[dali92]

Automatic machines are used in the OR- & where I work, these are the same machines we use in PACU & in ICU. When we have a patient w/an A-line- and this depends on positoning too-- it is very close to what we get on the automatic machines, so yes, I trust them!!! I asked one of the CRNAs once what they did years ago-- he said they used to have to take every BP manually in the OR- AND w/no Sa02 monitors they were watching their patients VERY closely-- this was also in the days of ether! I would say if you're getting all high one shift and all low another then you need to look at the technique of the people taking them, and whether or not your machines are regularly maintained to function optimally. What I DON'T trust are the tympanic thermometers!!! I have heard the temporal ones are more accurate, but that's what they used to say about the tympanic ones. (the mercury ones were alot more accurate but not as quick)

[Spidey's mom]

Originally Posted by marilynmom

I'm a tech and we do all the above as well.

As I said . . .amazing.

dali92 - I agree with you about temps . . .those tympanic things are useless in my mind and I'm not sure about the temporal . . . I went to an inservice with the guy selling the temporal and he took my temp and it was high so he waited and did it again and got a different number and then did it again and the number was different.

I just think oral or rectal are the best . . . . You'd be hardpressed to take a rectal on a 33 year old father of two though . . . .

steph

[AfloydRN]

I prefer manual blood pressures- they are more accurate, especailly if you are dosing meds based on pressures. I don't mind the temps and HR.

[possumtoes]

No,call me old fashion, but the ears don't lie. If the patient is running a-fib, both the pulse and b/p will not be accurate. Also, our cardiologists will always ask if it was manual if you call to report abnormalities.I usually try to get my own vita when I do my original assessment so that I have something to use as a baseline. It dosnt always work tha.t way, but that is my aim

[Indy]

No, I don't trust the machines.
1. I don't see too many people cleaning them, god knows what we're passing around germ-wise. Ugh.

2. blood thinners, old age, and the fact that the thing takes a minute or so to mash someone's arm to all heck and back before deciding on a number is just plain cruel. It takes me 30 seconds or less and I'm done.

3. A-fib makes the machines do some crazy stuff.

4. Use the manual and you're 1/4 of the way done with a skin assessment when you do your BP.

Now I have a good tech. She's priceless! Any wonky crap out of the machines and she will do a manual BP and tell me the difference. I usually follow her the first time around and do my assessments while she's on vitals so if it's screwy, I can help right then and there. But honestly, I don't work with her too often. So I'm used to doing my own vitals and I don't have it in my mind to even look for a machine. I grab a thermometer, a hand held pulse ox if there is one, and go. (Pulse ox's are in our rooms but they are way up on the walls... long story!) During the VS I notice: what the inside of the mouth looks like when I take a temp, what IV's and tubes are where, when I do BP, skin assessment on arms for BP, oh yeah, JVD during temp! For pulse ox I'm seeing cap refill, temp of hands, tremor, are the fingers arthritic, etc. I can hold their hands if they need a little TLC. There's a conversation going on the whole time if the patient's awake, so I can get a lot of work done in the few minutes it takes to get vitals. From there it's natural to finish the assessment and it doesn't seem to take me more than 5-8 minutes to do my assessment and VS together. I take less time on VS later in the shift 'cause I've already got a good idea of what the patient looks like.

My assessments go faster when I've got a tech helping with VS but I always wonder what I missed.

[TeleRNer]

Originally Posted by TigerGalLE I learned from them though.. I just graduated and passed my boards.. I will not be one of those nurses!

Oh yeah!!!! And you won't have a large derriere from bossing someone around while you're sitting down all the time!

[abundantjoy07]

Originally Posted by Indy

No, I don't trust the machines.
1. I don't see too many people cleaning them, god knows what we're passing around germ-wise. Ugh.

2. blood thinners, old age, and the fact that the thing takes a minute or so to mash someone's arm to all heck and back before deciding on a number is just plain cruel. It takes me 30 seconds or less and I'm done.

This is very true...the BP cuffs especially the automated (Dynamaps) that are used are very rarely cleaned in between patients. You just go room to room checking BPs and not cleaning them...

And yes, doing some things like pulses and even BPs is much more efficient manually. It's quicker, easier, more reliable, and for gosh sakes...did I say QUICKER!

There's just something about a Dynamap that takes them 5 minutes to get a BP that you could get in 30seconds...without all the repeated arm squeezing because of errors.

As far as trust. The thing I trust the most is myself. I have gotten some very strange readings from some machines...only to check myself and get something closer to what I expected.

[Schatzi RN CEN]

At the place where I work we now issue cuffs to our patients, that get marked with their name and stay in the room. Yhis has cut down significantly on cross contamination.

The other issue about trusting the machine brings something to mind that we heard over and over in Nursing School: Treat the patient and not the machine. I think it is great to use dynamaps or passport machines, if you still use a dose of good old nursing judgement. Does your assessment correspond with what the machine tells you? Have you ever ran down the hall, because a telemetry read v-tach or worse, and been met by a smiling patient that is just a little bewildered by the look of panic on your face? I think the same goes for automatic BP's, pulse counts and SaO2.

Especially the O2 sat is often misleading. Our patient may have a sat in the 90's, but how much effort is he putting into maintaining that O2 sat?

These are all questions that can only be answered by one thing and that is a good nursing assessment.

[Tiwi]

I have found that electronic sphygmos in the main, are accurate, and really help when it is difficutlt to hear a BP. But I have found them to be totally in accurate when there is an arrhythmia, eg AF, which then means that a manual is essential. What I often find inaccurate are the "ear thermometers" - how embarrassing, I can't remember the proper name! And these days there are no manual instruments around as anything containing mercury is banned...

[Grammie1]

Indy can be my nurse any day!
I was taught by an excellent preceptor to do the first set of vitals manually, then if the machine agrees, ok. However if the machine later tells me something else, check it and see if I agree. Another thing she said was "Before you do CPR on a patient who's telemetry says they've coded, ask them if they have a pulse, if they say yes then don't start CPR!" Of course we all know about v tach with a pulse, but the basic principles she taught me still work.