Brachial Occlusion Pressure

Esme12, ASN, BSN, RN · Aug 29, 2013

You really shouldn't have to pause but like any other nursing skill it takes practice. This link may help....The Brachial Blood Pressure | Adult Physical Examination - Prof B Kichu Nair ed.

**NICU Guy, BSN, RN** · Aug 29, 2013

I put the BP cuff on the arm, place the stethoscope over the brachial artery and listen for the pulse, inflate the cuff to 180 (for an adult), pause and listen for pulse, if no pulse start deflating and listen for pulse to return. I originally came from the EMS environment where you don't have much time to do an extensive BP (1 quick set of vitals before you leave the scene), but I have never had a clinical nursing instructor correct me. My opinion is that you are not concerned with the exact point the pulse disappears (as long as it is absent when you start deflating). I like having a little gap between the point at which I stop inflating and when I detect the pulse again. It confirms that I was above the point of the systolic pressure.

Like Esme said, it comes with practice.

smoup · Aug 29, 2013

So many sites gives techniques for using the radial artery, but we are using the brachial artery, which is why the cuff movements are getting mixed up with the pulse.

I guess in time I'll learn to differentiate the feel of the pulse from the feel of cuff inflating at the same time. I just hope it's in time for validations!

**NICU Guy, BSN, RN** · Aug 30, 2013

I have been taught to either feel for the brachial pulse or listen with the stethoscope prior to inflation. That is to locate the spot to place the diaphragm. Once I start inflating the cuff I don't listen for a pulse any longer. The only time that I have felt for a radial pulse is when it was impossible to hear a blood pressure with a stethoscope (trauma run with siren blaring and being tossed around the back of the ambulance). You get the blood pressure the same way, but feel for the pulses at the radial site without using a stethoscope. That is called blood pressure by palpitation (not really a nursing skill).

You need to learn the way your instructors are teaching you and not by youtube

smoup · Aug 30, 2013

I have been taught to either feel for the brachial pulse or listen with the stethoscope prior to inflation. That is to locate the spot to place the diaphragm. Once I start inflating the cuff I don't listen for a pulse any longer.
You need to learn the way your instructors are teaching you and not by youtube

Maybe I haven't been clear about what we are being told to do.

We are supposed to palpate the brachial artery and then put the cuff on. Palpate the brachial artery again while inflating the cuff, waiting until we no longer can feel the brachial pulse. When we no longer feel the brachial pulse, we take mental note of the brachial occlusion pressure and deflate the cuff. After waiting 10-15 seconds, we take the blood pressure, inflating the cuff 20-30 mmHg above the pressure we got for the brachial occlusion pressure.

I am having difficulty differentiating between the brachial pulse and the movement the cuff/arm is making as it inflates.

What any of this has to do with YouTube, I have no clue.

RedHeaded2bNurse16 · Aug 30, 2013

I was taught to do the same procedure but use the radial pulse and wait for it to disappear. Deflate add 20-30 mmhg to make sure you are above systolic.

**NICU Guy, BSN, RN** · Aug 30, 2013

Sorry my mistake. When you said "I did a search and I see that not every school teaches this way to do blood pressure." I assumed that you had watched other schools videos on youtube and tried to apply them to your school.

douxmusique · Aug 30, 2013

Maybe I haven't been clear about what we are being told to do.
We are supposed to palpate the brachial artery and then put the cuff on. Palpate the brachial artery again while inflating the cuff, waiting until we no longer can feel the brachial pulse. When we no longer feel the brachial pulse, we take mental note of the brachial occlusion pressure and deflate the cuff. After waiting 10-15 seconds, we take the blood pressure, inflating the cuff 20-30 mmHg above the pressure we got for the brachial occlusion pressure.
I am having difficulty differentiating between the brachial pulse and the movement the cuff/arm is making as it inflates.
What any of this has to do with YouTube, I have no clue.

We call this two step bp. Maybe try using that to search?

Jill2Shay · Sep 5, 2013

I get what you're saying, but I don't get why they would teach that method. The brachial artery branches to the radial and ulnar artery, so if the pulse cannot be felt in the radial, it stands to reason that it wouldn't be felt in the brachial either. The brachial artery isn't the easiest to find in the first place, and if you can get an accurate and easily found reading from the radial, why not use it?

We learned the 2-step as well, but we palpated the radial and inflated until it wasn't felt, deflated, waited two minutes and then did the BP at 20-30 mm/mg above the original value.

smoup · Sep 5, 2013

Completely agree about brachial pulse not being the easiest to find. I guess I'll just practice, a lot, on my dad and hope for the best come validation in a couple weeks. I also need to ask if we have the option of using radial if we can't brachial.

Esme12, ASN, BSN, RN · Sep 5, 2013

It really does just take practice....:)