Difficulty taking manual BP readings. Help!!!

ambitiousBSN · Jun 23, 2013

The very first sound you hear is the systolic; and the very last sound you hear is the diastolic. I generally inflate the cuff to about 140ish, and if I immediately hear a sound, I'd re-inflate a little further. You really can't depend on the needle "jumping around," but it's also a matter of deflating the cuff at a steady pace- not too fast, but definitely not too slow.

It definitely takes practice, so as long as you keep practicing, you'll get it! :-)

sharpeimom · Jun 23, 2013

This is peak allergy season and if you have severe allergies, always remember your meds before clinical days. Not giving medical advice, it's just that I've been there! Are you able to practice with a manual cuff and stethoscope as well as an automatic cuff? I am able to pick up the systolic more easily on a manual cuff, but after some practice with both, using my husband as a guinea pig, I became able to hear the beeps in both places on the automatic machine. If I were ever unsure of an automatic reading, I double checked the old fashioned way.

Have you asked your instructor for any tricks she may have?

RN&mom · Jun 23, 2013

When you say you take a manual then compare it to the automatic one, are you doing them one right after the other? Because you are supposed to wait after taking a BP 2 minutes (if I'm remembering it correctly)... Also how much of a difference? Can you post an example of a manual you took and one the machine got and if it was both on the same arm (and yes you waited or no you didn't), or was it on different arms.

Also if you don't have your own good stethoscope and can afford one I would suggest it. It makes all the difference! Yes you want the sound not when then needle jumps and go at a slow, steady, even pace.

Practice, practice, practice. I was a CNA for years before I went to nursing school but it was still hard to learn. I just did it at a different point in my career. You will get it, I promise :)

loveSBK · Jun 23, 2013

Hey guys, thanks for the responses. I have a manual cuff and stethoscope, and that is what we use in school. I think is a nice one and has been working fine for me. At home when i practice, I used my grandma's automatic BP machine to compare results. I take the manual BP first and then yes, I do wait two minutes and then I retake the BP with the automatic. I always try to mark the readings by the sound and not by the needle jumping around, but when I only go by the sound, the readings differ by a lot. For example, I took a bp on my cousin and I saw the needle jump around 138 but heard the first sound around 120, so I took the 120 as systolic, and then when I took it with the automatic, the reading said 130. I don't know if automatic bp machines are more accurate than manual (I would not think so). Sometimes is close but not enough. Our school only allows 4-6 points difference. I asked my teacher to take my partner's bp with me and we did it 3 times before I was close to what she said she heard. She used the double stethoscope but she said she heard the sound before me, maybe I just can't hear well. I've taken my friend's advice to hold your breath while youre hearing for the systolic and I've done that and I think it has helped, but I am just nervous about my lab test. Plus, I need to know it. I've been practicing and I will continue to do so. Its just crazy how out of all the things we will be tested on (colostomy, catheter, hygiene, bed making, elimination, vital signs, transfer and restraints) this is the part I am most nervous about!

Thank you guys, I will keep practicing!!!! :yes:

ambitiousBSN · Jun 23, 2013

Also if you don't have your own good stethoscope and can afford one I would suggest it. It makes all the difference!

I agree- a good, quality steth is definitely key to manual BP readings! I first started with one of those dual-tubed steths, and then eventually got a Littmann, and there was such a difference in quality and clarity.

futurenurseclark · Jun 23, 2013

I had the exact same problem! I thought my ears were jacked up, lol. I bought a Littman Cardio III and can hear so much better than on the one I bought from the school bookstore. I found I was looking way outside of normal ranges and once I realized that, it was much easier to pinpoint the systolic and diastolic. I practiced on my husband like crazy and I passed my skill labs in CNA class, so it worked : ) I knew I needed to conquer that for my ADN classes and the sooner the better!

I say best stethoscope you can afford and practice tons!

ArrowRN, BSN, RN · Jun 23, 2013

My stethscope costs 20 bucks and I would challange those with their $200 lithmanns any day. Getting manual BP more has to do with technique. Looking at the needle is a flawed technique and should only be a guide as to when to listen for the first "thump" . In a person with high bloop pressure the needle almost always jumps around. It takes time to train your ear on what to listen for and to get correct placement of the stethoscope.

Tips to avoid false readings:

1. make sure the persons arm is level with their heart with palm facing up

2. practice hand palpation first with your index and middle fingers to find correct placement. If you find the brachial pulse go straight along that line down to the lateral base of the biceps, which you should feel the artery still pulsing

3. Do not be scared to push down firmly with the diaphragm and hold it firmly in place. This is one of the main reasons why students do not hear anything.

4. PRACTICE PRACTICE PRACTICE...this is really the only way to get it...your mom, dad ,sister, aunt, cat, dog, bird practice on everyone you can you will get it.

Morainey, BSN, RN · Jun 23, 2013

Autocuffs are notoriously inaccurate. Here are my tips: check a brachial pulse, I tell my patients I'm looking for the best spot to listen in. Have them hold their arm with their elbow locked straight, hand with palm facing up. I also tap my stethoscope to make sure it's facing the right way - I have a Littman classic II and it does flip every once in a while. Press down HARD! It comes with practice. :)

ddl77 · Jun 23, 2013

I learned on the two-step method where you palpate the radial pulse before you auscultate anything to get an estimate of the systolic: Put on cuff, find radial, inflate cuff and note where the pulse disappears and reappears on deflation (should be the same number). This gives you an estimate of the systolic to avoid missing the auscultatory gap. Wait 30-60 secs and take BP as normal.

Sent from my iPhone using allnurses.com

loveSBK · Jun 23, 2013

Thanks again guys for all the advice. @man-nurse2b I also don't have a littman, I have another one that I bought from amazon and I love it and I think it works great. I use it all the time. When I do the lab test, the professor will use the double stethoscope so I need to practice with that one too. lol with cat, dog, bird.

@Weepingangel, we check the brachial also and that's where I place my stethoscope but I will try to push harder because I can hear noises other than the pulse like when you move your finger around and stuff.

@ddl77, I forgot to mention that we use the two-step method by using the radial and that does give me an idea but is not always accurate. We add 30 to the number after the first step, so if the pulse disappears at 90, we add 30 and that's an approximation of the systolic. Then I wait 2 minutes to take the BP. Thanks for the post!

Tomorrow is my exam, I'll let you guys know how it goes :nailbiting: