Vital Signs: Pulse Rate


There  has  been  very   little  research evaluating the measurement of pulse rates. It  is  likely,  that  when  heart  rate  is  of concern,  cardiac  monitors  are  used  to determine not  only rate, but  also rhythm. The  role  of the "pattern of the pulse", for example  regular  pulse  versus  irregular pulse  or  strong  pulse  versus  weak  pulse, have not been addressed in the context of vital signs or patient observations. On this basis,  an  important  role  of  pulse  rate monitoring will likely be  to  identify when more advanced monitoring is required. 

Measurement  of  a  person's  pulse  rate  in the  presence  of  atrial  fibrillation  was evaluated  and  results  suggest  that  pulse rate,    measured    apically    using    a stethoscope for a 60 second count period, is likely to be the most accurate rate. This study  noted  that  86%  of  nurses  underestimated  the  pulse  rate,  and  that  as  the heart rate increased the magnitude of error also      increased.      Another      study recommended a 30 second count  period as the most accurate and efficient way of measuring  pulse  rate,  noting  that  the  15 second count time was the least accurate. A  third  study  found  that  there  was  no advantage in using the longer 60 seconds, over  the  15 or  30 second count  periods. These researchers suggest that counting an accurate pulse rate may be more difficult than commonly recognised. 



A study assessing infants apical pulse rate using a stethoscope, suggested that length of  time  may  not  be  the  primary  factor  in errors, and that like respiratory rate, pulse rate also appears to be influenced by infant states in addition to illness.

While these studies have identified that the accuracy  of  pulse  rate  measurements  is influenced by the number of seconds that the   pulse   is   counted,   the   clinical significance of these findings is unclear. The contradictory  findings  of  studies  suggest that  the  count  period  used  to  determine pulse rate is of only limited significance.
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