HOW TO: Take a pulse


Una Haddick-Flynn, senior Nurse at The London Clinic, explains how best to take a pulse. 

Where on the body is the best place to take your pulse?
Many people try the centre of the wrist, but the best place is actually on the inside of the wrist, just below the base of the thumb. We call this the ‘radial pulse’ and, as nurses, it is the one we would always go for first. It doesn’t matter whether you try the left or right arm.

Take us through the process for checking your pulse?
To take your radial pulse, hold one hand out, facing upwards, with the elbow just slightly bent. Measure the pulse with your other hand, using the pads of your index and middle fingers. Do not use your thumb, because that has a pulse of its own, which can confuse your reading.

How long should you do it for?
Firstly, you have to use a watch or a clock, as it is virtually impossible to estimate time accurately while you are counting a rhythmic pulse. Take the pulse for 60 seconds. Alternatively, you can count for 30 seconds and then multiply by two.

Is 60 seconds better than 30?
In a normal healthy person, 30 seconds is fine. However, if the person is ill you should do the full 60. This makes it easier to pick out any abnormalities such as changes in the rhythm or strength of the pulse.

What if you can’t find the pulse, or you keep losing it?
The first thing is to lower the arm so that it is hanging beside the waist. The blood will flow more freely then, which might make the pulse easier to find and keep.

Is there an alternative to the wrist?
That would be the soft hollow in the side of your neck, just below your jaw and to the side of your windpipe—this is known as the ‘carotid pulse’. There are a couple of important differences. You need to apply a bit more pressure here than you would for the wrist, as you are pressing into a soft hollow as opposed to the firm wrist. Like the wrist, you can try either side, but it is very important not to try both at the same time. Compressing them both could restrict the blood flow to the brain.

What should you be noting when taking a pulse?
You should be noting the strength and rhythm of the pulse as well as the pace. The strength falls into four categories: weak, faint, strong and bounding. In a healthy adult in a resting state you want a nice strong pulse. The thing to remember is that you will get the occasional missed beat or arhythmical patterns in a perfectly healthy heart, so it is nothing to worry about initially. If you feel a missed beat, you should take your pulse once a day and take a note of the nature of the pulse. If it is happening on a regular basis you should go to your GP.

What is the expected pulse rate for a healthy person?
Between 60-100 beats per minute. But this will be lower if you are a fit person— some athletes can have a pulse rate of as little as 40 beats per minute. If the rate is consistently above 100-120 beats per minute or below 40—if you are not an elite athlete—you should get it checked by your doctor.
What are the best conditions for taking a pulse? In a relaxed atmosphere at home. Preferable after lying down quietly for about five minutes. That would give you your resting pulse rate.

Anything you should avoid when taking your pulse rate?
Alcohol is something people often don’t realise raises the heart rate, so it is best not to take it after a few drinks. Also, if you are on any medications check with your doctor as some will have an effect on the heart rate.