Question?

jb2u, ASN, RN · Aug 6, 2006

I work on a cardiac floor, so ir hr are the norm. I say let it out slow pump it up high (until you feel the pulse disappear plus 20) and let it go all the way down.

Daytonite, BSN, RN · Aug 6, 2006

You should be palpating for a pulse, maintaining your feel of the pulse, inflating the cuff slowly and noting the point at which the pulse is completely oblitered (where you stop feeling the pulse). Deflate the cuff. Let the patient open and close their fist and rest their arm for about 30 seconds. Now, place your stethoscope over the pulse point. Inflate the cuff 20 points above the point at which the pulse was obliterated and S-L-O-W-L-Y release the air. You should start to hear the pulse at that pre-determined point you just determined. This should be an accurate blood pressure reading. You usually will not get accurate pressures with electronic equipment. It is because the mathematical forumulas inside the equipment cannot account for the irregular heart rate in calculating the blood pressure. Therefore, you should do a manual blood pressure as I have described above.

Lil123 · Aug 6, 2006

Thank You! I'm sure it'll take some practice. Thanks for sharing.

AuntieRN · Aug 7, 2006

Daytonite...is that why sometimes you can not even get a reading from the automatic machines? You know I am about to graduate on Thurs with my ADN and noone and I mean noone in the past 5 semesters or even at work has ever told me not to use the machine with an irregular heart rate..now I am feeling unprepared...is this something I should have just known for some reason even if not specifically told? :idea:

chadash · Aug 7, 2006

It is really important to record and report.

If there are real pauses in the pulse, you might not get the most accurate reading, but you must record the reading you got, with explanation of the irregularity in the pulse. Don’t try to factor it in yourself.

I like to use the method Daytonite described: doing a preview while palpating the radial pulse to determine the approximate systole. It will give you an idea of when the pulse is obliterated, so you have a ball park notion of how high to pump it up. It will not help you estimate diastole: you will be able to palpate a pulse all the way down.

Again, always describe accurately what you observed.

If you run into a really tough one, ask the nurse to check that patient's BP and see how she handles it.

chadash · Aug 7, 2006

............
You usually will not get accurate pressures with electronic equipment. It is because the mathematical forumulas inside the equipment cannot account for the irregular heart rate in calculating the blood pressure. Therefore, you should do a manual blood pressure as I have described above.

Thought you might find this interesting:

Accuracy xxxxxx automated blood pressure monitor.

Beaubien ER, Card CM, Card SE, Biem HJ, Wilson TW.

Division of Nephrology, McGill University, Montreal, Quebec, Canada. [email protected]

Accurate blood pressure (BP) measurement is important for the detection and treatment of hypertension. Despite widespread use of automated devices, there is limited published evidence for their reliability and accuracy. To determine the reliability and accuracy of the xxxxxx, a commonly used non-invasive oscillometric BP monitor The Dinamap was evaluated against the mercury manometer in 70 randomly selected adult hospitalised medical patients. Each individual underwent three sets of standardised BP measurement by automated method and three sets by mercury manometer by two independent observers. Reliability of BP measurement was assessed by repeated measures analysis. Dinamap accuracy was evaluated according to the American Association of Medical Instrumentation (AAMI) and British Hypertension Society (BHS) guidelines. Most patients were either normotensive or had stage I hypertension. The Dinamap tended to overestimate lower diastolic BP, and displayed poor reliability (P 160/90 mm Hg (grade D) although these measures were based on a smaller sample of subjects. In conclusion the Dinamap yields inaccurate estimates of both systolic and diastolic BP even under standardised, and thus optimal conditions. This inaccuracy is exaggerated at higher BP (>160/90 mm Hg), although the number of measurements at higher pressures was small. We recommend that this device not be used when accurate BP measurement is needed for therapeutic decision-making.

PMID: 12214262 [PubMed - indexed for MEDLINE]

Daytonite, BSN, RN · Aug 8, 2006

some years ago i proudly bought and started using my own little automatic b/p cuff only to discover that something wasn't right with some of the b/ps. i did my own little survey and found that on the patients with irregular heart rates the cuff was often 20 points out of whack compared to my own manual pressure that i took on the same patient. i started taking manual b/ps on the patient's with irregular heart rates after that. i have talked with several respiratory therapists who have told me that the pulse ox machines also don't give an accurate reading on patients with irregular pulses. watch one sometime as it tries desperately to calculate a oxygen percentage with an irregular pulse. it has a very hard time doing the calculation because it can't get a accurate pulse count.

jb2u, ASN, RN · Aug 8, 2006

When doing a manual bp, you must do it slow to insure that you "get" every beat. It is not recommended to use a auto-bp machine, however there are times when you must. Sometimes we have VERY obese pts or pts with mast on one side and an av graft on the other, so we have to read it in the legs. Sometimes the pt's bp is just too faint...so you can use a doppler, but you get only the systolic number. Point is...manual is best, but sometimes you just can't get a manual.....it is better to be off by 20 than to not get it at all.

Lil123 · Aug 18, 2006

Thanks everyone what an interesting discussion! I guess I'd better practice,practice.

danh3190 · Aug 19, 2006

When counting pulses or manually measuring a BP on an irregular pulse I've often noticed that after a pause in the pulse the next beat would be very strong (Frank-Starling effect????). I was wondering if that beat would give an artificially high systolic reading and whether I should repeat the measurement? Would that strong pulse screw up automated equipment?