[LanaBanana]

I'm on a 6 week summer break from my PN program, but before we went on break my instructor showed us a different technique for taking BPs that she wanted us to practice. She had us feeling the radial pulse at the same time we were pumping up the cuff and then seeing when you stop feeling the radial pulse. Then you let out the cuff, wait a few seconds, and pump it up again but pump it 20 higher than when you stopped feeling the radial pulse and continue in the normal way of getting the BP. I understand the reasoning behind this - it keeps you from needlessly pumping the cuff to 180 and squeezing someones arm off when their systlolic # is only 110. But I'm concerned this is time consuming, makes you look a little imcompetent to the patient (because they think you're taking the BP twice), and could lead to a false reading because of pumping it up twice.
What do you think? Does anybody do this? She said we needed to do this technique in our assessments.

[RNsRWe]

We were taught to use the auscultation method for pulse obliteration. While pumping up, you're listening for the point at which you no longer hear the Korotkoff sound (spelling is probably off there, sorry). When you no longer hear that beat (pulse obliterated), you then pump to 20 mmHg above that. Then listen for the return of the sound (your systolic #) on the way down.

The reasoning is that it's not so unusual to find someone with what's called an "ausculatory gap": someone who, if you stopped pumping (and listening) at the point where you heard the sound stop, you could wind up with a false reading (a false low). There are people (and I've heard them!) who you think have a systolic of, say, 122, but once you pump up higher and listen on the way down, find that they are really at a systolic of 138. Quite a difference.

I do it this way automatically, all the time. I don't feel for a pulse obliteration (yes, I learned of it, it was a method, but frankly seemed more clumsy to me). I just put on my steth, listen, pump a bit more, listen / release. Never had anyone think I was incompetent, no one has even commented on my "pumping it twice". At least not when done this way, and done quickly and efficiently.

[LanaBanana]

So you're just listening and not letting the cuff out and pumping it up all over again, right?

[ukstudent]

Standard method of obtaining a B/P in my school. Practice on somebody while on break and it get's easier to do.

[ukstudent]

We were taught to let the air out and then pump up again after a minute break,

[RNsRWe]

Originally Posted by LanaBanana

So you're just listening and not letting the cuff out and pumping it up all over again, right?

Yes. Listen for the point at which you don't hear it (got it...got it....ok, it's gone). Cuff is inflated, of course. Now pump up an additional 20 mmHg. Let the cuff out slowly (but not too slow, learn the pace) and listen for when the korotkoff sound kicks in. There's your true systolic.

No, you definitely don't let it all out at the point of obliteration and pump it all back up again....frankly, I don't think that's even a good idea. Could bruise someone, as well as get a false reading because you've just constricted the vessels. If you need to take a second BP reading on someone right after the first for some reason (like you didn't think you got it correctly the first time) you'd go to the second arm.

With practice, this goes quickly and smoothly. Only awkward while you're learning

[Daytonite]

The technique your instructor is teaching you is a technique that is used to assure the most accurate blood pressure reading you can obtain. The actual performance of obtaining a blood pressure is not as accurate as you would think and five people could get five totally different readings. Here is a website that lists out the technique your instructor is teaching you. This particular protocol was taught to data collectors for a research project. All the data had to be as accurate and uniform as possible, so the data collectors were to follow this procedure exactly. You will see that the reason for palpating for the radial pulse and then inflating the blood pressure cuff until the radial pulse is obliterated is to obtain the point at which the pulse is obliterated. You then, according to the directions of this particular research project, add 30 more points (your instructor is only asking you to add 20 points) when inflating the cuff to take the next reading at the brachial pulse. Read this procedure over. You will see that the data collectors are instructed to wait some seconds to assure that any blood pooled in the arm has had a chance to return to circulation before continuing to take another B/P measurement. What you tell your patients is that you are (1) trying to get as accurate a reading as possible, and (2) trying to avoid unnecessary discomfort by inflating the cuff tighter than is necessary.
http://www.ktl.fi/publications/ehrm/product2/part_iii3.htm

[marilynmom]

Originally Posted by LanaBanana

I'm on a 6 week summer break from my PN program, but before we went on break my instructor showed us a different technique for taking BPs that she wanted us to practice. She had us feeling the radial pulse at the same time we were pumping up the cuff and then seeing when you stop feeling the radial pulse. Then you let out the cuff, wait a few seconds, and pump it up again but pump it 20 higher than when you stopped feeling the radial pulse and continue in the normal way of getting the BP. I understand the reasoning behind this - it keeps you from needlessly pumping the cuff to 180 and squeezing someones arm off when their systlolic # is only 110. But I'm concerned this is time consuming, makes you look a little imcompetent to the patient (because they think you're taking the BP twice), and could lead to a false reading because of pumping it up twice.
What do you think? Does anybody do this? She said we needed to do this technique in our assessments.

Lana,

We had Fundamentals last semester and we learned to take a BP the same way as you. Yes it takes longer, but from the reading I have done it is actually more accurate! So it's a good skill to learn to do it that way IMO.

I usualy would palpate for the systolic (with the radial or brachial pulse depending on the person) and then deflate, check the pulse and respirations in between to let the blood flow back, then reinflate and do the systolic while listening. I was ALWAYS right on with blood pressures that way.

[marilynmom]

Originally Posted by Daytonite

The technique your instructor is teaching you is a technique that is used to assure the most accurate blood pressure reading you can obtain. The actual performance of obtaining a blood pressure is not as accurate as you would think and five people could get five totally different readings. Here is a website that lists out the technique your instructor is teaching you. This particular protocol was taught to data collectors for a research project. All the data had to be as accurate and uniform as possible, so the data collectors were to follow this procedure exactly. You will see that the reason for palpating for the radial pulse and then inflating the blood pressure cuff until the radial pulse is obliterated is to obtain the point at which the pulse is obliterated. You then, according to the directions of this particular research project, add 30 more points (your instructor is only asking you to add 20 points) when inflating the cuff to take the next reading at the brachial pulse. Read this procedure over. You will see that the data collectors are instructed to wait some seconds to assure that any blood pooled in the arm has had a chance to return to circulation before continuing to take another B/P measurement. What you tell your patients is that you are (1) trying to get as accurate a reading as possible, and (2) trying to avoid unnecessary discomfort by inflating the cuff tighter than is necessary.
http://www.ktl.fi/publications/ehrm/product2/part_iii3.htm

Excellent. That is exactly how we learned to take a BP as well. Accuracy should be the most important thing when doing a BP!

[madwife2002]

You know we were taught how to do the BP by pulse only as well but for different reasons, occasionaly you wont hear a persons BP and in this case you can feel their BP. I have used this on very poorly pts in the past and I always teach the student to do it just in case. I have used it rarely but I have utilised it.