What should a nurse do if a posterior tibial pulse Cannot be obtained?

31 August, 2015

Pulse assessment is a vital component of good nursing care. Nurses must feel confident in their ability to accurately measure the pulse to assess patients’ health statuses Abstract Assessing the pulse is a common procedure and an important aspect of many nursing interventions; it should always be done with care and reassessed as needed. Assessment should always be taken seriously, with any deviations from the norm reported to a senior clinician, and pulse rate, rhythm and strength must always be documented. Pulses indicate numerous patient characteristics including the degree of relaxation, regularity of cardiac contractions and sufficiency of cardiac output. This article considers the relevant anatomy, physiology and practice of pulse assessment and recording. Citation: Lowry M, Ashelford S (2015) Assessing the pulse rate in adult patients. Nursing Times; 111: 36/37, 18-20. Authors: Mike Lowry is lecturer in nursing; Sarah Ashelford is lecturer in biological sciences; both at the University of Bradford. This article has been double-blind peer reviewed Scroll down to read the article or download a print-friendly PDF here

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Learn how to check pulse points in this nursing assessment review.

We will review 9 common pulse points on the human body. As a nurse you will be assessing many of these pulse points regularly, while others you will only assess at certain times.

When you assess a pulse point you will be assessing:

• Rate: count the pulse rate for 30 seconds and multiply by 2 if the pulse rate is regular, OR 1 full minute if the pulse rate is irregular.
  • Always count the apical pulse for 1 full minute.
  • A normal pulse rate in an adult is 60-100 bpm.
• Strength: grade the strength of the pulse and check the pulse points bilaterally and compare them. NOTE: always check the carotid pulse points individually (not at the same time) to avoid stimulating the vagal response.
  • 0: absent
  • 1+: weak
  • 2+: normal
  • 3+: bounding
• Rhythm: is the pulse regular or irregular

9 Common Pulse Points (start from head-to-toe…this makes it easier when you have to perform this skill)

1. Temporal
2. Carotid
3. Apical
4. Brachial
5. Radial
6. Femoral
7. Popliteal
8. Posterior Tibial
9. Dorsalis Pedis

Pulse Points Demonstration

Temporal

This artery comes off of the external carotid artery and is found in front of the tragus and above the zygomatic arch (cheekbone). This pulse point is assessed during the head-to-toe assessment of the head.

Carotid

This site is most commonly used during CPR in an adult as a pulse check site. It is a major artery that supplies the neck, face, and brain. As noted above, palpate one side at a time to prevent triggering the vagus nerve, which will decrease the heart rate and circulation to the brain.

To find the carotid pulse point, tilt the head to the side and palpate below the jaw line between the trachea and sternomastoid muscle.

Apical

This site is assessed during the head-to-toe assessment and before the administration of Digoxin. The pulse rate should be 60 bpm or greater in an adult before the administration of Digoxin. Always count the pulse rate for 1 full minute with your stethoscope at this location.

The apical pulse is the point of maximal impulse and is found at the apex of the heart. It is located on the left side of the chest at the 5th intercostal space midclavicular line.

To find the pulse point:

• Locate the sternal notch
• Palpate down the Angle of Louis
• Find the 2nd intercostal space on the left side of the chest
• Go to the 5th intercostal space at the midclavicular line and this is the apical pulse point
  

Brachial

This is a major artery in the upper arm that divides into the radial and ulnar artery. This site is used to measure blood pressure and as a pulse check site on an infant during CPR.

To find this pulse point, extend the arm and have the palms facing upward. The pulse point is found near the top of the cubital fossa, which is a triangular area that is in front of the elbow.

Radial

This is a major artery in the lower arm that comes off of the brachial artery. It provides circulation to the arm and hand. It is most commonly used as the site to count a heart rate in an adult.

To find this pulse point, extend the arm out and have the palms facing upward. It is found below the thumb in the wrist area along the radial bone.

Femoral

This is a major artery found in the groin and it provides circulation to the legs. This artery is palpated deeply in the groin below the inguinal ligament between the pubic symphysis and anterior superior iliac spine.

Popliteal

This artery is found behind the knee and comes off of the femoral artery. It is a rather deep artery like the femoral.

To find the artery, the knee should be flexed. It is located near the middle of the popliteal fossa, which is a diamond-shaped pitted area behind the knee. Use two hands to palpate the artery…one hand assisting to flex the knee and the other to palpate the artery.

Posterior Tibial

This pulse point, along with the dorsal pedis, is assessed during the head-to-toe assessment and is particularly important in patients who have peripheral vascular disease or a vascular procedure (example: heart catheterization when the femoral artery was used to assess the heart).

The posterior tibial pulse point is found on the inside of the ankle between the medial malleolus (bony part of the ankle bone) and Achilles tendon.

Dorsalis Pedis

To find this artery, locate the EHL (extensor hallucis longus) tendon by having the patient extend the big toe. Then palpate down this tendon and when you come to end of it, go to the side of the tendon and you will find this pulse point.