Do you trust automatic "vitals" machines??

[Fairlythere]

At our hospital the CNA's use "robo nurses" to take vitals. It is relatively fast for them, taking BP and pulse and o2 sats at the same time. However the more I work, the less I trust them. It seems like one night the CNA reports all my pts. BP's are up, another night they are low. Or they can't get the machine to work. I take them manually to check. Sometimes I agree with the machine, sometimes not. Also the pulse ox seems weird. It will often show lower sats then the hand held machine.

When I was in RN school we were told to not use these machines, but the BP cuffs in the rooms are not always in good shape either. I do prefer to check my pts. pulses on both sides during an assessment if I can and at the same time I can accurately check respirations.

What do you all think about these machines? Does your facility use them???

[MARIAN202]

In The Operating Room It's The Only Type Of Machines Used For Vitals.

[SEOBowhntr]

In controlled trials automatic NIBPMs perform constantly more accurate then manual auscultation. I will add this involves proper size and placement of cuff. If you have frequent errors (everybody’s pressure is up or down) it is far more likely operator error than machine

BINGO!!!! The NIBP's (at least the newer one's I've used, less than 10yrs old) ARE MORE ACCURATE!!! They actually sense the MAP, rather than figure it like we do, and they absolutely CANNOT give you a false high BP. I've heard nurses question them, then re-check, and say that they got something 40pts lower than the machine, and I tell them you'd better go re-check, because that machine CANNOT get a false HIGH. Many nurses are so set in their ways, that they cannot see the light, which is that sometimes machines do part of our tasks better than we do. The exception to NIBP's being more accurate IS with very irregular rhythms (A-fib, Heart Blocks, etc) or extreme brady patients. I actually showed one of my new orientees one night because she (little Ms. Know-it-all, didn't really know much, ended up failing her orientation, and was transferred to a lower acuity department) argued with me that the NIBP's were wrong, when our pt. had a 200/110 BP. I went in w/ the double stethoscope, and showed her that the pt. indeed was 200/110, not 160/80 like she tried to tell me. Nothing worse than a LIAR on my unit!!!! Game, set, match, she was done after a couple more Dishonest interactions with staff and doc's.

[Fairlythere, ASN, RN]

Oh I wasnt talking about the OR and PACU vitals which are hooked up to monitors and I am sure are VERY accurate! I was indicating the rolling "robo nurse" that the CNAs wheel from pt. to pt on the floors.

Thanks everyone, I will definately bring up the contamination factor and the idea of indiviual cuffs per pt. that could be cleaned by CS in between.

I cant count the number of times an aid has come to me with a low pulse ox reading and they didnt realize the machine needs certain perameters to read correctly, like a good pulse. :)

[PralineLPN]

I don't like the fact I don't get the "hand-on" aspect of autos. I like to feel my pulses and hear my sounds, I also get a chance to check skin moisture and temp. Autos are kind of dehumanizing, I think. I've also had pts complain of pain from the cuff squeezing too tight, I never get that doing it manually.

The OR is different, it's not reasonable to take vitals q10min. And their machines are calibrated (hopefully) and the operators should be skilled in their use.

[jimthorp]

BINGO!!!! The NIBP's (at least the newer one's I've used, less than 10yrs old) ARE MORE ACCURATE!!! They actually sense the MAP, rather than figure it like we do, and they absolutely CANNOT give you a false high BP.

Correct. The automatic machines actually calculate the systolic and diastolic from the measured MAP.

[Schatzi RN CEN]

Actually the individual cuffs that we issue are not cleaned between patients, that get thrown away after the patient is discharged. If the patient is transferred to another unit, they go with the patient. We actually have some frequent fliers that keep their cuff and bring it back on their next admission.

[Indy, LPN, LVN]

At the place where I work we now issue cuffs to our patients, that get marked with their name and stay in the room. Yhis has cut down significantly on cross contamination.

The other issue about trusting the machine brings something to mind that we heard over and over in Nursing School: Treat the patient and not the machine. I think it is great to use dynamaps or passport machines, if you still use a dose of good old nursing judgement. Does your assessment correspond with what the machine tells you? Have you ever ran down the hall, because a telemetry read v-tach or worse, and been met by a smiling patient that is just a little bewildered by the look of panic on your face? I think the same goes for automatic BP's, pulse counts and SaO2.

Especially the O2 sat is often misleading. Our patient may have a sat in the 90's, but how much effort is he putting into maintaining that O2 sat?

These are all questions that can only be answered by one thing and that is a good nursing assessment.

Amen! Especially the part about what I call "ventilation versus O2 sat." You know what I mean; the patient who has a sat of over 90 but how'd you get it? Oh, you had to put it on his nose?! Well that's not good! His resp. rate is what? 39? Tell ya what, you call the doc, ask for ABG's, then call respiratory while I get the crash cart.

If I'm not getting an answer on the O2 thingy pretty quick, and it's not a stubborn little handheld that won't admit it has batteries in it, there's a problem. Probably, it's a problem with the patient! I mean, no one should have to work like a mule pulling a tank uphill in summertime just to breathe while sitting up. Every once in a while we get the doc who'll try to treat the O2 sat, and I gotta explain that the ventilation is so crappy the patient can't last long regardless of what the pretty little machine says. I've seen a sat of 89 on a patient with a bicarb of 6. Sat, Schmat. Ventilation's where it's at.

[banditrn]

In controlled trials automatic NIBPMs perform constantly more accurate then manual auscultation. I will add this involves proper size and placement of cuff. If you have frequent errors (everybody's pressure is up or down) it is far more likely operator error than machine

Berry - I'm with you on this - I think the manual cuffs depend too much on operator interpretation, and the accuity of their hearing.

For a proper reading the patient has to be on their back with their arm still. I've seen just as many wide ranges done manually as with the machines.

[allantiques4me]

I personally prefer to do vitals manually,the "old fashioned way"you do use some of your assessment skills in this manner, You.can hear an irregular Pulse or heart rate Especially if the patient recives antihypertensives and I personally think it is quicker to do vitals manually.There've been too many times I would have to repeat doing BPs and HR because the machine would say error.We dont have time to waste like that.It really doesnt take that much longer to do it manually.

[Gromit]

Something interesting I learned about NIBP machines is that they calculate the BP using the oscillation method, which is different from auscultating a BP. I occasionally wonder about the accuracy of the machines, but I also sometimes wonder about the accuracy of manual BP readings on significantly bradycardiac patients, particularly those with an irregular heart rate. Any thoughts?

I know irregular heartbeats can (and often do) throw off the mechanized readings (and they really mess with those who are inexperienced at taking vitals manually -how often have you watched someone take a '15 second heart rate, multiply by four, to get the beats per minute' on someone with an irregular rhythm? ) but as was mentioned before, I'll usually trust the machine as long as the rhythm is regular, AND the vital signs are in line with what the patient has been doing (I always start my shift with manual ones, and I know I'm doing it correctly -once I get to know a patient (especially when I've had 'em for several shifts) I don't mind letting the machine do them -and I follow up with any readings that are out of the norms for that patient).

When in doubt, do 'em yourself, the old fashioned way.

[payitforward]

You know, machines ar eokay, but if you have an abnormal reading, how do you know it's abnormal, if you've never done a manual bp? The machines are good for convienence, but we shouldn't become so complacent as to rely on them more than our own skills.

[smarter]

The manual equipment is far more accurate. However, it helps when the equipment is new and working. The automatic BP machines are not accurate. Do not rely on them. They, I have found, report a much higher BP.