Why do some nurses guess on BP?

[Dixon, future NP]

Hello Everyone!

Why do some nurses guess when it comes to taking a blood pressure?

I am a patient, I am a CNA and CNA instructor. When I go to the doctor I do not share this information but it really bothers me when I see nurses make mistakes at the patients expense.

Yesterday I went to the doctor for a physical. I had my blood pressure checked by an LVN, a nurse, I was shocked that he guessed on my blood pressure. It took him about 30 seconds from placing the cuff to reading my BP. He didn't bother checking for brachial artery, stethoscope placement was wrong, blood pressure cuff placement was wrong and in my opinion BP was just a guess based on looking at sphygmomanometer. We all know that you cannot get an accurate blood pressure reading this way.

I tried to be very nice about it by saying my blood pressure is never that high, can you please re take it? He did but he did it the same way as the first time.

Please explain if you know, is reading a blood pressure that hard?

[NayRN]

Same thing happened to me-it was very quick, and the needle was sitting at about 115 when she said "ok, good!" Pretty sure she got my systolic, and then didn't bother with the diastolic. I know my pressure is fine, but still...

[Aeterna, BSN, RN]

Truthfully, once I realized that the brachial artery is pretty much in the same place in everyone, I've stopped checking for it (when I was in my first year of nursing school, an upper year nursing student taught me how to landmark for it and it works every single time). So, I put the diaphragm of my stethoscope in that spot. However, I was taught very specifically to listen for those key sounds (damn, I can't remember what they're called, lol) instead of eyeballing it.

I remember reading blood pressures was the most difficult part of learning vital signs as a student, but once we all had the steps and practice down, it became easy.

[itsnowornever, BSN, RN]

Kortikoff sounds (spelling) is what they are called. You don't need perfect placement. They are pretty frigging loud and for the most part the brachial artery is in the same place on everyone.

[Double-Helix, BSN, RN]

I agree that it's not necessary to palpate the brachial artery. Placing the stethoscope in the center of the antecubital fossa is sufficient to hear Karotkoff sounds in almost all patients. It's also not necessary to decrease the pressure in the cuff by 2mm of Hg every second, as you're taught in school. I can easily take an accurate BP in less than 30 seconds.

[loriangel14, RN]

Just because they were quick doesn't mean they were guessing.Experienced nurses can take a manual BP very quickly.

[awalker1015]

I do manual BPs all day long at work and I can get an accurate BP in less than 30 seconds. If you know what you are doing it is possible. Every now and then I get a tough pt I have to palate the brachial, etc. But generally I can get a quick one and that doesn't mean it is inaccurate.

[Dixon, future NP]

As the post stated, placement of key elements was wrong. The 30 seconds was a secondary factor in why I came to my conclusion.

My intent wasn't to find out which Nurse could do a BP in 30 seconds or less but thanks for the insight. One day I hope to be able to do the same and also do it correctly.

I have been doing manual BP's for only 10 years, I have a lot to learn, so I just don't cut corners like I felt this Nurse did. I had no confidence in any of his skills for many reasons this just being one.

[Meriwhen, ASN, BSN, MSN, RN]

I can easily take an accurate BP in less than 30 seconds.

So can I. Otherwise I'd be forever in triaging patients.

Can't say anything about the cuff placement as I wasn't there.

Just because the LVN was looking at the sphygmomanometer doesn't mean he also wasn't listening for the Karotkoff sounds. I look while I'm listening so I know exactly what the BP reading is. Again, I wasn't there--nor am I him--so I can't say for certain whether he was listening. But looking at the sphyg alone does't automatically designate it a bad BP reading.

Ironically, I can't look at my watch while taking a pulse--I have to look at the wall and glance at the watch periodically.

[GitanoRN, BSN, MSN, RN]

trust me, it's no guess...it's called experience, i as well can get a bp under 30sec.

[sauconyrunner]

I think it may have been the attitude of the taker? But I admit, I have sometimes wondered about the office girls at some offices, as my BP always seemed to be identical to the last time I was there...

I usually do look at the numbers while listening. It helps me confirm what i am hearing.

[nurseprnRN, BSN, RN]

you have to look at the gauge at the same time you listen to the korotkoff sounds, or you won't know what the pressure is when you hear the first and last sounds, so you won't know what to write down.

in answer to the op's question, it's because they are lazy, never learned what the blood pressure truly measures and what systolic and diastolic indicate physiologically, or they just don't care.

don't get me started on those autocuffs (dinamap and others). these must be applied properly or they can't "hear" the sounds, and they are not appropriate to use with anyone who has an irregular pulse and an irregular pulse pressure, like, oh, everyone in atrial fibrillation! i see them applied wrong all the time (including by the ma at my pcp's office) so the readings are useless for care decision-making, but nobody seems to care.