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By Root 2015 0

with cardiovascular conditions require regular assessment of the pulse to monitor their condition and the efficacy of medications.

Methods of pulse measurement

Manual

The pulse is measured by lightly compressing the artery against firm tissue and by counting the number of beats in a minute.

Electronic

Automated electronic equipment such as a pulse oximeter, blood pressure recording devices, 12lead ECG or continuous cardiac monitoring may be used to determine the pulse. However, even where the patient has continuous ECG monitoring, it is still essential to manually feel for a pulse to determine amplitude and volume and whether the pulse is irregular. In pulseless electrical activity (PEA), normal sinus rhythm is shown on the monitor but a pulse is not palpable (Levine et al. 2008).

Preprocedural considerations

Equipment

Pulse can be measured using a:

stethoscope: instrument used for listening to internal body sounds, especially from the heart and lung. It consists of a hollow tube, one end of which is placed to the ear of the examiner (Weller 2005) and the other end consists of a diaphragm (disc), used to pick up highpitched sounds, or bell (hollow cup), used to detect lowpitched sounds (Bickley and Szilagyi 2009)

electronic pulse measurement device (pulse oximeter): a small electronic device, consisting of a probe which is placed onto the end of a finger to record pulse rate.

Specific patient preparations

Ideally a patient should be at rest for 20 minutes before trying to obtain an accurate pulse. Strenuous activity will result in falsely elevated readings (RawlingsAnderson and Hunter 2008).

Procedure guideline 12.1 Pulse measurement

Essential equipment

A watch that has a second hand

Alcohol handrub

Observations chart

Black pen

A stethoscope (if counting the apical beat)

Electronic pulse measurement device, for example pulse oximeter, blood pressure measuring device or cardiac monitor

Preprocedure

Action Rationale

1 Wash hands and dry hands. To prevent crossinfection (Fraise and Bradley 2009, E).

2 Explain and discuss the procedure with the patient. To ensure that the patient understands the procedure and gives their valid consent (NMC 2008b, C).

Procedure

3 Where possible, measure the pulse under the same conditions each time. To ensure continuity and consistency in recording. E

4 Ensure that the patient is comfortable and relaxed. Ideally the patient should refrain from physical activity for 20 minutes. To ensure that the patient is comfortable. E

Strenous activity will result in falsely elevated readings (RawlingsAnderson and Hunter 2008), E).

5 Place the first and second or in addition the third finger along the appropriate artery and apply light pressure until the pulse is felt (see Action Figure 5). The fingertips are sensitive to touch. Practitioners should be aware that the thumb and forefinger have pulses of their own and therefore these may be mistaken for the patient’s pulse (Docherty and Coote 2006, E).

6 Press gently against the peripheral artery being used to record the pulse. The radial artery is usually used as it is often the most readily accessible (Bickley and Szilagyi 2009, E).

7 The pulse should be counted for 60 seconds. Sufficient time is required to detect irregularities in rhythm or volume. If the pulse is regular and of good volume subsequent readings may be taken for 30 seconds and then doubled to give beats per minute. If the rhythm or volume changes on subsequent readings then pulse must be taken for 60 seconds (RawlingsAnderson and Hunter 2008, E).

8 Record the pulse rate on appropriate documentation. Additional factors such as the rhythm, volume and skin condition (dry, sweaty or clammy) may be described in the patient’s nursing notes. To monitor differences and detect trends; any irregularities should be brought to the attention of the appropriate senior nursing and medical teams (NMC 2008a, C). Additional qualitative characteristics of the pulse may aid diagnosis of the patient’s condition (RawlingsAnderson and Hunter 2008, E).

Postprocedure

9 Discuss