Which arterial site does a nurse choose to assess circulation to the lower arm?

In your daily practice as a nurse, you will complete client assessments. And one of the components of an assessment is checking their pulse in their pulse points. Pulse points are the areas on the body where you can feel the heartbeat. 

Assessment of pulses is a vital fundamental skill required of nurses. The pulse provides information about the functioning of the heart and the circulatory system. 

Learning the location of pulse points (and how to count and grade pulses) is crucial for exams, NCLEX success, and real-world nursing – the clients’ health depends on it. 

What are Pulse Points?

Pulse points are specific areas of the body where blood vessels are close to the surface of the skin. These are areas where you can check your patient’s pulse and determine how well their heart is working.

The pulse is a pulsation of the beating of the heart, and what you’re actually feeling is a shock wave. This is the blood pounding as it is ejected from the heart under pressure. You can measure the pulse in areas where an artery passes close to the skin. 

There are many different pulse points on the body, but there are nine most commonly assessed in client care. These areas include the following:

1. Radial Pulse

The radial artery is one of two arteries in the upper arm that supply blood to the hand. It’s commonly used as a quick measure of heart rate. 

When you’re checking a client’s pulse, you’ll likely use your index finger and middle finger to do so — one on either side of the radial artery. When you put your fingers across your wrist at the base of your thumb, you’ll feel a slight bulge on either side of your thumb. 

The bigger bulge means you’re palpating (examine by touch) the radial artery.

2. Carotid Pulse

This pulse point may be hard to visualize, but can be palpated at the neck just below the jawline at the side of the neck. You’ll need to know the carotid artery pulse point because it’s one of the quickest ways to assess the client in an emergency. 

This pulse does not disappear with hypotension (low blood pressure)

When you palpate (press down) on this point, you’re pressing into an area called the carotid sinus, which controls blood pressure and heart rate. 

If palpated hard enough, you can cause carotid sinus syndrome (or vasodilation), which can possibly cause someone to faint or even go into cardiac arrest. DO NOT palpate both carotid arteries at the same time.

Read more about cardiac arrest and myocardial infarction here.

3. Femoral Pulse

The Femoral artery pulse point is on the lower leg, just above the crease where the thigh meets the calf. Therefore, the femoral pulse should be easily identifiable.

The femoral artery is a large vessel that transports oxygenated blood to the lower extremities and also a part of the abdominal wall. The clinical significance of the femoral artery is that it is often the site of peripheral artery disease complications.

When you check a client’s femoral pulse, you palpate the area where the groin meets the thigh and count the beats for fifteen seconds.

4. Brachial Pulse

The brachial artery runs from the heart and through the shoulder, where it branches into two arteries: the radial and ulnar arteries. The pulse point for this artery is located on the inside of the arm, on the arm’s antecubital fossa, just above where it meets the bicep. 

Checking the brachial pulse is a quick way to check someone’s blood pressure when equipment is not available. You can assess only the systolic blood pressure with this method. 

The brachial pulse is also used to identify the proper placement of the stethoscope during blood pressure measuring.

5. Temporal Pulse

The temporal pulse point is located in front of the ear toward the temple. This pulse is an ideal place to check in the elderly for vision loss or headaches assessment. The head-to-toe exam of the client should also include the temporal pulse.

6. Apical Pulse

The apical pulse point is a very reliable indicator of true cardiac status. You can find it at the fifth intercostal space (ICS) at the left midclavicular line. This can also be called the Point of Maximum Impulse (PMI). Assessment of this pulse can be for thirty seconds multiplied by two. 

If an irregular heart rate or rhythm is found, you should auscultate this pulse for one full minute. When listening to this pulse, it’s important to have the client sit or lie down for optimal assessment. 

7. Popliteal Pulse

Located behind the knee, the popliteal artery is an artery in the thigh that supplies oxygenated blood to the lower leg and foot. The popliteal pulse point is where nurses need to feel a pulse when they’re assessing circulation.

If there’s no pulse, it means either blocking blood flow or damaging the artery itself.

8. Posterior Tibial Pulse

The Posterior Tibial Pulse point is the best way to check for circulation in a patient’s lower leg. This artery branches from the femoral artery to supply blood and oxygen to the lower limbs.This pulse runs behind the knee.

The assessment of this pulse will indicate if there are any circulation issues. Circulatory issues could be deep vein thrombosis (DVT)/(blood clot), cardiac issues, or infection. 

When checking for a pulse, you can quickly determine if there’s any reason for concern and/or intervention.

9. Dorsalis Pedis Pulse

The Dorsalis Pedis Pulse point is located on the top of the foot, just below the ankle. Many nursing students find it more difficult to find this pulse due to the client’s anatomy, fluid volume load, and/or circulatory issues. Once a problematic pedal pulse has been found, mark it with an X. 

Try practicing on yourself to gain confidence and increase your skills.

If there’s no pulse at the dorsalis pedis point, it means that an artery is blocked — which could be a sign of heart disease or circulatory issues.

Grading Pulses

Grading pulses is how a nurse determines if a client’s heart rate is within normal ranges. If the pulse is not within a normal range (or strong), the situation may warrant immediate medical attention.

1. Listen for the sound of blood pumping through your arteries when assessing the apical pulse.
2. Use a watch with a second hand to count how many times the pulse is felt in one minute (heart rate). 
3. Also, feel if the pulse is regular or irregular.
4. Determine the strength of the pulse (is it strong or bounding? Is it weak and thready (difficult to palpate).

Factors that Affect Pulse Rate

• Blood pressure: As blood pressure increases, so does the pulse rate.
• Age: Older patients tend to have slower heart rates than younger people do, so their pulses will be harder to detect and grade.
• Biological sex: Men generally have faster heart rates than women do, so their pulses will be easier for nurses to detect and grade.
• Health status: Athletes tend to have lower heart rates and blood pressure.
• Temperature: The temperature of the patient’s body and environment.
• Weight: A larger (obese) person can have a lower pulse than someone who is of normal weight.

Normal Pulse Rates by Age

Newborns & Infants – 100-180 bpm (possibly up to 205 bpm for newborns)

Toddlers to School age – 75-120 bpm (possibly up to 140 bpm for toddlers)

Teens – 60-100 bpm

Young adults – 60-170 bpm

Adults – 95-150 bpm

Middle age – 80-160 bpm

Elderly – 75-130 bpm

Pulse rate is a crucial part of newborn APGAR scoring. Read more here.

Boost Your Cardiac Knowledge Here

Learning pulse points in nursing school is essential for both your exams and practical nursing. And using a supplemental tool can help you retain more cardiac knowledge. 

A tool like SimpleNursing can help you can memorize pulse points, and all other artery-related knowledge to ace your next test.

Start with a free trial today.

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