blood pressure

Hi! Wrap the cuff around the upper arm snug..not tight, you should be able to get a finger partway under the cuff, but not all the way or it will be to loose and pinch the patient when you inflate it. Put the stethoscope on the brachial artery inside the elbow. I like to put my thumb on the scope and wrap my hand around so my fingers are on the elbow joint so that I can hold the joint very straight and keep the scope snug on the artery. Pump up the cuff to about 140-150 and slowly release the screw on the valve, listen and watch the manometer, as you practice you will be able to hear what you see, count from the first beat you hear to the last beat. If you hear a beat as soon as you let off the valve and you are working with a cardiac pt that has a hx of high BPs then pump up higher that 150. Also remember not to take a pressure more that 2x in a row on one arm especially in elderly folks, this can damage their veins and every time you take a pressure after the first 1 or 2 it will not be as accurate. The first beat is the Systolic or top number, the last is the Diastolic or bottom number. The pressure is ___ over ___. Practice a lot at home on any willing person, this skill takes repetition to get good. Hope this helps!

I've had a lot of help from many wonderful nurses and nursing assistants on allnurses on this topic. Here's how I take a BP:

1. Open the valve on the bulb (if closed) and gently squeeze out any air remaining in the cuff. Close the valve.

2. Locate the brachial artery on the anterior medial elbow.
So, without the medical jargon: place 2-3 fingers (use the pads of your fingers, not just the tips) on the inside of the elbow closest to the body (little finger side).
Make sure the elbow is as straight as possible. If the person can hyperextend their elbow a little, it will help tremendously in finding the pulse. But, of course, never go beyond someone's natural range of motion.
I place my fingers as far over as possible, almost until I touch the elbow joint on the bottom, and slowly work my fingers across the elbow crease until I feel a pulse. (You may have to push a little. Just don't apply so much pressure that you cut off the blood supply, thereby obliterating the pulse completely.) Then I usually do a little extra feeling above, below, and to the sides of that area to see if the pulse is a little stronger anywhere else--the stronger the pulse feels, the easier it is to hear. You will feel the brachial pulse before you pass the center of the elbow. (Remember, start feeling on the little finger side and work toward the thumb side until you reach the center of the elbow. If you didn't find it, retrace your "fingersteps" back down to the little finger side of the elbow and try again. You may have to use varying levels of pressure.)

3. Place the person's arm at heart level and wrap the cuff around, about one inch above the elbow. The middle of the bladder (the part that fills with air when you pump it up) inside the cuff should be centered, in line, with where you felt the brachial pulse. Most BP cuffs have a little circle with a line through it to mark the middle of the bladder. Make sure the cuff is snug; you don't want it sliding around, but you also don't want it so tight that it effects circulation.

4. Find the radial pulse at the thumb side of the wrist. Pump the cuff up until you reach 90mmHg on the gauge. Check to see if you still feel a pulse. If you do, continue pumping the cuff up 10mmHg at a time and checking for the pulse until you no longer feel it. REMEMBER the number where the pulse disappeared, it will be your estimated systolic pressure. This is your range--you should expect to hear the first pulse (Korotkoff) sounds around that number when you listen with your stethoscope.

6. Open the valve and deflate the cuff completely. Re-adjust the cuff if it has moved out of position or is loose. (You can also take the cuff off, squeeze out the air, close the valve, and then re-apply the cuff). Close the valve. Wait 30 seconds.

7. Put the stethoscope earpieces in your ears (make sure they point toward your nose before you insert them) and feel for the brachial pulse again. Place the chest piece of your stethoscope (use the bell, if your stethoscope has one) over the area where you feel the strongest brachial pulse. Make sure that the tubing running from the bladder of the cuff isn't rubbing against your stethoscope and that your stethoscope isn't underneath the cuff.

8. Pump the cuff up to your estimated systolic pressure (Step 4) and then pump it up to 30mmHg above that number. (i.e. If you felt the radial pulse disappear at 120mmHg when you were finding the range, you would pump the cuff up to 150mmHg when you actually take the BP.) Open the valve and let the cuff deflate at a rate of 2-4mmHg/sec.

