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Pulse points: where to find them and how to grade them
The main pulse points are the temporal, carotid, apical, brachial, radial, ulnar, femoral, popliteal, posterior tibial and dorsalis pedis pulses. Nurses check rate, rhythm and strength, and grade strength from 0 (absent) to 4+ (bounding), with 2+ being normal.
Where to find each pulse
| Pulse | Where | When it is used |
|---|---|---|
| Temporal | In front of the ear, over the temple | When other sites are not available |
| Carotid | Side of the neck, beside the trachea | Emergencies and CPR in adults. Check one side at a time |
| Apical | Left chest, 5th intercostal space at the midclavicular line | Full 1-minute count before digoxin, irregular rhythms, infants |
| Brachial | Inner elbow, or inner upper arm in infants | Blood pressure; CPR pulse check in infants |
| Radial | Thumb side of the wrist | Routine adult pulse |
| Ulnar | Little-finger side of the wrist | Circulation to the hand |
| Femoral | Groin, midway between the pubic bone and the hip bone | Emergencies; after a femoral catheterization |
| Popliteal | Behind the knee (easier with the knee slightly bent) | Circulation to the lower leg |
| Posterior tibial | Behind the inner ankle bone | Circulation to the foot |
| Dorsalis pedis | Top of the foot, between the first and second toes' tendons | Circulation to the foot, casts, peripheral artery disease |
How to grade pulse strength
| Grade | Meaning |
|---|---|
| 0 | Absent |
| 1+ | Weak, diminished, easy to block |
| 2+ | Normal |
| 3+ | Full, increased |
| 4+ | Bounding, cannot be blocked |
How to take a pulse
- Use the pads of your first two or three fingers (nursing texts teach avoiding the thumb).
- Press gently until you feel it; pressing too hard can block a weak pulse.
- Count for 30 seconds and multiply by 2 if the rhythm is regular; count a full minute if it is irregular.
- Compare both sides for strength and equality.
- If you cannot feel a foot pulse, use a Doppler and mark the spot.
NCLEX tip: Compare pulses on both sides and above and below an injury, cast or procedure site. A new weak or absent pulse in a limb is an emergency to report right away.
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Frequently asked questions
What is a normal pulse grade?
2+ is normal. 0 is absent, 1+ is weak, 3+ is full and 4+ is bounding. Some references use a scale where 3+ is normal, so chart with your facility's scale.
Where is the apical pulse?
On the left chest at the 5th intercostal space in the midclavicular line, over the apex of the heart.
Why check the carotid pulse on one side only?
Pressing both carotid arteries at once can reduce blood flow to the brain, and pressure can slow the heart rate.
Where are the 9 pulse points?
Commonly taught pulse points are temporal, carotid, apical, brachial, radial, femoral, popliteal, posterior tibial and dorsalis pedis. Some lists add the ulnar pulse. Nurses compare both sides for rate, rhythm and strength.
Where are the best pulse points?
For a routine adult pulse, the radial pulse at the wrist. In an emergency, the carotid pulse in adults and the brachial pulse in infants. Use the apical pulse for a full one-minute count before giving digoxin or when the rhythm is irregular.
Keep studying
Sources
- Clinical Nursing Skills, 24.3 Nursing Assessment, OpenStax
- Peripheral Pulse, StatPearls, NCBI Bookshelf
For study only, not medical advice. Ranges and protocols vary by facility; follow your program, your facility's policies and the provider's orders.