Monitoring pulse in adults

A radial pulse can be taken by simply using a watch (to count 60 seconds) and the nurse’s middle and forefinger (Moore, 2017). This method will allow the rate, rhythm and amplitude to be assessed (Carvalho et al, 2020). Other equipment that can be used to monitor an adult pulse includes:

• telemetry
• oxygen saturation (Sp02) probes
• 12-lead electrocardiogram
• blood pressure monitoring devices

While these devices all assess the pulse rate, they vary in whether they assess rhythm and amplitude (Carvalho et al, 2020).

The below procedure outlines how to take a radial pulse:

1. Communicate with the individual by explaining the procedure and gaining consent
2. Ensure you adhere to infection prevention guidelines (hand hygiene, personal protective equipment)
3. Ensure the individual is rested and ask them not to talk or eat while measuring the pulse
4. Locate the radial pulse (near the wrist, thumb side), using the middle and forefinger
5. Apply gentle pressure using the middle and forefinger to feel the radial pulse, this pressure should be maintained throughout
6. Count the pulse for a full minute (60 seconds)
7. Take note of the rhythm and amplitude while counting the pulse rate
8. Document the pulse reading on the National Early Warning Score 2 or any other appropriate or required documentation tool, inform the patient and escalate to a healthcare practitioner if required
9. Remove personal protective equipment (if worn) and decontaminate hands using the appropriate methods (Carvalho et

Risks and complications associated with pulse monitoring relate to inaccuracies in measurement. Pulse rate can be affected by many factors, including anxiety, fear and exercise. If a person’s pulse rate increases because they have been given bad news or quickly walked back to their bed space, then their pulse rate at that time does not qualify as a resting pulse (Carvalho et al, 2020). Therefore, the person should be rested before taking a pulse (Moore, 2017).

The nurse should not measure a radial pulse using their thumb. The thumb has a pulse of its own, so it can be mistaken for the radial pulse, giving an inaccurate reading (Peate and Wild, 2018). Additionally, the nurse should ensure they count for a full 60 seconds, as this will ensure the rate is accurate and that sufficient time has been given to assess rhythm and amplitude (Carvalho et al, 2020).

Nursing and Midwifery Council: standards of proficiency for registered nurses

Part 1: Procedures for assessing people’s needs for person-centred care

1. Use evidence-based, best practice approaches to take a history, observe, recognise and accurately assess people of all ages:

1.2.1 symptoms and signs of physical ill health

2.1 take, record and interpret vital signs manually and via technological devices

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Moore T. Observations and monitoring (vital signs). In: Moore T, Cunningham S (eds). Clinical skills for nursing practice. London: Routledge; 2017:161–204

Olshansky V, Saha S, Gopinathannair R. Bradycardia. 2023. https://bestpractice.bmj.com/topics/en-gb/832 (accessed 27 August 2024)

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