9. Note the number where you hear the first pulse sound (wait until you hear at least two consecutive tapping sounds) as your systolic pressure. Continue listening until the repetitive tapping sounds disappear altogether (Phase 5 Korotkoff sounds). You would then mark the diastolic pressure as the number on the gauge when you heard the last sound. However, if you hear repetitive tapping sounds all the way down as you are deflating the cuff (this happens in some people, it's most common in children) mark the diastolic pressure as the point in which you heard the sounds change from clear, crisp tapping sounds (Phase 3 Korotkoff sounds) to muffled tapping sounds (Phase 4 Korotkoff sounds).

10. Listen for 10-20mmHg after you hear the last sound (if the sounds did cease) and then, if you don't hear any repetitive sounds after that, rapidly deflate the cuff and remove it.



Kind of long winded, I know. But I thought it might help. I'm also including some links below that have helped me.

Number one key to this is PRACTICE! I'm pretty new to it myself, but taking as many BPs as possible has helped a lot. You'll get the hang of it, I promise. I know I thought I was a lost cause with BPs, but it gets so much easier the more you practice.

And as far as everyone talking, you need to take that up with the instructor or tell them all to shut it. But tell them to shut it politely, of course. Good luck!


http://en.wikipedia.org/wiki/Korotkoff_sounds - General information about Korotkoff sounds.
http://www.abdn.ac.uk/medical/bhs/tutorial/tutorial.htm - Lots of nice practice videos with explanations.
http://deptets.fvtc.edu/nursing/index.htm - Lesson 51: Blood Pressure

These links courtesy of Daytonite:

• http://homepage.smc.edu/wissmann_paul/anatomy1/1bloodpressure.html - how to take a blood pressure
• http://www.uams.edu/csc/programs/orientation/bloodPressure.htm - How to Take a Blood Pressure
• http://medicine.osu.edu/exam/ - from Ohio State University College of Medicine, an Interactive Guide to Physical Examination for 8 body systems and includes sounds. Has an interactive blood pressure cuff (the link is toward the bottom of the page, "Take a blood Pressure") where you click on a blood pressure bulb to start the inflation of the cuff. You will then hear and watch the manometer and tell the program what the final blood pressure is. It re-cycles to give you lots of practice!
• http://nursing.about.com/od/assessmentskills/ht/bloodpressure.htm - How to Take a Blood Pressure
• http://allnurses.com/forums/f50/hearing-bps-177877.html - Hearing BPs
• http://allnurses.com/forums/f50/need...ll-138933.html - Need Helpt on Blood Pressure Skill
• http://www.ktl.fi/publications/ehrm/product2/part_iii3.htm - Blood Pressure Measurement where peak inflation level is determined first by palpating a radial pulse, inflating cuff and then determining the point at which the pulse is obliterated.
• http://www.sweethaven.com/free-ed/HealthCare/LessonMain.asp?cNum=1&iCode=fra0204 - taking and monitoring vital signs. From Sweethaven's Health Care.

Zooz gave you a great response! I just wanted to say DON'T FORGET that you can't hold the chest piece of the stethescope with *your* thumb...because your thumb has a heartbeat and you might get confused when reading the blood pressure. Just practice, practice, practice---it took me awhile! Good luck.

Good point! I've never done that myself, but I see people do it all the time. You might not be able to hear the thumb pulse at all (I know my stethoscope switches off the side that isn't being used, so I probably wouldn't be able to hear it anyway), but better safe than sorry.

When I'm ready to take a BP (found my range and all that other stuff) and I have my fingers over the brachial pulse, I usually just make a 'V' with my two fingers and place the bell of the stethoscope between them and then lightly place my fingers on the outer "circle" of the bell. It keeps me from losing the pulse site and seems to reduce the amount of "friction noise" from things bouncing around.

Also, make sure you apply enough pressure on the chest piece of the stethoscope to make a good seal with the skin, but not so hard that you cut off the pulse.

very helpful links..thanks!