Can you palpate the brachial (blood pressure) pulse?

Palpating the Brachial Pulse

Yes, the brachial pulse can be palpated on the inner surface of the upper arm between the bodies of the biceps and triceps muscles. 1

Anatomical Location and Technique

The brachial artery runs along the inner aspect of the upper arm and serves as an important pulse point for clinical assessment. According to the American Heart Association guidelines:

• The brachial pulse can be located on the inner surface of the upper arm between the biceps and triceps muscles 1
• This is the standard location for blood pressure measurement using the auscultatory method 2
• When palpating for the brachial pulse, apply gentle pressure with your fingertips (not thumb) to feel the pulsation

Clinical Significance

The brachial pulse has several important clinical applications:

1. Blood pressure measurement: The brachial artery is the standard site for blood pressure measurement using both auscultatory and oscillometric methods 1, 2

   • The stethoscope is placed over the brachial artery in the antecubital fossa to auscultate Korotkoff sounds
   • Proper cuff placement requires identifying the brachial artery first

2. Pulse assessment: The brachial pulse can be used to assess:

   • Heart rate and rhythm
   • Pulse amplitude (graded as 0/absent, 1+/decreased, 2+/normal, 3+/increased) 1
   • Arterial patency

3. Arterial stiffness assessment: Some methods for measuring arterial stiffness utilize the brachial pulse 1

Comparative Reliability

When comparing different pulse sites:

• In normotensive infants, studies show that apex auscultation is more accurate than pulse palpation, but among pulse sites (brachial, carotid, femoral), all were equally effective for detecting heartbeat 3
• In hypotensive infants, femoral pulse palpation was found to be more successful, rapid, and accurate than brachial pulse palpation 4
• For adults, the brachial pulse remains a standard site for clinical assessment, particularly for blood pressure measurement 2

Important Considerations

1. Proper technique is essential:

   • The arm should be supported at heart level 1, 2
   • Clothing should be removed from the area 1
   • Use the pads of your fingers, not your thumb (which has its own pulse)

2. Potential limitations:

   • Arterial calcification can affect pulse palpation accuracy, particularly in diabetic patients 5
   • Anatomical variations may make the pulse difficult to locate in some individuals
   • In obese patients, the pulse may be more difficult to palpate due to increased tissue thickness 1

3. Arm position matters:

   • If the arm is below heart level, readings will be falsely elevated
   • If the arm is above heart level, readings will be falsely decreased
   • These differences can be approximately 2 mm Hg for every inch above or below heart level 1

The brachial pulse remains an important clinical assessment point, particularly for blood pressure measurement, which is the standard approach recommended by major cardiovascular societies for assessment of hypertension and cardiovascular risk.