Apical-Radial (A-R) Pulse Assessment

The A-R pulse assessment involves simultaneous evaluation of the apical and radial pulses. When the apical and radial pulse rates vary, this assessment helps identify a pulse deficit.

Pre-Procedural Preparation

1. Equipment Preparation: Gather all necessary supplies, including a watch with a second hand (for accurate counting), a stethoscope, antiseptic wipes, and a vital signs flow sheet.
2. Patient Interaction:
   • Identification: Confirm the patient's identity.
   • Explanation of Procedure: Explain the complete A-R pulse assessment process before the procedure to the patient to alleviate anxiety.
   • Verbal Consent: Obtain verbal consent from the patient.
   • Hand Hygiene: Perform hand hygiene to reduce the risk of infection transmission.
   • Privacy: Ensure the patient's privacy is maintained during the assessment.

Procedure

1. Stethoscope Preparation: Clean the diaphragm and earpieces of the stethoscope with an alcohol swab to prevent cross-contamination.
2. Patient Positioning: Assist the patient into a comfortable sitting or prone position for easy access to the chest and wrist.
3. Methods for A-R Pulse Assessment:
   • Two-Nurse Method: This involves two nurses working simultaneously. One nurse uses a stethoscope to listen to the apical pulse at the heart's apex while the other nurse palpates and counts the radial pulse at the wrist.
   • One-Nurse Method: When only one nurse is available, they first assess the apical pulse and immediately assess the radial pulse. This method may be less accurate for detecting pulse deficits due to the time gap between assessments. For more accurate detection of pulse deficits, it is recommended that two nurses assess the apical and radial pulses simultaneously.

Post-Procedure

1. Patient Comfort: Ensure the patient is comfortable and safe after the assessment.
2. Equipment Replacement: Clean and replace the equipment used.
3. Hand Hygiene: Perform hand hygiene again after completing the assessment.
4. Documentation: Record the findings on the vital signs flow sheet, including any discrepancies between the apical and radial pulses. Note the presence of any pulse deficit and report it to the healthcare team as needed.