Can't hear Systolic :(, Help??

[oscarthecat3]

Hey all,* Please note, I'm a Student Nurse training in the UK, not in the US. Thanks :).To get down to the nitty gritty, I am currently on placement on a paeds ward, where we need to do many manual BP's. Since passing my BP exam, I have been training in the community, and had limited oppurtunities to practice Blood Pressure in that setting. Now that I'm back on wards, I'm finding it very difficult to hear the brachial pulse once the cuff is inflating/deflating. I can barely make out the Systolic or Diastolic pulse on most patients, and end up having to delegate the task to another nurse. The major route cause of the issue, is external sounds coming through on the steph. such as arm movements, my own finger movements, alarms buzzing in the background etc. Would any of you lovely people =) be able to recommend ways in which I can facillitate the task of hearing the brachial pulse. (I always palpate the brachial before attempting the BP by the way).Thanks so much for your help!Take care.Oscar

[brownbook]

I am not being facetious......have your hearing checked. After toooo many years as a nurse always having a hard time with stethoscopes, it finally dawned on me that I KNEW I had mild....to moderate....hearing loss in one ear from a childhood illness, so DUH I wasn't a dumb nurse....I had a hearing loss and of course couldn't hear a lot of stuff very well!

I invested in a high quality stethoscopes, and also read that stethoscopes come in a standard (I forget the number) length. You can cut the tubing to a shorter length, 12 inches was recommended. The shorter distance the noise travels, the better you can hear it.

[oscarthecat3]

Thank you for getting back to me!

Unfortunately I don't think it's a hearing issues, went to the ENT doctor when on holiday and they told me that my hearing way fine. Though, I'll have a look into a higher end stethoscope. With regard to drowning out finger creaking sounds, or other external noises, what type of things have you tried?

Thank you for getting back to me though!

Take care

Oscar

[Esme12, ASN, BSN, RN]

It is tough to take blood pressures on children. One BIG problem is that the the bell piece is too big. Try a correct size bell. That may be the issue.

[adventure_rn, MSN, NP]

Not a suggestion, just commiseration. I can't recall ever being asked to take a manual pressure in peds (I think I even remember one of my instructors saying that it was impossible). Between the rapid heart rate, distant sounds, and squirming children, that sounds like a very difficult task.

Could you ask your instructor if they have any suggestions? I agree that a quality stethoscope with a small diaphragm might help, but it seems like a large expense for one clinical rotation.

[shebrown]

I too work in a noisy busy unit with tons of background noise, I ended up buying an electronic stethoscope! Worth every penny I paid for it. I love it. It has so many features as well. Never tried it on peds unit. But i did try it on grandson and it worked fine...

[AnnieNP, MSN, NP]

Definitely invest in a good stethoscope.

[oscarthecat3]

Thank you all for your super suggestions! :) I'll take everything that you said into account; i'll certainly talk with my instructor and see what they can suggest with regard to drowning out ambient noise.

Thanks so much again!

Take care.

Oscar

[Wuzzie]

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I find that holding the chest piece like this tends sto minimize the artifact. Also make sure the ear tubes are pointing forward into your ear canals.