CNA needs help with BP's

johnjrb · Jul 14, 2005

Practice on anybody that will let you. The more Blood Pressures you take the better you will get.

leopold · Jul 14, 2005

When I was doing my CNA training we had to do it manually. Digital was considered "unacceptable." I lost a lot of sleep over that. The way they taught us was to palpate the brachial artery til you feel the pulse, put your stethescope on and listen, pump up the cuff til you hear the pulse stop and pump up another 30. Then let the valve loose and take the B/P. Actually pretty time consuming and not the way I've ever seen anyone do it and not the way I've ever done it since.

But a couple things were helpful. First, before you start, fiddle a little with the knob on the pump so it's tight but loose enough that you can easily loosen it with one hand when you need to. I can't tell you how many times I've just grabbed a cuff and started doing a b/p without checking the knob and ended up having to start all over again cause it was too tight. Duh. The other thing is to really practice feeling the brachial artery. It not only gives you a pinpoint of exactly where to place the stethescope, it'll give you a sense of how much pressure you have to apply to feel the pulse (on large people it can be very difficult so you have to really push around to get it). Do that when you practice and eventually you'll get the hang of it. Oh, and don't use the needle bounce as a measure of b/p. And practice on everyone you see! :chuckle

Roy Fokker, BSN, RN · Jul 14, 2005

And practice on everyone you see! :chuckle

Yes, strart grabbing arms left right and center :)

NurseBranch · Jul 14, 2005

Hello,

I, too had a hard time with BP's at first. But, I agree with everyone else, practice makes perfect. In my hospital, on my unit, we are not allowed to use digital cuffs, everything is manual. Other units, however do have digital. Anyway, when I applied to the hospital, I had to do a skills test during my orientation and a BP was part of it. Thank God I had an easy to hear one because I was terrified I wouldn't. I understand exactly what you are going through. But don't worry, you will do fine. Something I learned on the floor and not in class was for bigger people who's cuff does not fit on the upper arm, put it on the lower arm and feel for the pulse in the wrist and put your stethoscope on the wrist instead of the bend of the arm. You have to pay a little closer attention because sometimes it is a little harder to hear, but it works well. Good Luck, and be confident in what you learn and you will succeed.

nurse_wannabe · Jul 14, 2005

I do not trust digital readings, especially the wrist ones. We were taught to palpate the brachial artery, but I have never done it, nor have I ever had a nurse do it to me! Usually if you do not hear ANYTHING it's because you either have the wrong side of the cuff facing the skin or the cuff is too small. I have had a few instances where I had to take the cuff off, turn it around, and do it all over again. Talk about embarassing. :imbar

Another thing... I always thought that the lower edge of the cuff had to be positioned at the level of the elbow bend and then you had to stuff your steth under the cuff. Then I saw an RN taking BP's in the hospital and she actually had the lower edge of the cuff about 2 inches above the elbow bend and just placed her steth below it. It's much easier that way to me. I hope it's as accurate. :rolleyes:

NicInNC, CNA · Jul 15, 2005

Thanks everyone! I will start practicing daily because I really want this job.

DG5 · Jul 15, 2005

In some people it is REALLY hard to get the B/P so palpating the brachial or radial artery gives you an idea of where the systolic could be - when the brachial or radial stops pulsating as you are pumping up, that is probably where the systolic is. The diastolic is much harder to get sometimes, even after trying all of the suggestions. Don't get flustered by that. You will always find the odd one that is going to be difficult to get. You'll do great!

Cute_CNA, CNA · Jul 15, 2005

I was quite anxious about it too, as I'm a pretty new CNA. Here is my full "routine" for doing it, just for the sake of being thorough.

First of all, just relax.

What I do is I make sure that I pick up a blood pressure cuff that has good velcro on it, so it doesn't come off when I inflate it. I've had that happen before, and it's quite irritating.

Small cuffs go on small arms, larger cuffs go on larger arms. Of course.

I tell the person to give me the left arm (supposedly it's easier to hear, as the heart is a bit closer to that side) with their palm UP. There is a little mark that says "artery", and I make sure the mark is in the middle of the arm. The edge of the cuff goes right above the crease. If the cuff covers up the sphygmamometer (sp?), I fold it so that the very edge touches the velcro, and it is held in place.

After the cuff is on, I hold up the stethoscope so the ear pieces are facing away from me (though not all stethoscopes are this way). If the ear pieces are facing toward you, you will have problems hearing anything. Now that the earpieces are in, I put the little disk thing (whatever it's called) with the larger side down right above the crease in the person's arm. Make sure you tell the person to hold still! On the smaller disk that should be facing up, you'll see a hole in the middle. Put your left thumb over that hole, it seems to help me hear better. I'm right handed, so I pick up the bulb and hold it in my right hand, with my index finger and thumb on the knob. I make sure the knob is screwed on, but not so tight that I won't be able to loosen it when I pump it up a little past 180.

