Accurate assessment of peripheral impulses

Pulse assessment is crucial in diagnosing life- and limb-threatening injuries and diseases. Several various factors can influence the character and quality of the heartbeat, and early identification and intervention are paramount to good patient outcomes.

The general approach to assessment is to systematically examine the heartbeat from distal to proximal. This allows for probably the most objective assessment of impulses from their weakest point to their strongest. Pay attention to the standard of the heartbeat, the scale of the arteries and the symmetry.

The radial and brachial arteries within the arms and the dorsal arteries of the feet, posttibial, popliteal and femoral arteries within the legs needs to be included. Normal impulses are rated 2+. Limit pulses have a grade of three+ and reduced pulses have a grade of 1+. No impulses are assigned a rating of 0.

The radial pulse needs to be assessed by grasping the fingertips and placing them on the flexor side of the wrist. The brachial pulse is assessed at the middle of the biceps tendon within the antecubital fossa. The comparison needs to be made with the contralateral arm. Any discrepancies needs to be reported to the supplier for further assessment.

The dorsalis pedis is assessed by placing the fingertips on the dorsum of the foot, just lateral to the extensor tendon of the large toe. The posterior tibial pulse is situated behind or distal to the medial malleolus. The popliteal artery is situated behind the knee, deep within the popliteal space, and might be found more easily if the knee is barely bent. The femoral pulse is situated deep within the inguinal region and might be more easily situated through the use of each hands and deep palpation.

Generally, the radial artery is used to measure heart rate. The patient should sit comfortably, with the wrist resting on the treatment table or arm of the chair. The artery is palpated, the heartbeat is counted for 30 seconds and multiplied by 2 or a complete minute if irregular. If you experience an irregular heart rate, this needs to be reported to your doctor for further evaluation.

Remember…

• Examination of a patient by one other provider during a transition of care helps eliminate discrepancies within the assessment of pulse quality and maintain continuity of test results.
• Cyanosis, pallor or lack of hair on the limb may indicate arterial insufficiency.
• Bordering radial and femoral pulses may indicate aortic regurgitation.
• Pulsus parvus means a weak pulse and will indicate atherosclerotic disease.
• A femoral pulse with a murmur needs to be reported to the physician for further evaluation for a possible aneurysm.

Bickley, L. S., Szilagyi, P. G., Hoffman, R. M., & Soriano, R. P. (2021). Bate’s guide to physical examination and interviewing (thirteenth ed.). Wolters Kluwer Health: Philadelphia.