comfortable position.
  9. Perform hand hygiene.
  10. Document the pulse rate and pattern in the patient’s record and inform the nurse of any rate or rhythm abnormality or difference between the two arms or if there is a significant change from the previous measurement per institutional or unit protocol.

Amanda R. McDaniel, MS, BSN, RN

References

Fetzer, S. J. (2014). Vital signs and physical assessment. In A. G. Perry, P. A. Potter, and W. R. Ostendorf (Eds), Clinical nursing skills & techniques (8th ed., pp. 77-80). St. Louis, MO: Mosby Elsevier.

More Resources

Measuring Blood Pressure

Many factors can interfere with obtaining an accurate blood pressure. The most common mistakes that lead to inaccurate blood pressures are a result of improper technique, including: not supporting the patient’s arm, using the wrong sized cuff, positioning the cuff too low on the patient’s arm, improper positioning of the cuff’s artery marker, and attempting to measure blood pressure through clothing.

Feeding the Patient

Not all patients will need help feeding themselves. Some patients will only need assistance opening cartons or cutting their food. To promote independence, always let the patient do as much as he or she can before assisting. It is vitally important that the nurse’s aide verifies that the patient receives the correct meal tray. Patients may have special diets that play a critical role in their health (i.e., pureed diet, gluten-free diet, food allergies, etc.). Feeding the wrong food to the wrong patient could result in serious complications.

Assisting the Resident to Sit on the Side of the Bed

Having the resident sit on the side of the bed is otherwise referred to as dangling. When a resident quickly changes position, especially from lying to sitting or standing, there can be a rapid drop in the resident’s blood pressure. This drop in blood pressure may cause dizziness or lightheadedness.

Axillary Temperature with Electronic Thermometer

Compared to other temperature measurement methods, the axillary measurement is considered the least reliable. An axillary temperature measurement typically reads 0.5 to 1 degree Fahrenheit lower than an oral temperature reading [1]. For this reason, it is recommended to use this method only when other methods are contraindicated or when taking an axillary temperature is the safest method for the patient.

Transferring the Resident from a Bed with a Mechanical Lift

A mechanical lift is used to transfer residents who cannot support their own weight. When used properly, mechanical lifts prevent injuries for both residents and health care workers. It is important that a nurse’s assistant be trained to use the mechanical lift before attempting to operate it. Most facilities require at least two health care workers to assist when using a mechanical lift.

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