I pump it up past 180 (unless I know they have a history of high blood pressure). Make sure you don't hear any air releasing as this happens. When you get to about 180 or so, SLOWLY turn the knob so that the air is released, and the needle starts to SLOWLY but steadily head back to zero. Sometimes when you see the needle start to bounce as it goes down, and you should hear the pounding. The patient should feel it, too. Hearing the pounding is more accurate than seeing the needle bounce when you're trying to get the number. When you start hearing the pounding, that's your systolic. Continue to slowly release the air, and when you hear the pounding again and start seeing the needle bounce, there's your diastolic. Write down the numbers ASAP before you forget them.

I'm sure I said more than I needed to, but I hope this helped.

Lorel · Jul 15, 2005

hi,

there is a lot of geat advice here, and i can't think of anything elese to add except that in my opinion, the most accurate method is the manual bpc. it is true, it takes practice but it is well worth it. i trust my ears more than any machine. that is why nursing clinicals were so nice too...(i got my cna licence after i completed med surg i...that is how it was in 1995)... becuase we had the opportunity to take the bp's of some who were very difficult to pick up...but when you can and do, you never forget the sound or the techinque.

my mom had to monitor her bp at home before she got her pacemaker and she bought several battery operated models. they were rarely accurate, but she had an arrhythmia and as far as i know, they are not accurate in these situations. i always ended up just going to her house and doing it myself. i am not working now, but i still check my families bps' just for practice so i know my skills are good when i go back to work...heck, i even take my own when i am bored :chuckle .

so my two cents are this...if you have to use the wrist one ok, practice that too, but i can't imagine anyone making that a requirement. once you get comfortable with doing it manually though, you will never want another battery jobbie again...just my 2 cents.

laurel

NicInNC, CNA · Jul 16, 2005

I was quite anxious about it too, as I'm a pretty new CNA. Here is my full "routine" for doing it, just for the sake of being thorough.
First of all, just relax.
What I do is I make sure that I pick up a blood pressure cuff that has good velcro on it, so it doesn't come off when I inflate it. I've had that happen before, and it's quite irritating.
Small cuffs go on small arms, larger cuffs go on larger arms. Of course.
I tell the person to give me the left arm (supposedly it's easier to hear, as the heart is a bit closer to that side) with their palm UP. There is a little mark that says "artery", and I make sure the mark is in the middle of the arm. The edge of the cuff goes right above the crease. If the cuff covers up the sphygmamometer (sp?), I fold it so that the very edge touches the velcro, and it is held in place.
After the cuff is on, I hold up the stethoscope so the ear pieces are facing away from me (though not all stethoscopes are this way). If the ear pieces are facing toward you, you will have problems hearing anything. Now that the earpieces are in, I put the little disk thing (whatever it's called) with the larger side down right above the crease in the person's arm. Make sure you tell the person to hold still! On the smaller disk that should be facing up, you'll see a hole in the middle. Put your left thumb over that hole, it seems to help me hear better. I'm right handed, so I pick up the bulb and hold it in my right hand, with my index finger and thumb on the knob. I make sure the knob is screwed on, but not so tight that I won't be able to loosen it when I pump it up a little past 180.
I pump it up past 180 (unless I know they have a history of high blood pressure). Make sure you don't hear any air releasing as this happens. When you get to about 180 or so, SLOWLY turn the knob so that the air is released, and the needle starts to SLOWLY but steadily head back to zero. Sometimes when you see the needle start to bounce as it goes down, and you should hear the pounding. The patient should feel it, too. Hearing the pounding is more accurate than seeing the needle bounce when you're trying to get the number. When you start hearing the pounding, that's your systolic. Continue to slowly release the air, and when you hear the pounding again and start seeing the needle bounce, there's your diastolic. Write down the numbers ASAP before you forget them.
I'm sure I said more than I needed to, but I hope this helped.

I know how to do it (But boy did you give good directions to someone that may not! great explanation!), it's just that I have a hard time with some people. I'm going to keep practicing.

Also, I thought the LAST beat you hear it diastolic. I rememebr diastolic as being the low one because when you "die" you get buried low into the ground... :rotfl:

chadash · Jul 17, 2005

Absolutely, practice is every thing. And take your time. An accurate reading is more important than impressing folks with your finesse!

I still find it hard to hear very tiny old frail ladies with their wee little heartbeats. I knew of NAs who would guess rather than admit that they could not hear. If in doubt, ask the nurse for help. Always: what's best for the pt?

You"ll be a pro in no time!

It is great to palpate for the brachial artery. After a while, you'll be putting it right on the mark without a hitch.