Peripheral pulses are the high-pressure wave of blood felt in arteries away from the heart, primarily in the arms and legs. Assessing and accurately documenting these pulses is standard practice to monitor a person’s circulatory status. This evaluation provides immediate insight into the heart’s pumping action and the patency of peripheral blood vessels. Consistent documentation allows healthcare providers to track blood flow over time, which is important for identifying conditions like Peripheral Artery Disease (PAD) or acute vascular changes.
Identifying Key Pulse Locations and Characteristics
The assessment of peripheral circulation focuses on specific anatomical locations where arteries run close to the skin surface. Commonly assessed sites are the Radial and Brachial arteries (upper extremities) and the Dorsalis Pedis (DP) and Posterior Tibial (PT) pulses (lower extremities). DP and PT pulses are the most distal sites and sensitive indicators of poor circulation.
A complete pulse assessment requires recording three characteristics: rate, rhythm, and amplitude. Rate is the number of beats per minute (BPM), typically 60 to 100 BPM. Rhythm refers to the pattern of the beats, documented as regular or irregular.
Amplitude describes the strength of the pulse wave felt against the fingertips. This strength reflects the volume of blood ejected by the heart and the arterial wall condition. Amplitude is standardized using a numerical grading scale for consistent documentation.
The Standardized Pulse Amplitude Scale
Documentation of pulse strength relies on a standardized, five-point scale ranging from 0 to 4+. This numerical system translates the subjective sensation of the pulse into an objective data point to communicate the quality of circulation.
A grade of 0 is documented when the pulse is completely absent and cannot be palpated, indicating a severe obstruction or lack of blood flow. A grade of 1+ is noted for a diminished or weak pulse, feeling thready and easily obliterated with light pressure. This finding suggests reduced blood volume or flow.
The expected finding is a grade of 2+, which represents an easily palpable pulse considered normal or brisk. This pulse is felt with moderate pressure and requires slightly firmer pressure to be obliterated.
When the pulse is stronger than normal, it is documented as 3+, described as full or increased. The highest grade, 4+, is reserved for a bounding pulse that is very strong and difficult to obliterate with finger pressure. This finding can be associated with conditions causing a hyperdynamic state, such as fluid overload or certain vascular conditions. The clear definition of each grade ensures that all healthcare providers interpret the documented findings consistently.
Formatting and Recording the Assessment
Translating the physical assessment into a written record requires a specific, standardized format. The primary rule is the necessity of a bilateral assessment, meaning pulses must be checked and recorded on both the right and left sides. This comparison is essential because asymmetry in pulse strength can signal a localized vascular issue.
A typical documentation entry must include the pulse location, the numerical amplitude grade, and the side of the body. Common abbreviations like DP (Dorsalis Pedis) and PT (Posterior Tibial) streamline charting. An example of a normal entry is “DP 2+ bilaterally, PT 2+ bilaterally.”
If a pulse cannot be felt by standard palpation, a handheld Doppler ultrasound device is used to detect arterial blood flow. When the Doppler is used, the finding must be recorded explicitly to distinguish it from a pulse felt by touch. For instance, an entry would read “L DP non-palpable, Doppler present,” confirming blood flow even though the pulse was not manually detectable. This detailed and structured approach ensures that the documented assessment is a precise communication tool regarding a patient’s peripheral circulation status.